Cytotoxicity and concentration of silver ions released from dressings in the treatment of infected wounds: a systematic review.

Introduction: Silver-releasing dressings are used in the treatment of infected wounds. Despite their widespread use, neither the amount of silver released nor the potential in vivo toxicity is known. The aim of this study was to evaluate the cytotoxic effects and the amount of silver released from commercially available dressings with infected wounds. Methods: The review was conducted according to the PRISMA statement. The Web of Science, PubMed, Embase, Scopus, and CINAHL databases were searched for studies from 2002 through December 2022. The criteria were as follows: population (human patients with infected wounds); intervention (commercial dressings with clinical silver authorized for use in humans); and outcomes (concentrations of silver ions released into tissues and plasma). Any study based on silver-free dressings, experimental dressings, or dressings not for clinical use in humans should be excluded. According to the type of study, systematic reviews, experimental, quasi-experimental, and observational studies in English, Spanish, or Portuguese were considered. The quality of the selected studies was assessed using the JBI critical appraisal tools. Studies that assessed at least 65% of the included items were included. Data were extracted independently by two reviewers. Results: 740 articles were found and five were finally selected (all of them quasi-experimental). Heterogeneity was found in terms of study design, application of silver dressings, and methods of assessment, which limited the comparability between studies. Conclusion: In vivo comparative studies of clinical dressings for control of infection lack a standardized methodology that allows observation of all the variables of silver performance at local and systemic levels, as well as evaluation of its cytotoxicity. It cannot be concluded whether the assessed concentrations of released silver in commercial dressings for the topical treatment of infected wounds are cytotoxic to skin cells. Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022351041, PROSPERO [CRD42022351041].

Barreras y actitudes para prevenir el efecto adverso de úlceras por presión en una unidad de traumatología / Barriers and attitudes to prevent the adverse effect of pressure ulcers in a trauma unit

Objetivo: Determinar el tipo de barreras y actitudes hacia la prevención de las úlceras por presión en una unidad hospitalaria de traumatología. Metodología: Estudio observacional descriptivo realizado en la Unidad de Traumatología General. Se aplicaron 3 cuestionarios: cuestionario de percepción de seguridad del paciente (PSP); cuestionario de actitudes hacia la prevención de las úlceras por presión (APuP) y cuestionario de barreras hacia la prevención de las úlceras por presión (BPUPP). Resultados: La muestra estuvo constituida por 35 profesionales (21 enfermeras y 14 auxiliares). Rango medio de edad, 31-50 años (57,2%); género predominante, mujer (94,3%); la media de experiencia laboral fue de < 5 años (71,4%), y como profesional titulado, < 10 años (34,3%). El 86,6% de los profesionales tenían formación en prevención de úlceras por presión. Se puntuó con un 7 a la unidad donde trabajaban en relación con la cultura de la seguridad y prevención de las úlceras por presión como evento adverso. Las enfermeras identificaron hasta 16 barreras y las auxiliares 18, de ellas 14 resultaron comunes. Conclusiones: Se observó una actitud positiva de los profesionales hacia las medidas de prevención, existiendo acuerdo en que las úlceras por presión son evitables y prevenibles. Sin embargo, prevalecen algunas barreras relacionadas con factores de tipo organizacional (excesiva rotación de personal), déficit de conocimientos (“siempre se ha hecho así”) o insuficiente colaboración y comunicación entre niveles asistenciales, resultados estos que concuerdan con lo publicado en la literatura y que urge buscarles solución (AU)

Objective: To determine the type of barriers and attitudes towards the prevention of pressure ulcers in a traumatology hospital unit. Methodology: Descriptive observational study conducted in the General Traumatology Unit. Three questionnaires were applied: Patient Perception of Safety Questionnaire (PSP); Attitudes towards PPU Prevention Questionnaire (APuP) and Barriers to PPU Prevention Questionnaire (BPUPP). Results: The sample consisted of 35 professionals (21 nurses and 14 assistants). Mean age range, 31-50 years (57.2%); predominantly female gender (94.3%), mean work experience was < 5 years (71.4%), and as a qualified professional < 10 years (34.3%). A total of 86.6% of the professionals were trained in PU prevention. The unit where they worked was scored with a seven in relation to the culture of safety and prevention of PUs as an adverse event. Nurses identified up to 16 barriers and assistants 18, of which 14 were common. Conclusions: A positive attitude of the professionals towards prevention measures was observed, with agreement that PUs are avoidable and preventable. However, some barriers related to organizational factors prevail (excessive staff turnover), knowledge deficit (“it has always been done this way”) or insufficient collaboration and communication between care levels, results that agree with those published in the literature and that it is urgent to seek solution (AU)

