CHRONOFALLS: A multicentre nurse-led intervention in the chronoprevention of in-hospital falls in adults.

BACKGROUND: Falls are among the most common and serious adverse events for hospitalised patients. In-hospital falls pose a major medical and economic challenge for public health worldwide. Nevertheless, the issue is often addressed without regard to certain relevant variables such as the time of the fall. The aim of this study was to determine the effect of the implementation of a nurse-led intervention based on the temporal patterns of falls and their aetiology on the occurrence of falls. METHODS: A mixed-method research design was carried out in three phases: a) a longitudinal prospective study (audits, chronobiological analyses and implementation of a multicentre nurse-led intervention based on temporal patterns of falls); b) a retrospective study of fall records; and c) a qualitative study based on focus groups. The protocol was published in 2021. RESULTS: A difference was observed in the number of fall records before and after the chronopreventive intervention (retrospective: 64.4% vs. 35.6%; p < 0,001). According to the interrupted series analysis, considering the influence of the COVID-19 pandemic, a reduction in falls of 2.96% (95% CI 1.70%-4.17%) was observed. The concepts of falls, the COVID-19 pandemic and the causes of non-registration have emerged as categories for qualitative analysis. CONCLUSIONS: A multicentric nurse-led program based on tailored organisational, educational and behavioural chronopreventive measures seems to lead to a reduction in the number of in-hospital falls. The findings of the present study, highlighting the implementation of chronopreventive measures, can serve as a basis for future health policies. TRIAL REGISTRATION: The project was registered on the Clinical Trials Registry NCT04367298 (29/04/2020).

Chronotype, general health and quality of sleep in a population of Spanish nurses.

OBJECTIVE: The aim of this study was to investigate the association between chronotype, general health status and sleep quality in a sample of Spanish nurses. METHOD: An observational study assessing morningness-eveningness predisposition, general health status and quality of sleep was conducted between January and April 2018. Univariate and multivariate analyses were performed. A linear regression model was carried out to determine the influence of the variables on the morningness-eveningness type. RESULTS: Morning-type was associated with aging (ß = 0.249, p = 0.005), being married (ß = 3.970, p = 0.033), and with a self-assessed low daily sleepiness (ß = -0.311, p = 0.152). Good quality of sleep was moderately correlated with high values of general health (r = 0.337) and perceived quality of life (r = 0.426). CONCLUSION: Anomalies of the circadian rhythm together with the features of shift workers may play an important role in predicting self-assessed general health status or the quality of sleep in nurses.

Chronotype, general health and quality of sleep in a population of Spanish nurses / Cronotipo, salud general y calidad del sueño en una población de enfermeros españoles / Cronótipo, saúde geral e qualidade do sono em uma população de enfermeiros espanhóis

ABSTRACT Objective The aim of this study was to investigate the association between chronotype, general health status and sleep quality in a sample of Spanish nurses. Method An observational study assessing morningness-eveningness predisposition, general health status and quality of sleep was conducted between January and April 2018. Univariate and multivariate analyses were performed. A linear regression model was carried out to determine the influence of the variables on the morningness-eveningness type. Results Morning-type was associated with aging (β = 0.249, p = 0.005), being married (β = 3.970, p = 0.033), and with a self-assessed low daily sleepiness (β = -0.311, p = 0.152). Good quality of sleep was moderately correlated with high values of general health (r = 0.337) and perceived quality of life (r = 0.426). Conclusion Anomalies of the circadian rhythm together with the features of shift workers may play an important role in predicting self-assessed general health status or the quality of sleep in nurses.

RESUMEN Objetivo Este estudio tuvo como objetivo investigar la asociación entre el cronotipo, el estado general de salud y la calidad del sueño en una muestra de enfermeras españolas. Método Desde enero a abril de 2018, se realizó un estudio observacional para evaluar la predisposición matutina-vespertina, el estado de salud general y la calidad del sueño. Se realizaron análisis univariante y multivariante. Se efectuó un modelo de regresión lineal para determinar la influencia de las variables en el tipo matutino-vespertino. Resultados El tipo matutino se asoció con el envejecimiento (β = 0,249; p = 0,005), estar casado (β = 3,970; p = 0,033) y con un bajo nivel de somnolencia diaria autoevaluada (β = -0,311; p = 0,152). La buena calidad del sueño se correlacionó moderadamente con valores altos de salud general (r = 0,337) y de calidad de vida percibida (r = 0,426). Conclusión Las anomalías del ritmo circadiano junto con las características de los trabajadores por turnos pueden desempeñar un papel importante en la predicción del estado de salud general autoevaluado o la calidad del sueño de las enfermeras.

