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

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

ELABORACIÓN Y VALIDACIÓN PSICOMÉTRICA DE UNA ESCALA DE CONOCIMIENTOS SOBRE LA ENFERMEDAD DE ALZHEIMER Y OTRAS DEMENCIAS. APLICACIÓN EN PROFESIONALES DE RESIDENCIAS DE MAYORES Y EN ESTUDIANTES DE ENFEMERÍA

Objetivos: Elaborar y establecer las propiedades psicométricas de una escala para medir el conocimiento sobre los cuidados a personas con enfermedad de Alzheimer (EA) y otras demencias. Metodología: Cuatro fases: 1) Identificación y evaluación de calidad de Guías de práctica clínica sobre Enfermedad de Alzheimer (EA); 2) Elaboración de una escala de conocimientos sobre cuidados a personas con EA y validación de contenido. 3) Evaluación psicométrica de la escala en 2 muestras (personal de enfermería y estudiantes). 4) Medición de conocimientos en personal de Residencias de Mayores de Jaén, y en estudiantes de Grado de Enfermería de la Universidad de Jaén Resultados: La versión 1 de la escala con 30 ítems tuvo buena validez de contenido. Tras su administración a dos muestras (Profesionales:361; y estudiantes:297) queda una versión final de 23 ítems con adecuadas propiedades psicométricas: fiabilidad y validez. Conclusión: La escala UJA Alzheimer-Care es un instrumento fiable y valido para medir conocimiento sobre cuidados de la enfermedad de Alzheimer aplicable a profesionales de las residencias de mayores y a estudiantes de enfermería.Aim: To develop and establish the psychometric properties of a scale aimed to measure knowledge on caring for people with Alzheimer disease and dementia. Methods: Four phases: 1) Identification and quality assessment of clinical guidelines about Alzheimer disease (AD). 2) Construction of a scale about knowledge on the care for people with AD and content validation. 3) Psychometric evaluation of the scale using 2 samples (nursing staff and students). 4) Measurement of the level of knowledge in Nursing homes staff in Jaén and in undergraduate nursing students at the University of Jaén. Results: The version 1 of this scale, with 30 items, showed good content validity. After the study with the 2 samples (nursing staff N= 361; Students N= 297) the 23-items final version of the scale have adequate psychometric properties, both reliability and validity. Conclusion: The UJA Alzheimer-Care scale is a reliable and valid instrument aimed to measure knowledge on Alzheimer disease care; it can be applied both to Nursing Homes staff and to nursing students.Tesis Univ. Jaén. Departamento de Enfermería. Leída el 26 de mayo de 2017

Knowledge about the Care of People with Alzheimer’s Disease of the Nursing Staff of Nursing Homes in Spain

People with Alzheimer&rsquo;s disease often live in nursing homes. Updated knowledge among the nursing staff has led to better quality of care. The aim of this study was to measure the knowledge about the care of people with Alzheimer&rsquo;s disease of the nursing staff of nursing homes in Spain. A cross-sectional study was conducted in 24 nursing homes in the province of Ja&eacute;n (Spain) with a sample of 361 members of staff, i.e., registered nurses (RNs), assistant nurses (ANs), and eldercare workers (EWs). The University of Ja&eacute;n UJA-Alzheimer&rsquo;s Care Scale was used to measure the knowledge. The knowledge was higher among the RNs (83.3% of the maximum) than among the ANs and EWs (71.6%). Work experience and updated training were associated with the knowledge score in RNs, but only the updated training in ANs and EWs. Nursing homes with less experienced nursing staff and with a small proportion of staff receiving training on dementia have a low knowledge score. The nursing staff of nursing homes in Ja&eacute;n have medium to high knowledge about Alzheimer&rsquo;s care. There is a wide range of variation in the knowledge score among the nursing homes. Up-to-date staff training in dementia care is the factor with the strongest association with knowledge

Guías de práctica clínica de cuidados a personas con Alzheimer y otras demencias: revisión de la literatura

Introducción: la enfermedad de Alzheimer es la demencia más frecuente en España y su incidencia aumenta con la edad. En los últimos años se han elaborado diferentes guías de práctica clínica (GPC) para guiar las decisiones de tratamiento y cuidados sobre esta enfermedad. Objetivos: identificar las GPC sobre cuidados a personas con Alzheimer publicadas en lengua española. Métodos: una revisión de la literatura y de fuentes documentales en Internet. Resultados: se han identificado 9 GPC sobre cuidados a personas con Alzheimer publicadas entre 2002 y 2011. Se ha analizado el proceso de elaboración, el contenido de las guías y las diferentes recomendaciones clínicas que hacen. Discusión: se observa que no existe homogeneidad en las guías, siendo difícil el acceso a ellas por parte de los profesionales. Destacan dos de las guías por ser las más completas tanto en contenidos como en su estructura y desarrollo. Se trata de la guía del Servicio Canario de Salud y la GPC del Ministerio de Ciencia e Innovación, siendo esta última la más actual (2011) y basada en evidencias científicas