Diseño y validación de un instrumento sobre calidad de la planificación anticipada de decisiones para profesionales / Design and validation of an instrument about quality of the advance care planning for professionals

Objetivo: Diseñar y validar un cuestionario dirigido a profesionales para la medición de la calidad del proceso de planificación anticipada de decisiones y determinar sus propiedades psicométricas. Método: Estudio instrumental de validación de cuestionario. Emplazamiento: centros de atención primaria y consultas externas de hospitales de Ferrol, Ourense, Monforte-Lugo y el Área Sanitaria V del Servicio de Salud de Asturias. Participantes: médico/as y enfermera/os. Fases: 1) diseño de la primera versión del cuestionario mediante técnica Delphi; 2) construcción de la segunda versión de 21 ítems, tras acuerdo de jueces y prueba W de Kendal; 3) pilotaje, análisis de consistencia interna mediante alfa de Cronbach y coeficiente omega, test-retest mediante coeficiente de correlación de Pearson; y 4) validación, test de esfericidad de Barlett y medida de Kaiser-Meyer-Olkin, análisis factorial exploratorio con rotación varimax y estudio de las dimensiones del cuestionario (número, coeficiente de correlación intraclase y correlación), consistencia interna mediante alfa de Cronbach. Resultados: Estudio piloto con 28 profesionales. Fiabilidad ɷ = 0.917, α = 0, 841 y coeficiente de correlación test-retest 0,785 (intervalo de confianza del 95%: 0,587-0,894; p < 0,001). Validación del cuestionario (21 ítems) en 204 profesionales. El análisis de los ítems y el factorial exploratorio (test de Barlett [χ2 = 1298,789] y KMO = 0,808; p < 0,001) arrojaron un modelo de cinco factores que explican el 64,377% de la varianza total, con 18 ítems agrupados en 5 dimensiones (información, preferencias, intención de conducta, capacitación y comunicación). El alfa de Cronbach del cuestionario global fue de 0,841. Conclusiones: El cuestionario ProPAD-pro ha demostrado ser un instrumento válido y fiable para evaluar la calidad del proceso de planificación anticipada de decisiones. (AU)

Objective: To develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality. Method: Instrumental questionnaire validation study. Scope: primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias. Participants: physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges’ agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest–test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser–Meyer–Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha. Results: Pilot study with 28 professionals. Reliability ɷ = 0.917, α = 0.841, and test–retest correlation coefficient of 0.785 (95% confidence interval: 0.587–0.894; p < 0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ2 = 1298,789] and KMO = 0.808; p < 0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841. Conclusions: The ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process. (AU)

[Design and validation of an instrument about quality of the advance care planning for professionals]. / Diseño y validación de un instrumento sobre calidad de la planificación anticipada de decisiones para profesionales.

