Effectiveness of the best practice spotlight organizations program to reduce the prevalence of pressure injuries in acute care settings for hospitalized patients in Spain: A quasi-experimental study.

BACKGROUND: Pressure injuries are a major public health problem because of their impact on morbidity and mortality, quality of life, and increased healthcare costs. The Centros Comprometidos con la Excelencia en Cuidados/Best Practice Spotlight Organization (CCEC/BPSO®) program provides guidelines that can improve these outcomes. AIMS: This study aimed to assess the effectiveness of the CCEC/BPSO® program in improving the care of patients at risk of pressure injury (PI) at an acute care hospital in Spain. METHODS: A quasi-experimental regression discontinuity design in three periods was used: (1) baseline (2014), (2) implementation (2015-2017), and (3) sustainability (2018-2019). The study population was comprised of 6377 patients discharged from 22 units of an acute care hospital. The performance of the PI risk assessment and reassessment, the application of special pressure management surfaces, and the presence of PIs were all monitored. RESULTS: Forty-four percent of patients (n = 2086) met the inclusion criteria. After implementing the program, the number of patients assessed (53.9%-79.5%), reassessed (4.9%-37.5%), the application of preventive measures (19.6%-79.7%), and the number of people identified with a PI in implementation (1.47%-8.44%) and sustainability (1.47%-8.8%) all increased. LINKING EVIDENCE TO ACTION: The implementation of the CCEC/BPSO® program achieved improved patient safety. Risk assessment monitoring, risk reassessment, and special pressure management surfaces were practices that increased during the study period and were incorporated by professionals to prevent PIs. The training of professionals was instrumental to this process. Incorporating these programs is a strategic line to improve clinical safety and the quality of care. The implementation of the program has been effective in terms of improving the identification of patients at risk and the application of surfaces.

Implantación de la guía de práctica clínica Valoración y manejo de las lesiones por presión para equipos interprofesionales / Implementation of the clinical practice guideline “Risk assessment and prevention of pressure ulcers for interprofessional teams

Objetivo: evaluar la implantación de la guía Valoración y manejo de las lesiones por presión para equipos interprofesionales de la Asociación Profesional de Enfermeras de Ontario (RNAO®) en el Hospital Universitario Virgen de las Nieves (Granada, España), con objeto de identificar mejoras producidas en la formación de profesionales, en el proceso de cuidados y en los resultados en salud de los pacientes con lesiones por presión (LPP). Método: estudio descriptivo longitudinal retrospectivo (2018-2022). Variables: formación impartida, materiales elaborados, edad, sexo, valoración del riesgo de LPP, plan de cuidados especifico, uso de superficie especial para el manejo de la presión, LPP previas y nuevas, categoría de LPP, cicatrización y días de estancia de hospitalización. Resultados: la formación pasó de tres actividades y 86 asistentes a 16 actividades y 229 asistentes, y se elaboraron nueve materiales de apoyo a la formación. La valoración del riesgo y el plan de cuidados se realizó a más del 88% de la muestra. La aplicación de superficies especiales descendió en 2021 a 57,1%. Un 49,2% de pacientes tuvo una nueva lesión durante su estancia hospitalaria, siendo predominante la categoría II y presentaron signos de cicatrización un 42,6% de las lesiones tratadas. Conclusiones: la implantación ha supuesto un incremento de la actividad formativa en actualización de conocimientos sobre metodología de implantación de evidencia y en el manejo de LPP. El proceso de cuidados del paciente con LPP se realiza conforme a alguna de las recomendaciones de la guía, siendo necesario mejorar. Hay indicios que apuntan a que las cifras de LPP nosocomiales están disminuyendo.(AU)

Objectives: to assess the implementation of the guideline "Risk assessment and prevention of pressure ulcers (PU) for interprofessional teams” by the Registered Nurses' Association of Ontario (RNAO®) at the Hospital Universitario Virgen de las Nieves (Granada, Spain), with the objective of identifying any improvements made in professional training, in the care process, and in the health outcomes for patients with PU. Method: a descriptive longitudinal retrospective study (2018-2022). Variables: training given, materials prepared, age, gender, risk assessment for PU, specific care plan, use of a special surface for pressure management, previous and new PU, PU categories, PU healing, and hospitalization days.Results: training went from three activities and 86 attendees to 16 activities and 229 attendees, and nine support materials were prepared. Risk assessment and care plan were applied to >88% of the sample. The use of special surfaces was reduced to 57.1% in 2021; 49.2% of patients presented a new lesion during their hospital stay, with Category II as the predominant; 42.6% of the lesions treated presented healing signs. Conclusions: the implementation has represented an increase in training activities for updating the knowledge regarding methodology for evidence implementation and in PU management. The process of care for patients with PU is conducted following only some of the recommendations in the guideline, and an improvement is required. There are signs pointing to a reduction in the number of hospital PU.(AU)