RESUMO Objetivo O objetivo deste estudo foi investigar a associação entre cronótipo, estado geral de saúde e qualidade do sono em uma amostra de enfermeiras espanholas. Método Foi realizado um estudo observacional entre janeiro e abril de 2018 que avaliou a predisposição matutina-vespertina, o estado geral de saúde e a qualidade do sono. Foram realizadas análises univariadas e multivariadas. Um modelo de regressão linear foi realizado para determinar a influência das variáveis sobre o tipo matutino-vespertino. Resultados O tipo matinal foi associado ao envelhecimento (β = 0,249, p = 0,005), ser casado (β = 3,970, p = 0,033) e com baixa sonolência diária autoavaliada (β = -0,311, p = 0,152). Boa qualidade de sono foi moderadamente correlacionada com altos valores de saúde geral (r = 0,337) e qualidade de vida percebida (r = 0,426). Conclusão Anomalias do ritmo circadiano em conjunto com as características dos trabalhadores em turnos podem desempenhar um papel importante na previsão do estado geral de saúde autoavaliado ou da qualidade do sono em enfermeiras.

Complicaciones graves en las colonoscopias de cribado del cáncer colorrectal en la Comunidad Valenciana / Severe complications in colorectal cancer screening colonoscopies in the Valencian Community

OBJETIVO: Identificar y caracterizar las complicaciones graves de las colonoscopias de confirmación diagnóstica del Programa de Prevención de Cáncer Colorrectal de la Comunitat Valenciana (PPCCR-CV). MÉTODO: Estudio observacional retrospectivo (2005-2012). Para identificar las complicaciones se utilizó el sistema de información del PPCCR-CV, las altas hospitalarias del conjunto mínimo básico de datos (CMBD) y la historia clínica. Se estimaron tasas de incidencia acumulada para el total de complicaciones, para inmediatas (mismo día de la colonoscopia) y tardías (1-30 días desde la colonoscopia) por 1.000 colonoscopias. Análisis bivariado con la prueba Chi cuadrado para la aparición de complicación según sexo, edad y tipo de test (guayaco/inmunológico) y para el tiempo de aparición de la complicación (inmediata/tardía) según el tipo de colonoscopia (diagnóstica/terapéutica) y el tipo de complicación (hemorragia/perforación). RESULTADOS: De las 8.831 colonoscopias del estudio se detectaron 23 complicaciones graves de las cuales 13 fueron perforaciones (56,5%) y 10 hemorragias (43,5%) y ningún síndrome vagal grave, peritonitis o fallecimiento. La tasa de incidencia acumulada fue del 2,60‰, para el test de guayaco del 2,85‰ y del 2,56‰ para el inmunológico. La tasa de incidencia fue mayor en hombres (2,93‰) que en mujeres (2,16‰) y en grupos de mayor edad (3,02‰ vs. 1,98‰). El 61% (n = 14) de las complicaciones fueron inmediatas. CONCLUSIONES: Las tasas de complicaciones de las colonoscopias de cribado graves son un indicador de calidad de los programas poblacionales de cribado de cáncer colorrectal y requieren una investigación exhaustiva para mantener el balance adecuado de beneficios y efectos adversos de estos programas

OBJECTIVE: To identify and characterise the severe complications of diagnostic confirmation colonoscopies carried out as part of the Colorectal Cancer Screening Program of the Valencian Community (CCSP-VC). METHOD: A retrospective observational study from 2005 to 2012. To identify complications, the CCSP-VC information system was used, as well as Spanish Minimum Basic Data Set hospital discharge summaries and medical records. Cumulative incidence rates were estimated for all complications, immediate complications (occurring the same day as the colonoscopy) and delayed complications (occurring 1-30 days after the colonoscopy) for the 1,000 colonoscopies performed. A bivariate analysis using the Chi-square test was performed for the onset of complications, according to gender, age and type of test (guaiac/immunological), as well as for the complication onset time (immediate/delayed) based on the type of colonoscopy (diagnostic/therapeutic) and type of complication (haemorrhage/perforation). RESULTS: Of the total 8,831 screening colonoscopies performed, 23 severe complications were observed, 13 of which were perforations (56.5%) and 10 haemorrhages (43.5%). No serious vagal syndrome, peritonitis or deaths were recorded. The cumulative incidence rate was 2.60‰; 2.85‰ for the guaiac test and 2.56‰ for the immunological test. The incidence rate was higher in men (2.93‰) than in women (2.16‰), as well as in older groups (3.02‰ versus 1.98‰). Of the total complications, 61% (n=14) were immediate. CONCLUSIONS: The severe complication rates of screening colonoscopies are a quality indicator for population-based colorectal cancer screening programs that require extensive research in order to maintain the appropriate risk/benefit ratio of such programs

