Evaluation of pharyngeal lidocaine anesthesia for esophagogastroduodenoscopy: Double-blind randomized control trial.

OBJECTIVES: The aim of this study was to assess whether the use of topical pharyngeal anesthesia improves endoscopist- and patient-reported tolerance and satisfaction, the total dose of propofol used and the rate of adverse effects associated with this procedure. METHODS: This double-blind randomized clinical trial was conducted in patients undergoing elective oesophagogastroduodenoscopy, who met the inclusion criteria. Patients were randomly assigned to receive five squirts of lidocaine 10% spray (50 mg, n = 268) or placebo (n = 271) 3 min before starting the procedure or sedation. The main outcome measures were patient- and endoscopist-reported tolerance, and additionally, satisfaction with the procedure, adverse events and supplementary propofol used. RESULTS: In the lidocaine group, it was twice (odds ratio [OR] 2.136, 95% confidence interval [CI] 1.228-3.715) or three times (OR 3.311, 95% CI 1.623-6.757) more likely that the endoscopist rated the procedure as well tolerated and easy to intubate than as well tolerated but the patient difficult to intubate or as poorly tolerated, respectively. Further, in these patients, less propofol was used (80 vs. 100 mg, P = 0.001). Controls were more likely to cough during the intubation (OR 2.172, 95% CI 1.378-3.423) and the procedure (OR 1.989, 95% CI 1.325-2.984), as well as more likely to retch (OR 3.582, 95% CI 1.667-7.7). CONCLUSIONS: Topical lidocaine may improve the procedure as rated by the endoscopist, as well as reduce the requirement for propofol and rate of adverse events such as retching and coughing. No adverse events associated with lidocaine administration were observed. ClinicalTrials registration no. NCT02733471.

Experience in the use of midclavicular catheters: An inception cohort study.

AIMS AND OBJECTIVES: To describe the outcomes of midclavicular catheters related to first insertion success rate, catheter dwell time, rate of catheter survival until the end of the treatment, and complication rates, as well as identify risk factors associated with early catheter removal. BACKGROUND: Midclavicular catheters are peripheral venous catheters that are typically 20-25 cm in length. DESIGN: Inception cohort study. METHODS: We included all the midclavicular lines inserted in patients who met any of the following criteria: (a) difficult venous access; (b) administration of intravenous therapy expected to last between 6 and 30 days with non-irritant (pH=5-9) and/or non-vesicant drugs; or (c) contraindications to central venous catheter placement. The incidence of adverse events was calculated using percentages and episodes per 1,000 catheter days. Univariate and multivariate logistic regression analyses were performed to identify significant risk factors for unexpected catheter removal by calculating odds ratios. Catheter survival was assessed using Cox regression analysis. The STROBE guidelines were followed. RESULTS: Overall, 2,275 midclavicular lines were placed in 1,841 participants. The insertion success rate was 99.4% and the mean catheter dwell time was 21.82 days. The rate of adverse events was .7 per 1,000 catheter days, the most common complications being thrombosis (.39) and catheter-associated bacteraemia (.14). No significant association was found between adverse events and the administration of irritant drugs. The incidence of unexpected removal was 6.7 per 1,000 catheter days. The multivariate analysis showed that both age ≤70 years and home therapy were associated with a lower likelihood of catheter failure. CONCLUSIONS: Midclavicular catheters are associated with a high rate of insertion success and low rates of adverse events and unplanned removal. RELEVANCE TO CLINICAL PRACTICE: Midclavicular lines are a safe alternative for intravenous therapy lasting more than 6 days, even with irritant drugs.

Vascular access care in patients with multimorbidity.