Violencia en el noviazgo y su relación con la ansiedad, la depresión y el estrés en jóvenes universitarios andaluces / Dating violence and its relationship with anxiety, depression, and stress in young Andalusian university students

Objetivo: Analizar la prevalencia de la violencia en el noviazgo (VN) y su relación con los estados de depresión, ansiedad y estrés en jóvenes universitarios andaluces. Método Estudio cuantitativo descriptivo transversal en 8 universidades públicas de Andalucía. La recogida de datos se realizó de septiembre a noviembre de 2020 a través de un cuestionario autoadministrado que incluía variables sociodemográficas y variables relacionadas con la VN, depresión, ansiedad y estrés. Para el análisis de los datos se realizó un descriptivo y pruebas no paramétricas a través de la U de Mann-Whitney y rho de Spearman para la relación entre variables. Resultados: Participaron 1.091 jóvenes universitarios andaluces. La VN más prevalente fue la psicológica, incluyendo conductas relacionadas con el ciberacoso, control-vigilancia y psicoemocional (68,42-42,90%), seguida de la sexual (16,68-3,57%) y por último la física (5,60-1,92%). Se mostraron diferencias estadísticamente significativas en función del sexo y la VN, donde las chicas puntuaron más alto en ser víctimas de conductas relacionadas con el ciberacoso, control-vigilancia y sexual, y los chicos en perpetrar violencia de tipo psicoemocional, física y sexual. Todos los tipos de VN evidenciaron correlaciones significativas y positivas con la depresión, la ansiedad y el estrés, menos la VN física perpetrada con el estrés. Conclusiones: La alta prevalencia de VN y su relación con la salud mental muestran la importancia de realizar investigaciones en esta línea en el ámbito educativo, ya que es un espacio garante de relaciones igualitarias y promotor de la salud.(AU)

Aim: To analyze the prevalence of dating violence (DV) and its relationship with states of depression, anxiety, and stress in young Andalusian university students. Method: Cross-sectional descriptive quantitative study in 8 public universities in Andalusia. Data collection was carried out from September to November 2020 through a self-administered questionnaire that included sociodemographic variables and variables related to DV, depression, anxiety, and stress. For the analysis of the data, descriptive and nonparametric tests were performed through the U Mann–Whitney and Spearman rho for the relationship between variables. Results: Thousand ninety-one young university students from Andalusia were participated. The most prevalent DV was psychological, including behaviors related to cyberbullying, control-surveillance and psychoemotional (68.42-42.90%), followed by sexual (16.68-3.57%) and finally physical (5.60-1.92%). Statistically significant differences were shown according to sex and DV, where girls scored higher in being victims of behaviors related to cyberbullying, control-surveillance and sexual, and boys in perpetrating psycho-emotional, physical and sexual violence. All types of DV showed significant and positive correlations with depression, anxiety, and stress, except physical DV perpetrated with stress. Conclusions: The high prevalence of DV and its relationship with mental health show the importance of conducting research on this line in the educational field, since it is a space that guarantees egalitarian relationships and promotes health.(AU)

Short version of the Multidimensional Scale of Dating Violence (MSDV 2.0) in Spanish-language: Instrument development and psychometric evaluation.

