Nursing students bringing first aid to the community

AimThis study aimed to evaluate the theoretical and practical skills acquired by nursing students and school students after the service-learning project.MethodsThis study promotes nursing students and school students working together to gain awareness and basic theoretical knowledge of first aid. The learning project was conducted with nursing students (n = 67) and school students (n = 131) from April to June 2022. The nursing students gave scores higher than 8 on the aspects linked to expectations, self-perception, overall assessment, and attainment of the goals, and these results are in line with the qualitative analysis.ResultsMoreover, 100% of the school students reported a satisfactory outcome about the service.ConclusionService-learning is a challenging and motivating methodology for nursing students, which results in greater engagement with theory and practice and the development of essential skills for future professionals

Realist evaluation of the implementation of the surgical checklist in a tertiary hospital

Introducción. Cada día son más las cirugías realizadas en el mundo, lo que aumenta el riesgo de cometer errores dentro del área quirúrgica. Por ello, es necesario contar con un arraigado clima de seguridad del paciente que permita desarrollar la efectividad de herramientas clave como el listado de verificación quirúrgica. Objetivos. Evaluar de forma realista la implantación del listado de verificación quirúrgica en un hospital de tercer nivel a través de sus profesionales. Metodología. La evaluación realista permite obtener una visión integral de una intervención compleja como es la incorporación del listado de verificación quirúrgica. Se llevarán a cabo tres etapas diferenciadas: análisis del contexto, análisis del mecanismo y análisis del resultado. Estas fases requieren distintas formas de recogida de datos: revisión de la literatura, entrevistas semiestructuradas, encuestas y recogida de indicadores de calidad del programa cirugía segura. Aplicabilidad práctica. Durante el análisis de los datos se obtendrán datos cuantitativos y cualitativos que se integrarán para conseguir una evaluación exhaustiva del proceso de implantación del listado de verificación quirúrgica desde el inicio hasta la actualidad con los correspondientes flujos entre el contexto y sus circunstancias. Con esto conseguiremos destacar la importancia de un plan de implantación con estrategias sólido a través de intervenciones programadas que permiten una mejora y evaluación constante de las herramientas.Introduction. Every day there are more surgeries performed in the world, which increases the risk of making mistakes within the surgical area. For this reason, it is necessary to have a developed patient safety climate that allows the development of the effectiveness of key tools such as the surgical safety checklist. Objective. Evaluate the implementation of the surgical safety checklist in a tertiary hospital through its professionals. Methodology. The realist evaluation allows obtain a comprehensive vision of a complex intervention such as the incorporation of the surgical safety checklist. Three different stages will be carried out: context analysis, mechanism analysis and result analysis. These phases require different forms of data collection: literature review, semi-structured interviews, surveys, and collection of quality indicators of the safe surgery program. Clinical relevance. Quantitative and qualitative data will be obtained that will be integrated to achieve an exhaustive evaluation of the surgical safety checklist implementation process from the beginning to the present with the corresponding flows between the context and its circumstances. This exhaustive evaluation will be able to highlight the importance of an implementation plan with solid strategies through programmed interventions that allow constant improvement and evaluation of the tools

Approximation to the Consumption of Healthcare Resources and the Economic Cost of SARS-CoV-2 Patient Management: A Retrospective Study

Spain has become one of the countries most affected by coronavirus disease 2019 (COVID-19), with the highest testing rates, and one of the worst-performing countries in the fight against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. There are no studies related to the consumption of health resources and the economic cost of the SARS-CoV-2 virus. We present a retrospective analysis of 9,811 (Primary Care and Hospital) patients which aimed to estimate public health expenditure by the consumption of health resources due to COVID-19. According to the results, the gender distribution of patients has a similar rate in both groups, with slightly higher rates in women. Similarly, age is the same in both groups, with a median of 62 years in the case of hospitalizations and 61 years in the case of primary care; using a weighted average of these rates and costs, we can estimate that the average cost of care per patient infected with the SARS-CoV-2 virus, regardless of the course is €2373.24. We conclude that a patient with COVID-19 without hospitalization costs €729.79, while the expenses of a hospitalized patient are between €4294.36 and €14440.68, if there is ICU admission

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

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020

[EN] Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3,4,5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes.S