BACKGROUND: More than half of patients with multimorbidity require intravenous therapy during their hospital stay. The aims of this study are to describe difficult intravenous access (DIVA) and vascular access care provided to this patient population and to explore the differences between easy and DIVA groups. METHODS: A cohort study was conducted in patients with multimorbidity admitted to 2 hospitals between March and November 2013. The variables used to describe vascular care included choice and placement of devices, catheter swell time, and occurrence of adverse events. The incidence of adverse events was expressed as number cases per 1000 catheter days and χ2, Student's t, or Mann-Whitney U tests were used to compare the care provided between both groups. Odds rates were calculated to determine the risk of complications associated with DIVA. RESULTS: We recruited 135 patients, of whom 34.8% were women. Overall, 59.3% had DIVA. A total of 224 catheters were inserted, patients with difficult access requiring a mean of 1.71 catheters and those with easy access 1.58 catheters. Two or more attempts were required to place catheters in 23% of cases in the difficult access group versus 2.50% in the easy access group. Mean catheter dwell time was 3.84 days and 3.99 days, and the adverse event rate was 111/1000 and 83.6/1000 catheter days, respectively. The odds ratio for complications was 1.596. CONCLUSIONS: Multimorbid patients with DIVA have a higher rate of complications as well as requiring more catheters and more placement attempts.

Impact of the implementation of best practice guidelines on nurse's evidence-based practice and on nurses' work environment: Research protocol.

AIM: To determine the impact of the Best Practice Spotlight Organization® initiative on nurses' perception of their work environment and their attitudes to evidence-based practice. DESIGN: Quasi-experimental, multicentre study. The intervention is the participation in Best Prectice Spotilight Organizations to implement Best Practice Guidelines. METHODS: The study will include seven centres in the interventional group and 10 in the non-equivalent control group, all of them belonging to the Spanish national health system. The Practice Environment Scale of the Nursing Work Index, and the Health Sciences Evidence-Based Practice Questionnaire will be administered to a sample of 1,572 nurses at the beginning of the programme and at 1 year. This 3-year study started in April 2018 and will continue until December 2021. Statistical analyses will be carried out using the SPSS 25.0. This project was approved by the Drug Research Ethics Committee of the Parc de Salut Mar and registered in Clinical Trials. DISCUSSION: The study findings will show the current state of nurses' perception of their work environment and attitudes to evidence-based practice, and possible changes in these parameters due to the programme. IMPACT: The findings could provide a strong argument for health policymakers to scale up the Best Practice Spotlight Organization® initiative in the Spanish national health system.

With a smartphone in one's pocket: A descriptive cross-sectional study on smartphone use, distraction and restriction policies in nursing students.

BACKGROUND: The use of personal smartphones is a reality in healthcare settings. Current research is allowing us to understand in what ways they help with communication and decision making at the point of care and their impact on patient safety. OBJECTIVES: The objectives of this study were to characterize the use of smartphones by nursing students, and assess their opinions about the use of such phones as a distracting factor during clinical practicum and smartphone restriction policies. DESIGN: Descriptive cross-sectional study. PARTICIPANTS: 234 students from one School of Nursing in Spain completed the survey in 2017. METHODS: A questionnaire was created based on various validated instruments for assessing students' use of smartphones, distraction associated with this use and the development of policies on their use during clinical practice. RESULTS: While 23.3% of participants admitting to using their smartphone for personal reasons at least once during their practicum, they perceived that their own level of distraction was low (6.9%). Notably, the level of distraction associated with others' smartphone use was perceived to be higher than that associated with their own use. Students' opinions about policies were significantly related to the frequency of witnessing other students and nurses being distracted (r = 0.139, p < 0.05), but not to their own distraction experiences (r = 0.114, p = 0.084). CONCLUSIONS: Smartphones are not widely used for professional purposes among nursing students, while personal use is commonplace. Nurse educators, students and nurse mentors need to work together to introduce strategies to facilitate care delivery through the use of mobile devices but at the same time must be aware of the risks associated with distractions, including to patient safety.

Prevalence of difficult venous access and associated risk factors in highly complex hospitalised patients.

