The Effectiveness of Advanced Practice Nurses with Respect to Complex Chronic Wounds in the Management of Venous Ulcers

This study aims to evaluate the effectiveness of advanced practice nurses with respect to complex chronic wounds (APN-CCWs) in the care of patients with venous ulcers. A multicentric, quasi-experimental pre-post study was conducted without a control group in the sanitary management areas where the APN-CCW program is being piloted. The intervention consisted of a mass training of clinical nurses from the participating districts on the proper management of injuries and the use of compression therapy. The data were collected through a specifically constructed questionnaire with questions regarding descriptive variables of injuries and their treatment. A total of 643 professionals responded (response rate of 89.1%), attending to a total population of 707,814 inhabitants. An increase in multilayer bandage use by 15.67%, an increase in elastic bandage use by 13.24%, and a significant decrease in the referral of patients to consultation with hospital specialists was achieved, from 21.08% to 12.34%. The number of patients referred to the APNs was 13.25%, which implied a resolution rate of 94.08% of their injuries. In conclusion, the coordination by the APN-CCWs in patients with venous ulcers was effective in improving the continuity of care, in the optimization of resources, and in their care role

Materiales didácticos para el Grado en Criminología

Elaboración de materiales que sirvan para la enseñanza presencial del Grado en Criminología, resolviendo casos prácticos desde la perspectiva de las distintas asignaturas que forman parte de este plan de Estudios multidisciplinar

The composting potential of the by-product marc resulting from the white and red winemaking process

The production of an organic fertilizer was carried out, from waste generated in the winemaking process of white (Riesling Italian-RI) and red (Cabernet Sauvignon-CS) grapes obtained from the vineyard of Pietroasa (Romania). The potential of the biotransformation process of by-product marc in an open pile in the autumn-winter season was controlled and the thermophilic phase reached average values of 60 ºC at a neutral pH which gives it suitable characteristics to be used as a soil fertiliser. The values of the germination index (GI) of Lepidium sativum L. seeds, using water dilutions from the RI and CS compost marc, demonstrated that there was no degree of phytotoxicity (average GI 144.2% and 139.8%, respectively). The compost marc microflora was represented by bacterial and fungal isolates belonging to genera Rhizopus (10%), Aspergillus (80%), and Penicillium (17%), compared to by-product marc that only present fermentation yeasts. The structure of the microorganism populations in the compost marc dried by lyophilisation showed an almost double number of CFUg-1 compared to the oven-dried compost. The presence of potential antagonistic microorganisms and the high number of CFUg-1, demonstrated that this compost can have a suppressive effect on soil pathogens in addition to its quality as a fertilizer

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Development and evaluation of a training programme on asset-based community development aimed at general practice trainees: protocol for a mixed-method multilevel and multicentric action research study

Introduction Asset-based community development (ABCD) is a strategy aimed at strengthening communities of interest through the identification and enhancement of those protective resources (also called ‘health assets’) that contribute to improve population health. Although primary care is specially well placed to contribute to ABCD by facilitating patients’ access to community health assets, the implementation of ABCD approaches is limited, in part due to training deficiencies amongst general practitioners. In this study, we will develop a training programme on ABCD aimed at general practice trainees and evaluate its implementation and scale-up in Andalusia, Spain. We will also investigate whether the programme may contribute to strengthen the community orientation of the primary care practices involved in the study.Methods and analysis We will undertake a mixed methods, multilevel and multicentric action research study drawing on theoretical frameworks relevant to learning (pedagogy) and community health promotion. The intervention will be implemented and evaluated in eight different study areas over 48 months. It will comprise a classroom-based session and a practical exercise, which will involve general practice trainees producing a map of community health assets relevant to common health conditions. In each study area, we will set up a stakeholder group to guide our study. We will run the intervention sequentially across the eight study areas, and modify and refine it iteratively by incorporating the findings from the evaluation. We will employ qualitative (interviews and focus groups with general practice trainees, primary care workers, members of the teaching units and policymakers) and quantitative methods (self-administered questionnaires with an approximate sample of 157 general practice trainees and 502 primary care workers).Ethics and dissemination Ethics approval from the Andalusian Regional Health Council has been granted (6/2020). It is envisaged that this research will provide relevant, evidence-based guidance on how best to incorporate learning on ABCD into the general practice training curriculum. Findings will be disseminated in an ongoing manner and will target the following audiences: (1) general practice trainees, primary care workers and members of the teaching units, (2) policymakers and strategic decision makers and (3) the academic community

Monolitos edafológicos: una herramienta útil para dar a conocer el suelo más allá del ámbito universitario

El potencial didáctico de los monolitos edafológicos es bien conocido en ámbitos relacionados con la Ciencia del Suelo; sin embargo, los eventos divulgativos sobre el suelo, aunque en auge, son todavía escasos. El Área de Edafología y Química Agrícola de la Escuela Técnica Superior de Ingenierías Agrarias de Palencia (Universidad de Valladolid) ha promovido la creación de una colección de monolitos de suelos característicos de las provincias de Palencia y Valladolid. Esta iniciativa surge con fines educativos, divulgativos y de sensibilización ambiental. Actualmente cuenta con dos mononolitos listos para ser expuestos junto con información adicional detallada. Su uso más inmediato será formar parte de una exposición sobre bosques y cambio climático en el Museo de la Ciencia de Valladolid, un evento integrado dentro del Proyecto “Ciencia en acción: Bosques y emergencia climática” (FECYT). En este contexto se pretende dar visibilidad al papel crucial de los suelos para combatir el cambio climático como secuestradores de CO2 entre un público no especializado. A corto plazo los monolitos se utilizarán en talleres de divulgación dentro de “La Noche Europea de los Investigadores” o la “Semana de la Ciencia de Castilla y León”, entre otros. Esta colección se irá ampliando en los próximos años y su uso se irá diversificando.Departamento de Ciencias Agroforestale