OBJECTIVE: To develop a questionnaire aimed to measure the quality of the advance care planning process in healthcare professionals and to assess its psychometric quality. METHOD: Instrumental questionnaire validation study. SCOPE: primary care centers and outpatients clinics from general hospitals in Ferrol, Ourense, Monforte-Lugo and Health Area V of the Health Service of Asturias. PARTICIPANTS: physicians and nurses. Phases: (1) design of the first version of the questionnaire using the Delphi technique; (2) construction of the second version of 21 items, after judges' agreement and Kendall's W test; (3) pilot study: internal consistency using Cronbach's alpha and omega coefficient, retest-test by Pearson's correlation coefficient; (4) validation: Barlett's spherity test and Kaiser-Meyer-Olkin measurement, exploratory factor analysis with varimax rotation and study of the dimensions of the questionnaire (number, CCI and correlation), internal consistency using Cronbach's alpha. RESULTS: Pilot study with 28 professionals. Reliability É·=0.917, α=0.841, and test-retest correlation coefficient of 0.785 (95% confidence interval: 0.587-0.894; p<0.001). Validation of the questionnaire (21 items) in 204 professionals. Ítem analysis and exploratory factor analysis (Barlett's test [χ2=1298,789] and KMO=0.808; p<0.001) yielded a five-factor model explaining 64.377% of the total variance, with 18 items grouped into 5 dimensions (information, preferences, behavioral intention, training and communication). Cronbach's alpha of the global questionnaire was 0.841. CONCLUSIONS: The ProPAD-pro questionnaire has showed to be a valid and reliable instrument to assess the quality of the advance care planning process.

La revisión sistemática: pluralidad de enfoques y metodologías / The systematic review: Plurality of approaches and methodologies

Una revisión sistemática se considera un tipo «especial» de artículo o documento científico que, sin llegar a ser original, resume el estado actual de la investigación sobre un tema en particular, mediante un proceso sistemático riguroso y reproducible. Surgió con el fin de ofrecer una visión y comprensión más profunda de un fenómeno específico de la realidad, tomando como base los resultados de otras investigaciones para consolidar el conocimiento existente e identificar problemas no resueltos. Esto facilitaría la toma de decisiones según la evidencia. Sin embargo, bajo el término genérico «revisión sistemática» se engloba muchos sinónimos que, por desconocimiento o mal uso, pueden confundirse. Este artículo explora cuáles son las diferentes tipologías de revisiones sistemáticas que podemos encontrar publicadas, en función de la organización de su enfoque y la metodología de síntesis del conocimiento empleada

A systematic review is considered a "special" type of scientific article that, without being original, summarizes the current state of research on a particular topic, through a rigorous and reproducible systematic process. It emerged in order to offer a deeper insight and to understand a specific phenomenon of reality, based on the results of other research to consolidate existing knowledge and identify unresolved problems. This could facilitate decision-making according to the evidence. However, many synonyms are included under the generic term "review" that, through ignorance or misuse, can be disconcerting. This article explores the different types of published systematic reviews that we can find published, depending on the organization of their approach and the knowledge synthesis methodology used

The systematic review: Plurality of approaches and methodologies. / La revisión sistemática: pluralidad de enfoques y metodologías.

A systematic review is considered a "special" type of scientific article that, without being original, summarizes the current state of research on a particular topic, through a rigorous and reproducible systematic process. It emerged in order to offer a deeper insight and to understand a specific phenomenon of reality, based on the results of other research to consolidate existing knowledge and identify unresolved problems. This could facilitate decision-making according to the evidence. However, many synonyms are included under the generic term "review" that, through ignorance or misuse, can be disconcerting. This article explores the different types of published systematic reviews that we can find published, depending on the organization of their approach and the knowledge synthesis methodology used.

Calidad de las guías de práctica clínica sobre úlceras venosas de la extremidad inferior / Quality of clinical practice guidelines of lower extremity venous ulcers

La variabilidad clínica y la incertidumbre profesional en la prevención y tratamiento de las úlceras venosas de la extremidad inferior (UV) traen, como principal consecuencia, el hecho de que los pacientes puedan verse sometidos a pruebas diagnósticas y terapéuticas, a veces de dudosa utilidad, o incluso que estas puedan resultar nocivas para la salud del paciente o que, en otras ocasiones, puedan llegar a omitirse determinados procedimientos o procesos que sí podrían resultar adecuados a la situación y necesidades del paciente. Es por ello que surgen una serie de documentos específicos denominados guías de práctica clínica para el abordaje de las UV (GPC-UV), con la finalidad de mejorar la efectividad y la calidad de los cuidados, disminuir la variabilidad injustificada y establecer criterios homogéneos para su manejo. Sin embargo, la literatura recoge que no todas las GPC tienen el mismo criterio metodológico y de elaboración de la evidencia, por lo que muchas de ellas son de escasa calidad científica y rigor editorial. Esto implica que las GPC deben ser revisadas y actualizadas periódicamente en función de la evidencia más actual, y su calidad contrastada con instrumentos validados como el AGREE-II. Tras un análisis de la calidad de 6 GPC-UV disponibles en la actualidad, se ha podido identificar qué guías son recomendables para su implementación en la práctica asistencial y cuáles deberían modificarse para mejorar su aplicabilidad y desarrollo de las evidencias (AU)