AIMS: To develop and psychometrically test the short version of the Multidimensional Scale of Dating Violence (MSDV 2.0) in Spanish-language to detect violence perpetrated and suffered in dating relationships. DESIGN: A psychometric instrument development and validation study. METHODS: A two-phase approach was used: Phase (1) the items of the original instrument were revised and new items related to online violence and sexual violence were incorporated. Content validation by a Delphi panel with 25 psychometric and dating violence experts were performed. Next, a face validity was performed in 32 students followed by a pilot study in another 74 participants. Phase (2) Psychometric validation, the instrument was tested in a sample of 1091 university students, analysing the psychometric properties based on construct validity and internal consistency. The study was conducted from September to November 2020 in the context of the Andalusian Public University System. RESULTS: In phase (1) 42 items for each subscale (perpetration, victimization) were accepted by the Delphi panel, and acceptable values were obtained for the criteria of clarity, coherence, and relevance. In phase (2) the MSDV 2.0 showed acceptable psychometric properties. Confirmatory factor analysis showed a five-dimensional structure with 18 items for each subscale with excellent fit rates. Reliability analysis indicated adequate internal consistency (α = .879-.802) and correlations with the Depression, Anxiety, and Stress Scale (ρ = .418-.225) and the self-perceived health item (ρ = .380-.179), providing evidence of its convergent validity. Cut-off points were also calculated for each dimension, with their corresponding sensitivity and specificity, indicating to be a good instrument for detecting possible cases of dating violence. CONCLUSION: The MSDV 2.0 is the only short instrument published to date that measures the dating violence suffered and perpetrated taking into account all its dimensions. Its use would serve as support in prevention programs and design of public policies. IMPACT: The short version of the MSDV 2.0 could be a comprehensive enough instrument to enable a detection and evaluation of dating violence in the educational setting.

Instruments used to measure dating violence: A systematic review of psychometric properties.

AIMS: To identify, synthesize and evaluate the psychometric properties of instruments that measure dating violence (DV). DESIGN: Psychometric systematic literature review. DATA SOURCES: The databases SCOPUS, PubMed, CINAHL, PsychINFO, and Web of Science were searched up to December 2021. REVIEW METHOD: We evaluated the psychometric properties of the instruments included and their methodological quality using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist and Terwee's quality criteria. The Modified Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used to rate the best available evidence. The entire process was carried out by three independent reviewers. The review was registered at PROSPERO (registry number CRD42020161137). RESULTS: A total of 35 studies evaluated 29 instruments measuring DV. Most studies reported data on content validity, structural validity and internal consistency. No studies tested measurement error and responsiveness. Only one instruments tested cross-cultural validity. It is of interest that the data reported for content validity were the worst evaluated, despite the fact that content validity is one of the key properties in developing and validating the measuring instrument. CONCLUSIONS: There are a significant number of instruments published in this field, and it is important to evaluate and show their psychometric properties to help select evidence-based instruments. After carrying out the evaluation following the COSMIN guidelines, the authors of this study recommend that the three most suitable instruments are CADRI, WAS/Chinese version and PMWI-SF/Portuguese version (in that order). IMPACT: Identifying and evaluating DV is the first step in designing effective interventions. To achieve this, it is necessary to have validated instruments with suitable psychometric properties. To date, this is the only published systematic review evaluating the psychometric properties of instruments that measure DV which reports on their methodological qualities. The results we found show a growing trend in developing new instruments, with the most suitable approach being to make a cross-cultural adaptation and validation of the instrument that best suits the value to be measured. In this way, data can be compared between different countries and standardized health care plans and policies designed to achieve better health outcomes. This study may help future researchers to choose the most suitable instrument for their research.

Proteomic analysis of postprandial high-density lipoproteins in healthy subjects.

The relationship between the functionality and composition of high-density lipoproteins (HDL) is yet not fully studied, and little is known about the influence of the diet in HDL proteome. Therefore, the aim of this research was to elucidate the HDL proteome associated to postprandial hyperlipidemia. Male volunteers were recruited for an interventional study with high fatty acid-based meals. Blood samples were collected before the intake (baseline), and 2-3 (postprandial peak) and 5-6 (postprandial post peak) hours later. HDL were purified and the protein composition was quantified by LC-MS/MS. Statistical analysis was performed by lineal models (amica) and by ANOVA and multi-t-test of the different conditions (MetaboAnalyst). Additionally, a clustering of the expression profiles of each protein was done with coseq R package (RStudio). Initially, 320 proteins were identified but only 119 remained after the filtering. APOM, APOE, APOB, and APOA2, proteins previously identified in the HDL proteome, were the only proteins with a statistically significant altered expression in postprandial hyperlipidemia when compared to baseline (p values <0.05 and logFC >1). In conclusion, we have been able to describe several behaviors of the whole HDL proteome during the postprandial hyperlipidemic metabolism.

Dating violence and its relationship with anxiety, depression, and stress in young Andalusian university students.