AIMS AND OBJECTIVES: To estimate the prevalence of difficult venous access in complex patients with multimorbidity and to identify associated risk factors. BACKGROUND: In highly complex patients, factors like ageing, the need for frequent use of irritant medication and multiple venous catheterisations to complete treatment could contribute to exhaustion of venous access. DESIGN: A cross-sectional study was conducted. METHODS: 'Highly complex' patients (n = 135) were recruited from March 2013-November 2013. The main study variable was the prevalence of difficult venous access, assessed using one of the following criteria: (1) a history of difficulties obtaining venous access based on more than two attempts to insert an intravenous line and (2) no visible or palpable veins. Other factors potentially associated with the risk of difficult access were also measured (age, gender and chronic illnesses). Univariate analysis was performed for each potential risk factor. Factors with p < 0·2 were then included in multivariable logistic regression analysis. Odds ratios were also calculated. RESULTS: The prevalence of difficult venous access was 59·3%. The univariate logistic regression analysis indicated that gender, a history of vascular access complications and osteoarticular disease were significantly associated with difficult venous access. The multivariable logistic regression showed that only gender was an independent risk factor and the odds ratios was 2·85. CONCLUSIONS: The prevalence of difficult venous access is high in this population. Gender (female) is the only independent risk factor associated with this. Previous history of several attempts at catheter insertion is an important criterion in the assessment of difficult venous access. RELEVANCE TO CLINICAL PRACTICE: The prevalence of difficult venous access in complex patients is 59·3%. Significant risk factors include being female and a history of complications related to vascular access.

Epidemiología de los ingresos por intoxicación medicamentosa voluntaria en un servicio de Medicina Interna / Epidemiology of admissions for voluntary drug intoxication in an Internal Medicine Unit

OBJETIVO: conocer el perfil epidemiológico de los pacientes atendidos en el servicio de Medicina Interna (MI) por intoxicación medicamentosa voluntaria y describir las condiciones de ingreso y alta. MÉTODO: estudio descriptivo transversal, con datos retrospectivos, de los pacientes ingresados en el servicio de MI del Hospital Universitario de Álava, sede Santiago, por intoxicación medicamentosa voluntaria. Se revisaron las historias clínicas de mayo de 2009 a diciembre de 2010. Se calcularon intervalos de confianza al 95% de seguridad. RESULTADOS: fueron estudiadas las historias clínicas de 131 pacientes. La edad media fue de 41,2 años, un 63,7% eran mujeres. Un 45% presentaba dependencia a tóxicos de forma habitual y solamente 17 pacientes no tenían patología psiquiátrica diagnosticada. Las benzodiacepinas fueron las sustancias de elección para la intoxicación (58,3%) e igualmente era la medicación habitual más predominante entre la muestra (43,1%). En la unidad, la mayoría requirió solamente sueroterapia como tratamiento (51,9%) y la estancia media fue de 1,5 días. 57 pacientes causaron algún tipo de incidencia, la mayoría relacionada con la contención mecánica (26%). En el momento del alta se realizaron informes de continuidad de cuidados al 47%.CONCLUSIONES: los pacientes tienden a utilizar la medicación que tienen a mano para llevar a cabo la intoxicación voluntaria. Se requiere de un control más exhaustivo de la medicación de la que disponen y mejorar la gestión al alta. Se necesitan unos criterios más claros y específicos para el ingreso en MI de aquellas intoxicaciones sin riesgo vital

OBJECTIVE: to understand the epidemiological profile of patients seen at the Internal Medicine (IM) Unit due to voluntary drug intoxication, and to describe their admission and discharge situations. METHOD: transversal descriptive study, with retrospective data, of those patients admitted at the IM Unit of the Hospital Universitario de Álava, based on Santiago, due to voluntary drug intoxication. Clinical records from May, 2009 to December, 2010 were reviewed. Confidence intervals were estimated at 95%.RESULTS: the clinical records of 131 patients were studied. Their average age was 41.2 years, and 63.7% were women. Out of these,45% presented habitual dependence on toxic substances, and only 17patients had no diagnosed psychiatric condition. Benzodiazepines were the substance of choice for intoxication (58.3%), and it was also the habitual medication with the highest prevalence within the sample(43.1%). In the unit, most patients required only serum therapy as treatment (51.9%), and the average stay was 1.5 days. 57 patients caused some type of incident, mostly associated with the use of restraints (26%). At discharge, Continuity of Care Reports were prepared for 47% of patients. CONCLUSIONS: patients tend to use that medication which is at hand in order to conduct voluntary intoxication. A more thorough control of the medication available to them is required, and management at discharge must be improved. Clearer and more specific criteria are required for admission at IM of those intoxication cases which are not life threatening