The clinical variability and professional uncertainty in the prevention and treatment of lower extremity venous ulcers (VU) has as a main consequence, the fact that patients can be subjected to diagnostic and therapeutic tests, sometimes of dubious utility, these may even be harmful to the health of the patient and that, at other times, certain procedures or processes that may be appropriate to the patient's situation and needs may be omitted. It is for this reason that a series of specific documents called clinical practice guidelines for the approach of VU (CPG-VU) have been created, with the aim of improving the effectiveness and quality of care, reducing unjustified variability and establishing homogeneous criteria for its handling. Nevertheless, the literature shows that not all CPGs have the same methodological and evidence-drawing criteria. Many of them are of poor scientific quality and editorial rigor. This implies that CPGs should be periodically reviewed and updated based on the most current evidence and their quality contrasted with validated instruments such as AGREE-II. After an analysis of the quality of six CPG-VU available today, it has been possible to identify what guidelines are recommended for its implementation in the practice of care, which should be modified to improve their applicability and development of the evidence (AU)

Quality of clinical practice guidelines of lower extremity venous ulcers. / Calidad de las guías de práctica clínica sobre úlceras venosas de la extremidad inferior.

The clinical variability and professional uncertainty in the prevention and treatment of lower extremity venous ulcers (VU) has as a main consequence, the fact that patients can be subjected to diagnostic and therapeutic tests, sometimes of dubious utility, these may even be harmful to the health of the patient and that, at other times, certain procedures or processes that may be appropriate to the patient's situation and needs may be omitted. It is for this reason that a series of specific documents called clinical practice guidelines for the approach of VU (CPG-VU) have been created, with the aim of improving the effectiveness and quality of care, reducing unjustified variability and establishing homogeneous criteria for its handling. Nevertheless, the literature shows that not all CPGs have the same methodological and evidence-drawing criteria. Many of them are of poor scientific quality and editorial rigor. This implies that CPGs should be periodically reviewed and updated based on the most current evidence and their quality contrasted with validated instruments such as AGREE-II. After an analysis of the quality of six CPG-VU available today, it has been possible to identify what guidelines are recommended for its implementation in the practice of care, which should be modified to improve their applicability and development of the evidence.

Antecedentes de la terapia compresiva: el ‘método Baynton’ para el tratamiento de úlceras de la pierna / History of the compressive therapy: the ‘Baynton Method’ for the treatment of ulcers of the leg

El método Baynton o "cura Baynton" fue una técnica terapéutica de finales siglo XVIII que revolucionó el tratamiento conservador que hasta la fecha se aplicaba a la curación de las úlceras de la pierna. A través de la aplicación de un emplaste, un vendaje compresivo elástico en espiral y la movilización temprana de la extremidad, se lograron asentar las bases empíricas de lo que se conoce como "terapia de compresión". Se evidenció cómo la compresión mejoraba el edema, favorecía el ambiente húmedo logrando un efecto bacteriostático y cicatrizante sobre las úlceras tórpidas de la extremidad inferior, convirtiéndose en uno de avances médicos y de salud pública más importantes e innovadores de su época. Esta investigación representa uno de los escasos documentos que nos describen cómo fue evolucionando el conocimiento de la terapia de compresión para el tratamiento de úlceras crónicas de la extremidad inferior