AIM: To analyze the prevalence of dating violence (DV) and its relationship with states of depression, anxiety, and stress in young Andalusian university students. METHOD: Cross-sectional descriptive quantitative study in 8 public universities in Andalusia. Data collection was carried out from September to November 2020 through a self-administered questionnaire that included sociodemographic variables and variables related to dating violence, depression, anxiety, and stress. For the analysis of the data, descriptive and nonparametric tests were performed through the U Mann-Whitney and Spearman Rho for the relationship between variables. RESULTS: Thousand ninety-one young university students from Andalusia participated. The most prevalent DV was psychological, including behaviors related to cyberbullying, control-surveillance and psychoemotional (68.42-42.90%), followed by sexual (16.68-3.57%) and finally physical (5.60-1.92%). Statistically significant differences were shown according to sex and DV, where girls scored higher in being victims of behaviors related to cyberbullying, control-surveillance and sexual, and boys in perpetrating psycho-emotional, physical and sexual violence. All types of DV showed significant and positive correlations with depression, anxiety, and stress, except physical DV perpetrated with stress. CONCLUSIONS: The high prevalence of DV and its relationship with mental health show the importance of conducting research on this line in the educational field, since it is a space that guarantees egalitarian relationships and promotes health.

Uso del cuestionario g_Clinic para valorar satisfacción laboral en el personal de Enfermería de hospitales públicos / Use of the g_Clinic questionnaire to assess job satisfaction in the Nursing staff from public hospitals

Objetivo: evaluar la validez externa y determinar el punto de corte del cuestionario g_Clinic para medir la satisfacción laboral de los profesionales de Enfermería y de los técnicos de cuidados auxiliares de Enfermería (TCAE) en los hospitales del Sistema Sanitario Público Andaluz. Método: estudio clinimétrico basado en la aplicabilidad del cuestionario g_Clinic en una muestra de 1.099 profesionales de Enfermería y TCAE. La recogida de datos se realizó durante los meses de octubre a diciembre de 2017 mediante un cuestionario online. El análisis clinimétrico de g_Clinic consistió en evaluar la fiabilidad y la validez. Para establecer el punto de corte de g_Clinic se hizo una curva de rendimiento diagnóstico (ROC) que permitió discriminar entre profesionales satisfechos e insatisfechos. Resultados: se garantizó la consistencia interna del cuestionario g_Clinic, siendo su valor alfa de Crombach de 0,8. La sensibilidad y especificidad fueron de 72% y 70,3 % respectivamente y el punto de corte se situó en 30 puntos. El cálculo de la curva ROC mostró un área bajo la curva de 0,754. Conclusión: el cuestionario g_Clinic es un instrumento válido y fiable para medir la satisfacción laboral de los profesionales de Enfermería y de los TCAE con el punto de corte en 30 puntos. Presenta alta sensibilidad y especificidad para la detección de la insatisfacción laboral.(AU)

Objective: to assess the external validity and determine the cut-off point of the g_Clinic questionnaire to measure the job satisfaction in Nursing professionals and Certified Nursing Assistants (CNAs) in the Andalusian Public Health System hospitals. Method: clinimetric study based on the applicability of the g_Clinic questionnaire in a sample of 1,099 Nursing professionals and CNAs. Data were collected from October to December 2017 through an online questionnaire. The clinimetric analysis of g_Clinic consisted in an evaluation of reliability and validity. In order to determine the g_Clinic cut-off point, a receiver-operating curve (ROC) was used, which allowed to discriminate between satisfied and dissatisfied professionals. Results: the internal consistency of the g_Clinic questionnaire was guaranteed, with a Cronbach alpha’s vale of 0.8. Sensitivity and specificity were 72% and 70.3 % respectively, and the cut-off point was determined at 30 points. The ROC curve calculation showed a 0.754 under the curve area. Conclusion: the g_Clinic questionnaire is a valid and reliable instrument to measure job satisfaction in Nursing professionals and CNAs with 30 as cut-off point. It presents high sensitivity and specificity to detect job dissatisfaction.(AU)

Predictive validity of the INTEGRARE scale in identifying the risk of hospital-acquired pressure ulcers in acute care hospital settings.

BACKGROUND: Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive validity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these indicators reflecting the patient's condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. METHODS: A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. RESULTS: The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85-0.923). Within the 30-point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54-33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. CONCLUSIONS: The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4.

Filling a gap in standardized nursing terminology. Development of a new nursing diagnosis proposal on heart failure self-care.