Severe complications in colorectal cancer screening colonoscopies in the Valencian Community. / Complicaciones graves en las colonoscopias de cribado del cáncer colorrectal en la Comunidad Valenciana.

OBJECTIVE: To identify and characterise the severe complications of diagnostic confirmation colonoscopies carried out as part of the Colorectal Cancer Screening Program of the Valencian Community (CCSP-VC). METHOD: A retrospective observational study from 2005 to 2012. To identify complications, the CCSP-VC information system was used, as well as Spanish Minimum Basic Data Set hospital discharge summaries and medical records. Cumulative incidence rates were estimated for all complications, immediate complications (occurring the same day as the colonoscopy) and delayed complications (occurring 1-30 days after the colonoscopy) for the 1,000 colonoscopies performed. A bivariate analysis using the Chi-square test was performed for the onset of complications, according to gender, age and type of test (guaiac/immunological), as well as for the complication onset time (immediate/delayed) based on the type of colonoscopy (diagnostic/therapeutic) and type of complication (haemorrhage/perforation). RESULTS: Of the total 8,831 screening colonoscopies performed, 23 severe complications were observed, 13 of which were perforations (56.5%) and 10 haemorrhages (43.5%). No serious vagal syndrome, peritonitis or deaths were recorded. The cumulative incidence rate was 2.60‰; 2.85‰ for the guaiac test and 2.56‰ for the immunological test. The incidence rate was higher in men (2.93‰) than in women (2.16‰), as well as in older groups (3.02‰ versus 1.98‰). Of the total complications, 61% (n=14) were immediate. CONCLUSIONS: The severe complication rates of screening colonoscopies are a quality indicator for population-based colorectal cancer screening programs that require extensive research in order to maintain the appropriate risk/benefit ratio of such programs.

Incidence of advanced neoplasia during surveillance in high- and intermediate-risk groups of the European colorectal cancer screening guidelines.

Background and study aims: The European guidelines for quality assurance in colorectal cancer (CRC) screening have established high-risk (≥ 5 adenomas or an adenoma ≥ 20 mm) and intermediate-risk (3 - 4 adenomas or at least one adenoma 10 - 19 mm in size, or villous histology, or high grade dysplasia) groups with different endoscopic surveillance intervals. The aim of this study was to evaluate the difference in the incidence of advanced neoplasia (advanced adenoma or CRC) between the two risk groups. Patients and methods: This retrospective group study included patients meeting high- or intermediate-risk criteria for adenomas detected in CRC screening programs and the COLONPREV study before European guidelines were adopted in Spain (June 2011) with a 3-year surveillance recommendation according to Spanish guidelines. The primary outcome measure was the incidence of advanced neoplasia in patients undergoing surveillance. The secondary outcome measure was the CRC incidence. We used an adjusted proportional hazards regression model to control confounding variables. Results: The study included 5401 patients (3379 intermediate risk, 2022 high risk). Endoscopic surveillance was performed in 65.5 % of the patients (2.8 ±â€Š1 years). The incidence of advanced neoplasia in the high- and intermediate-risk groups was 16.0 % (59.0 cases/1000 patient-years) and 12.3 % (41.2 cases/1000 patient-years), respectively. The CRC incidence was 0.5 % (1.4 cases/1000 patient-years) and 0.4 % (1 case/1000 patient-years), respectively. The advanced neoplasia and CRC attributable risk to the high risk group was of 3.7 % and 0.1 %, respectively. In the proportional hazards analysis, the risk of advanced neoplasia was greater in the high-risk group (hazard ratio [HR] 1.5, 95 % confidence interval [CI] 1.2 - 1.8), with no significant differences in the CRC incidence (HR 1.6, 95 %CI 0.6 - 3.8). Conclusions: Patients meeting high-risk criteria have a higher incidence of advanced neoplasia during endoscopic surveillance. No differences were found in the CRC incidence at a 3-year surveillance recommendation.