The Baynton method or "Baynton cure" was a therapeutic technique of the late eighteenth century that revolutionized the conservative treatment that until the date applied to the healing of ulcers of the leg. Through the application of a dressing of diachylon, a compressive bandage pad spiral and the early mobilization of the extremity, it managed to settle the empirical bases of what is known as compression therapy. It is evident as the compression improved the edema, favored the humid environment and achieved a bacteriostatic effect and healing on the chronic ulcers of the lower extremity, becoming one of medical advances and most important public health and innovative of his time. This research represents one of the few documents that describe us as was evolving knowledge of the compression therapy for the treatment of chronic ulcers of the lower extremity

Cómo mejorar los cuidados de salud: la importancia de la implementación / How to improve health care: The importance of implementation

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Implementar evidencias e investigar en implementación: dos realidades diferentes y prioritarias / Implementing evidence and implementation research: two different and prime realities

La investigación científica puede contribuir a hacer más eficientes los cuidados de salud, a mejorar la calidad asistencial y la seguridad de las personas. Para que así suceda, el conocimiento generado debe transferirse a la práctica. Se conoce como implementación la introducción de un cambio o innovación en la práctica diaria, lo que exige una comunicación efectiva y la eliminación de barreras que dificulten este proceso. En el ámbito de enfermería, cada vez es más frecuente la realización de experiencias de implementación de buenas prácticas. La dificultad para identificar los factores que permiten conocer el éxito o fracaso de la implementación ha dado lugar al incremento de estudios encaminados a construir un cuerpo de conocimientos diferenciados, conocido como ciencia de la implementación o investigación en implementación. La investigación en implementación es el estudio científico cuyo objetivo es la adopción e incorporación sistemática de los resultados de investigación en la práctica clínica para mejorar la calidad y eficacia de los servicios de salud. El fin que persigue la investigación en implementación es mejorar la salud de la población mediante la aplicación equitativa y eficaz del conocimiento científico rigurosamente evaluado, lo que implica la captación de aquellas evidencias que hayan producido un impacto positivo en la salud de la comunidad. En este texto se exponen las particularidades de la investigación enfermera en implementación, realizándose una síntesis de los diferentes métodos, teorías, marcos determinantes y estrategias de implementación, junto con la terminología propuesta para una mayor claridad conceptual

Scientific research can contribute to more efficient health care, enhance care quality and safety of persons. In order for this to happen, the knowledge gained must be put into practice. Implementation is known as the introduction of a change or innovation to daily practice, which requires effective communication and the elimination of barriers that hinder this process. Best practice implementation experiences are being used increasingly in the field of nursing. The difficulty in identifying the factors that indicate the success or failure of implementation has led to increased studies to build a body of differentiated knowledge, recognized as implementation science or implementation research. Implementation research is the scientific study whose objective is the adoption and systematic incorporation of research findings into clinical practice to improve the quality and efficiency of health services. The purpose of implementation research is to improve the health of the population through equitable and effective implementation of rigorously evaluated scientific knowledge, which involves gathering the evidence that has a positive impact on the health of the community. In this text, we set out the characteristics of nursing implementation research, providing a synthesis of different methods, theories, key frameworks and implementation strategies, along with the terminology proposed for greater conceptual clarity

[Implementing evidence and implementation research: two different and prime realities]. / Implementar evidencias e investigar en implementación: dos realidades diferentes y prioritarias.

Scientific research can contribute to more efficient health care, enhance care quality and safety of persons. In order for this to happen, the knowledge gained must be put into practice. Implementation is known as the introduction of a change or innovation to daily practice, which requires effective communication and the elimination of barriers that hinder this process. Best practice implementation experiences are being used increasingly in the field of nursing. The difficulty in identifying the factors that indicate the success or failure of implementation has led to increased studies to build a body of differentiated knowledge, recognized as implementation science or implementation research. Implementation research is the scientific study whose objective is the adoption and systematic incorporation of research findings into clinical practice to improve the quality and efficiency of health services. The purpose of implementation research is to improve the health of the population through equitable and effective implementation of rigorously evaluated scientific knowledge, which involves gathering the evidence that has a positive impact on the health of the community. In this text, we set out the characteristics of nursing implementation research, providing a synthesis of different methods, theories, key frameworks and implementation strategies, along with the terminology proposed for greater conceptual clarity.