PURPOSE: Heart failure is a highly prevalent chronic health problem associated with poor quality-of-life and negative outcomes. Self-care is a cornerstone in patients suffering from heart failure. Nurses are commonly engaged in enhancing patients' self-care behaviors, but the specific condition of deficit on self-care is not clearly identified by nurses. No nursing diagnoses focused on self-care of heart failure patients is currently available. This study aimed to develop a new nursing diagnosis that focuses on self-care in heart failure patients. DATA SOURCES: A concept and content analysis were used. Some steps of the concept analysis were performed through an integrative literature review conducted searching in PUBMED and CINAHL databases to identify attributes, antecedents, and consequences of the diagnosis. Forty-five articles were selected from the 1450 studies found. Then, the content analysis was performed by an international panel of 29 experts. Two Delphi rounds were used to achieve consensus and an item content validity index was calculated for each diagnostic element. DATA SYNTHESIS: Integrative review proposed four diagnostic labels, two definitions, 15 defining characteristics, and 44 related factors. After the two Delphi rounds a consensus was reached for each diagnostic indicator with a content validity index ranging from 82.8% to 100%. The nursing diagnosis-labeled heart failure self-care deficit-was validated with a definition, eight defining characteristics, 15 related factors, and five at-risk populations. CONCLUSIONS: This diagnosis allows nurses to document patients' self-care in daily clinical practice through a standard nursing terminology, by naming this health problem, describing its etiology, and clinical manifestations. IMPLICATIONS FOR NURSING PRACTICE: This new diagnosis is expected to assist nursing clinicians, educators, and students in clinical reasoning with the aim to improve diagnostic accuracy in identifying patients with a heart failure self-care deficit, to select the most appropriate interventions and pursue better outcomes.

Health Problems and the Use of Medications and Traditional Therapies among Chinese Immigrants Living in Spain.

In this study, we investigate the health problems and the use of medications and traditional therapies among Chinese immigrants in the Southern region of Spain. A qualitative study using semi-structured interviews and including 133 immigrants and 7 stakeholders was conducted in 2017. Transcription, literal reading, and theoretical categorization were performed, and a narrative content analysis was carried out. The most common health problems were musculoskeletal (28.6%) and allergies (25.6%) related to work activity and unhealthy lifestyles. Key informants also reported gastric problems, stress, and changes in eating habits, mostly related to their work activity. For these problems, a large number of traditional remedies (herbs, diet therapy, acupuncture, vitamins, etc.) were used, usually combined with pharmaceutical drugs used for colds, flu, general malaise (29%), pain and fever (23%), and allergy drugs (9.2%). Chinese immigrants reported health conditions associated with their working conditions and life habits in Spain, using Traditional Chinese Medicine instead of pharmacological drugs. Understanding these health problems and promoting awareness towards traditional therapies in the healthcare system may help to design public policies and Health Promotion strategies targeting this group.

Impacto de la ratio paciente-enfermera en los resultados de salud en los hospitales públicos del Servicio Andaluz de Salud. Estudio ecológico / Impact of the patient-nurse ratio on health outcomes in public hospitals of the Andalusian Health Service. Ecological Study

Objetivo: Analizar la ratio paciente-enfermera y su asociación con los resultados en salud en hospitales públicos del Servicio Andaluz de Salud (SAS). Método: Estudio ecológico transversal realizado en unidades de adultos de 26 hospitales públicos andaluces. Se recogieron datos de estructura (camas, tipo de unidad, control de enfermería), de gestión (estancia media, índice de utilización de estancias, índice de complejidad) y de dotación enfermera. Fueron extraídos de fuentes oficiales: CMBDA, publicaciones de SAS/Consejería de Salud (CS) y específicos demandados a Direcciones de Enfermería. Se calculó la ratio paciente-enfermera y se relacionó con 19 indicadores de calidad hospitalaria, seguridad y mortalidad. Para el análisis estadístico se utilizaron medidas de tendencia central y el coeficiente de correlación de Spearman. Resultados: Se obtuvo respuesta del 100% de los hospitales andaluces. El promedio de ratio pacientes-enfermera en los 3 turnos fue menor en hospitales con cartera de servicios más amplia-ámbito regional (11,6), seguido de los de cartera media-especialidades (12,7) y los hospitales con cartera básica-comarcales (13,5). Por tipo de unidad, en las médicas fue menor 11,8 (DE=1,8) respecto a las quirúrgicas 13,5 (DE=2,7). Solo se hallaron diferencias significativas en unidades médicas de los hospitales regionales 10,5 (DE=1,4) y comarcales 13,03 (DE=1,46) (p=0,001). En cuidados críticos la ratio fue mayor de 2 pacientes por enfermera en los 3 grupos. Al relacionar la ratio con resultados en salud se hallaron 5 asociaciones significativas: úlceras por presión (p=0,005), prevalencia de infecciones nosocomiales (p=0,036), sepsis postoperatoria (p=0,022), verificación bacteriemia zero (p=0,045) y mortalidad por insuficiencia cardíaca (p=0,004).(AU)