Calidad de las guías de práctica clínica españolas sobre la enfermedad de Alzheimer y otras demencias

ABSTRACT Background: The care of patients with Alzheimer's disease and other dementias has become a priority for healthcare systems. This is evidenced by the increasing number of clinical practice guidelines (CPG) developed in our country aimed to help professionals in making health decisions. The aim of our study was to evaluate the quality of the Spanish CPG on Alzheimer's disease and other dementias using the AGREE II instrument. Method: Nine GPC were selected according to the inclusion criteria: Full GPC available; aimed to healthcare professionals; and published between 2002-2013. Two reviewers independently assessed the quality of the guides through the AGREE II instrument, in order to assess the methodological rigor and transparency of the GPC. Results: 88.8% of the guides scored a very poor quality editorial independence. Respect to rigor in the development and clarity of presentation, 77.7% also scored very low quality. There is a guide that stands out for a score above 50% in all domains of the instrument. Conclusions: The worst scored domains were Editorial independence, Rigor in the development and Applicability, in this order. The highest rated domains were Scope and Objectives and Clarity of Presentation. The guideline of the Ministry of Health, Social Policy and Equality is the best, obtaining a score above 50% in all domains. Overall, the quality of the 9 guidelines evaluated is low or very low, only two of them score as good overall quality.RESUMEN Fundamento: La atención a pacientes con enfermedad de Alzheimer y otras demencias se ha convertido en un objetivo prioritario de los sistemas sanitarios. Así lo demuestra el aumento del número de guías de práctica clínica (GPC) elaboradas en nuestro país para ayudar a los profesionales en la toma de decisiones sanitarias. El objetivo de nuestro estudio fue evaluar la calidad de las GPC españolas sobre enfermedad de Alzheimer y otras demencias a través de la metodología de evaluación Appraisal of guidelines research and evaluation (AGREE II). Método: Se seleccionaron nueve GPC españolas con los criterios de inclusión: guías completas, dirigidas a personal sanitario, publicadas entre 2002-2013. Dos revisores evaluaron independientemente la calidad de las guías a través del instrumento AGREE II para la evaluación del rigor metodológico y la transparencia de las GPC. Resultados: El 88,8% de las guías obtuvieron una calificación de muy baja calidad con respecto a la Independencia editorial. En cuanto al rigor en la elaboración y la claridad en la presentación el 77,7% también obtuvieron muy baja calidad. Hay una guía que destaca por obtener una puntuación por encima del 50% en todos los dominios del instrumento. Conclusiones: El dominio peor valorado es la independencia editorial seguido de los dominios de rigor en la elaboración y aplicabilidad. Los dominios mejor valorados son alcance y objetivos y claridad en la presentación. La guía del Ministerio de Sanidad, Servicios Sociales e Igualdad destaca obteniendo una valoración por encima del 50% en todos los dominios. La calidad global de las 9 guías evaluadas es baja o muy baja, sólo dos obtienen una puntuación global de buena calidad

Evaluating Satisfaction and Self-Confidence among Nursing Students in Clinical Simulation Learning

Background: Clinical simulation is effective in nursing student education, fostering autonomous learning and critical skill development in safe environments. This method is adaptable to dynamic educational approaches and integrates technology. Satisfaction and self-confidence are key elements in its evaluation. The general objective of this research was to describe the levels of satisfaction and self-confidence among undergraduate nursing students regarding the use of clinical simulation in the field of family and community nursing. Methods: A cross-sectional descriptive study was conducted at the University of Jaén, Spain, during the 2023/2024 academic year. Data on sociodemographic aspects, satisfaction, and self-confidence were collected using a validated instrument. The statistical analysis included central measures, dispersion, and frequencies, with confidence intervals. Results: The study involved 96 students in scenario 1 (family assessment) and 97 in scenario 2 (family intervention), with the majority being women. In scenario 1, the mean satisfaction score was 4.38 out of 5, and self-confidence was scored 4.44 out of 5. Prior preparation time correlated significantly with higher levels of satisfaction and self-confidence. In scenario 2, the mean scores were slightly higher but not statistically significant. Conclusions: Our study demonstrated high levels of satisfaction and self-confidence among nursing students following clinical simulations. Prior preparation was associated with better outcomes, and the quality of the simulation positively impacted the results