Aim: To analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS). Method: Cross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis. Results: A response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio- county (13.5). By type of unit, the medical units were 11.8 (SD=1.8) lower than the surgical ones 13.5 (SD=2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD=1.4) and district hospitals 13.03 (SD=1.46) (p=.001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p=.005), prevalence of nosocomial infections (p=.036), postoperative sepsis (p=.022), zero bacteraemia verification (p=.045) and mortality from heart failure (p=.004). Conclusions: The results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.(AU)

Obesity-Associated Metabolic Disturbances Reverse the Antioxidant and Anti-Inflammatory Properties of High-Density Lipoproteins in Microglial Cells.

High-density lipoproteins (HDLs) play an important role in reverse cholesterol transport and present antioxidant properties, among others. In the central nervous system (CNS), there are HDLs, where these lipoproteins could influence brain health. Owing to the new evidence of HDL functionality remodeling in obese patients, and the fact that obesity-associated metabolic disturbances is pro-inflammatory and pro-oxidant, the aim of this study was to investigate if HDL functions are depleted in obese patients and obesity-associated microenvironment. HDLs were isolated from normal-weight healthy (nwHDL) and obese men (obHDL). The oxHDL level was measured by malondialdehyde and 4-hydroxynoneal peroxided products. BV2 microglial cells were exposed to different concentrations of nwHDL and obHDL in different obesity-associated pro-inflammatory microenvironments. Our results showed that hyperleptinemia increased oxHDL levels. In addition, nwHDLs reduced pro-inflammatory cytokines' release and M1 marker gene expression in BV2 microglial cells. Nevertheless, both nwHDL co-administered with LPS+leptin and obHDL promoted BV2 microglial activation and a higher pro-inflammatory cytokine production, thus confirming that obesity-associated metabolic disturbances reverse the antioxidant and anti-inflammatory properties of HDLs in microglial cells.

Impact of the patient-nurse ratio on health outcomes in public hospitals of the Andalusian Health Service. Ecological study.

OBJECTIVE: To analyse the patient-nurse ratio and its association with health outcomes in public hospitals of the Andalusian Health Service (SAS). METHOD: Cross-sectional ecological study carried out in adult units of 26 Andalusian public hospitals. Data on structure (beds, type of unit, nursing control), management (average stay, index of use of stays, complexity index) and nursing staff were collected. They were extracted from official sources: CMBDA, SAS/Health Council (CS) publications and specific respondents to Nursing Directorates. The patient-nurse ratio was calculated and related to 19 indicators of hospital quality, safety, and mortality. Measures of central tendency and Spearman's correlation coefficient were used for statistical analysis. RESULTS: A response was obtained from 100% of the Andalusian hospitals. The average patient-nurse ratio in the three shifts was lower in hospitals with a broader portfolio of services-regional scope (11.6), followed by those with a medium portfolio-specialties (12.7) and hospitals with a basic portfolio-county (13.5). By type of unit, the medical units were 11.8 (SD = 1.8) lower than the surgical ones 13.5 (SD = 2.7). Significant differences were only found in medical units of regional hospitals 10.5 (SD = 1.4) and district hospitals 13.03 (SD = 1.46) (p = .001). In critical care, the ratio was greater than 2 patients per nurse in the three groups. When relating the ratio to health outcomes, 5 significant associations were found: pressure ulcers (p = .005), prevalence of nosocomial infections (p = .036), postoperative sepsis (p = .022), zero bacteraemia verification (p = .045) and mortality from heart failure (p = .004). CONCLUSIONS: The results indicate a high patient-nurse ratio in adult hospitalization units and that there is a positive association between the patient-nurse ratio and worse results related to nursing care.

Implementing Holistic Care in Isolated Patients During COVID-19 Pandemic: A Case Study Using Nursing Outcomes (NOC) and Interventions (NIC) Classifications.

The most effective strategy against SARS-Cov-2 virus spread is therapeutic isolation. Consequences of this measure are the presence of anxiety and depression. Therefore, it is the nurse's responsibility to identify strategies to implement humanized and holistic care in order to avoid physical and mental consequences of isolation.