Nursing Education in a Real-Life Context: The Teaching Ward Round

Education in nursing is continually changing. The didactic methods used in other fields may be useful for closing the gap between theoretical learning and the reality of practical nursing. This study aimed to determine the association between a teaching model centered on the reality of nursing care, which is individualized to each context, and knowledge acquisition. A controlled experimental study was conducted with random allocation to two groups of students in their second year of a nursing degree (University of Jaén). The control group undertook practical work placements according to the traditional model. The intervention group participated in a “teaching round” during their practical placements. Knowledge tests were conducted after the placements. No significant differences were found for age or education level between the students of the control group (n = 46) and the intervention group (n = 48). In terms of the association between participation in the teaching round and the knowledge test (maximum score of 10), the mean grade in the intervention group was 8.83 ± 0.22, while it was 7.68 ± 0.23 in the control group (p = 0.001). The teaching round increased the student’s acquisition of knowledge, even though this was not reflected in the global grade of the course

Measuring knowledge of Alzheimer’s: development and psychometric testing of the UJA Alzheimer’s Care Scale

Abstract Background Care for people with Alzheimer’s disease or other dementias should be based on up-to-date clinical practice guidelines. The education and training of nurses and other healthcare staff in dementia is a key factor in providing quality care. Knowledge of Alzheimer’s disease can be measured through questionnaires. The aim of this study was to develop and validate a scale to measure Alzheimer’s disease knowledge among both nursing staff and students. Methods This was a cross-sectional survey study undertaken in three stages: 1) development of the questionnaire and item wording; 2) content validation by an expert panel; 3) questionnaire testing with two samples to establish psychometric properties. Sample 1 comprised 361 Registered Nurses, Assistant Nurses and eldercare workers from 24 nursing homes in Jaén (southern Spain). Sample 2 comprised 297 nursing students. The data were analysed through item analysis and a Rasch model. Convergent and construct validity and internal consistency were also examined. Results The 23-item UJA Alzheimer’s Care Scale shows good outfit and infit values based on the Rasch model. One item presented differential functioning between Registered Nurses and Assistant Nurses. The intraclass correlation coefficient between the UJA Alzheimer’s Care Scale and the Spanish version of the Dementia Knowledge Assessment Tool 2 showed strong agreement among nursing staff (0.63) and students (0.79). The scale is able to distinguish between professionals with low or high knowledge of Alzheimer’s care. The overall Cronbach’s alphas were 0.70 (nursing staff) and 0.82 (nursing students). The intraclass correlation coefficient between the first test and the retest was good (0.84). Conclusions The UJA Alzheimer’s Care Scale is a useful tool for measuring knowledge of Alzheimer’s disease and dementia care among nursing professionals or nursing students. The initial validation study obtained good psychometric properties concerning validity and reliability

Afrontamiento y carga subjetiva en cuidadores primarios de adultos mayores dependientes de Andalucía, España

Objetivo: Analizar la relación entre el tipo de afrontamiento y la carga subjetiva en cuidadores primarios de familiares mayores dependientes en Andalucía (España). Diseño: Estudio transversal. Emplazamiento: Atención primaria (comunidad autónoma de Andalucía, España). Participantes: Muestra por conveniencia de 198 cuidadores primarios de familiares mayores dependientes. Mediciones principales: Afrontamiento (cuestionario Brief COPE), carga subjetiva (índice esfuerzo del cuidador de Robinson), carga objetiva (capacidad funcional [índice de Barthel], deterioro cognitivo [test de Pfeiffer], problemas de conducta de la persona cuidada [inventario neuropsiquiátrico de Cummings] y dedicación al cuidado de la persona cuidadora), género y parentesco. Resultados: La mayoría de las personas cuidadoras eran mujeres (89,4%), hijas de la persona cuidada (57,1%), y compartían domicilio con esta (69,7%). Al controlar por carga objetiva, género y parentesco, se encontró que la carga subjetiva estaba asociada de forma positiva con el afrontamiento disfuncional (β = 0,28; p < 0,001) y de forma negativa con el afrontamiento centrado en emociones (β = −0,25; p = 0,001), mientras que no había asociación con el afrontamiento centrado en problemas. Conclusiones: El afrontamiento disfuncional se relaciona con una mayor carga subjetiva y el afrontamiento centrado en las emociones se relaciona con una menor carga subjetiva, con independencia de la carga objetiva, el género y el parentesco de la persona cuidadora