[Implementation of the "Best Practice Spotlight Organization" Program at the Virgen de las Nieves University Hospital.] / Implantación del programa "Centros Comprometidos con la Excelencia en Cuidados" en el Hospital Universitario Virgen de las Nieves. Rev Esp Salud Pública.

The objective of this work was to describe the implantation project presented by the Virgen de las Nieves University Hospital (Granada, Spain) to be selected as a candidate for "Best Practice Spotlight Organization"® (in Spain CCEC®) program in the cohort (2015-2017) to implement three guidelines for Nurses Association of Canada Ontario (RNAO) clinical practice of care. The methodology used was the model called "knowledge for action" and the actions developed for each of the phases of the action cycle for applying knowledge to practice were described: 1) identification of the problem, 2) adaptation to the local context, 3) evaluation of facilitators and barriers, 4) adaptation and implementation of interventions, 5) monitoring and evaluation of results and 6) sustainability. This work adds to the set of studies that address the improvement and maintenance of evidence-based practice programs in nursing, and in health services in general. It shows the application of a framework for the implementation of clinical practice guidelines for care in a specific health environment for its replication in other different health settings. It has been shown that it is essential to dedicate efforts to planning the implementation of this type of programs, taking into account the context in which they are developed, the specific characteristics of the population being served, identifying the different barriers and facilitators that may affect during the course of the program. process and defining actions to make the changes in practice sustainable.

El objetivo de este trabajo fue describir el proyecto de implantación presentado por el Hospital Universitario Virgen de las Nieves (Granada, España) para ser seleccionado candidato del programa "Centros Comprometidos con la Excelencia en Cuidados" (CCEC)® en la cohorte (2015-2017) para implantar tres guías de práctica clínica de cuidados de la Asociación de Enfermeras de Ontario de Canadá (RNAO). La metodología utilizada fue el modelo denominado "conocimiento para la acción" y se describieron las actuaciones desarrollas para cada una de las fases de las que consta el ciclo de acción para la aplicación de conocimientos a la práctica: 1) identificación del problema, 2) adaptación al contexto local, 3) evaluación de los facilitadores y barreras, 4) adaptación e implantación de las intervenciones, 5) monitorización y evaluación de resultados y 6) sostenibilidad. Este trabajo se suma al conjunto de estudios que abordan la mejora y el mantenimiento de programas de prácticas basadas en la evidencia en enfermería, y en los servicios de salud en general. Muestra la aplicación de un marco de implantación de guías de práctica clínica de cuidados en un entorno sanitario específico para su replicación en otros escenarios de salud diferentes. Se ha demostrado que resulta esencial dedicar esfuerzos en planificar la implantación de este tipo de programas atendiendo al contexto en el que se desarrollan, a las características específicas de la población a la que se atiende, identificando las diferentes barreras y facilitadores que pueden afectar durante el proceso y definiendo acciones para hacer sostenible los cambios en la práctica.

[Effect of the guideline implementation "Risk assessment and prevention of pressure ulcers" of the Registered Nurses'Association of Ontario (RNAO).] / Alcance de la implantación de la guía "Valoración del riesgo y prevención de úlceras por presión" de la Registered Nurses' Association of Ontario (RNAO).

OBJECTIVE: The Best Practice Spotlight Organizations Program is being developed in Spain to reduce the variability of clinical practice by implementing clinical practice guidelines from the Registered Nurses' Association of Ontario. This study described the results of the implementation of the guide "Risk assessment and prevention of pressure ulcers". METHODS: We carried out a retrospective observational study (2015-2018) at the Hospital Universitario Virgen de las Nieves on 4,464 patients from 22 hospitalization units, analyzing type of unit, risk assessment, preventive measures, origin and category of ulcers. Descriptive analysis and contingency tables were performed with the Chi-square statistic p<0.05. RESULTS: The patients at risk were 62.2% in medical units, 53.4% in surgical units and 90% in intensive care. The application of preventive measures was 67.9%, 60.2% and 92.1% (respectively) for each unit. In medical units, 13.1% of pressure ulcers were identified, of which 68.1% were present at the time of admission. While in surgical units and intensive care they developed during hospitalization (60.8% and 88.9% respectively) (p<0.001). The presence of ulcers seemed to show a decreasing trend in the years analyzed (19.6% to 11.2%). CONCLUSIONS: There are favorable environments for implantation (medical units and intensive care) that reflect a higher level of risk assessment, use of pressure management surfaces and a decrease in prevalence. The recommendations have not been implemented homogeneously, with differences depending on the type of unit.

OBJETIVO: El Programa Centros Compro-metidos con la Excelencia en Cuidados®, se desarrolla en España, para reducir la variabilidad de la práctica clínica, implantando guías de práctica clínica de la Registered Nurses' Association of Ontario. Este estudio describió los resultados de la implantación de la guía "Valoración del riesgo y prevención de las úlceras por presión". METODOS: Se realizó un estudio observacional retrospectivo (2015-2018) en el Hospital Universitario Virgen de las Nieves sobre 4.464 pacientes de 22 unidades de hospitalización, analizando el tipo de unidad, la valoración del riesgo, las medidas preventivas, la procedencia y la categoría de las úlceras. Se realizó análisis descriptivo y tablas de contingencia con el estadístico Chi-cuadrado p<0,05. RESULTADOS: Los pacientes de riesgo fueron el 62,2% en unidades médicas, 53,4% en las quirúrgicas y el 90% en cuidados intensivos. La aplicación de medidas preventivas fue del 67,9%, 60,2% y 92,1% (respectivamente) para cada unidad. En unidades médicas se identificaron un 13,1% de úlceras por presión, de las cuales el 68,1% estaban presentes en el momento del ingreso. Mientras que en unidades quirúrgicas y en cuidados intensivos se desarrollaron durante la hospitalización (60,8% y 88,9% respectivamente) (p<0,001). La presencia de úlceras pareció mostrar una tendencia a la disminución en los años analizados (19,6% a 11,2%). CONCLUSIONES: Existen entornos favorecedores para la implantación (unidades médicas y cuidados intensivos) que reflejan mayor nivel de valoración del riesgo, de utilización de superficies de gestión de la presión y disminución de la prevalencia. No se ha conseguido implantar las recomendaciones de forma homogénea existiendo diferencias en función del tipo de unidad.

Acculturation, Health Behaviors, and Social Relations among Chinese Immigrants Living in Spain.

This study aims to identify acculturation experiences about social relations and health behaviors of first-generation Chinese immigrants in the South of Spain, including food patterns, physical exercise, and tobacco and alcohol use. A phenomenological qualitative study was conducted using semi-structured interviews, informal conversations, and field notes. All data were analyzed under the Berry's Model of Acculturation. A total of 133 Chinese immigrants were included. Our findings show that separation was the dominant acculturation strategy, followed by integration and assimilation, while marginalization was not present in this immigrant population. Most of the immigrant population maintains a link to the customs of their home country, favoring the process of identity and collective self-esteem. These results can help health managers and the government to further understand Chinese immigrants in Europe and to establish appropriate health interventions to this group.

Factors That Influence Nurse Staffing Levels in Acute Care Hospital Settings.

PURPOSE: To identify which patient and hospital characteristics are related to nurse staffing levels in acute care hospital settings. DESIGN: A cross-sectional design was used for this study. METHODS: The sample comprised 1,004 patients across 10 hospitals in the Andalucian Health Care System (southern Spain) in 2015. The sampling was carried out in a stratified, consecutive manner on the basis of (a) hospital size by geographical location, (b) type of hospital unit, and (c) patients' sex and age group. Random criteria were used to select patients based on their user identification in the electronic health record system. The variables were grouped into two categories, patient and hospital characteristics. Multilevel linear regression models (MLMs) with random intercepts were used. Two models were fitted: the first was the null model, which contained no explanatory variables except the intercepts (fixed and random), and the second (explanatory) model included selected independent variables. Independent variables were allowed to enter the explanatory model if their univariate association with the nurse staffing level in the MLM was significant at p < .05. RESULTS: Two hierarchical levels were established to control variance (patients and hospital). The model variables explained 63.4% of the variance at level 1 (patients) and 71.8% at level 2 (hospital). Statistically significant factors were the type of hospital unit (p = .002), shift (p < .001), and season (p < .001). None of the variables associated with patient characteristics obtained statistical significance in the model. CONCLUSIONS: Nurse staffing levels were associated with hospital characteristics rather than patient characteristics. CLINICAL RELEVANCE: This study provides evidence about factors that impact on nurse staffing levels in the settings studied. Further studies should determine the influence of patient characteristics in determining optimal nurse staffing levels.