Development of a wound healing index for chronic wounds

Objectives: to systematically review the literature on healing measurement tools. To develop a scale for measuring progress towards healing for chronic wounds. Material and methods: the study was conducted in two phases: Phase 1: Systematic review in major databases of health sciences (MEDLINE, CINAHL, WIDEN, SCIELO, LILACS, COCHRANE, IME) from the start of the database until 2009. Search strategy: instrument, tool, ulcer, chronic wound, healing, assessment, validation, reliability, and the same in Spanish, with their corresponding formulations using Booleans AND, OR and truncation term for some of them. The search took place initially in the thesauri and if the word did not exist, in free text. Study design not was taken. GRADE system was used to quality appraisal. Phase 2: modified Delphi study with a group of experts in chronic wounds, to reach consensus on variables that could measure the dimension of “progress towards healing”. In the first round started with all variables of the wound and the patient found in the different instruments of the systematic review. In the second round sent the items that had obtained the highest score. Finally sent the final version and experts were asked to rate on a scale of 1 to 4 to obtain the content validity index (CVI). Those variables that had obtained more than 80% CVI were included. Results: the systematic review revealed a number of 8 healing tools as set out in 20 articles (10 articles about PUSH, 3 PSST, 1 DESIGN, 1 PWAT, 1 Sessing Scale, 1 Scale Sussman, 1 WHS, CODED 1, and finally, a literature review to collect 4 of the above). Regardless of the number of items per scale, scale PSST has the best research on validity and reliability. However, most are for pressure ulcers. Only 4 papers studied validity and reliability of scales (PUSH, PSST, DESIGN and CODED). The only scale that has been validated for venous ulcers has also been the PUSH, in English and Portuguese. The only scale found in Spanish is coded, developed in the Basque Country in 2000, but only presents a partial survey. That is why they decided to develop a “de novo” scale for all types of chronic wounds. The scale developed, receives the provisional name of “RESVECH V1.0. Expected results of the assessment and evolution in the healing of chronic wounds”. CVI scores obtained by the experts above 80% on all items compose. Is defined, pending the study of validity and reliability, 9 items: size of the lesion, depth/tissue concerned, edges, maceration, perilesional, tunneling, type of tissue in the wound bed, exudate, infection/inflammation, frequency of pain (in last 10 days). The scale is scored numerically and can score ranging from 0 to 40 points, wound healed and the worst possible lesion respectively. Also accompanied by operational definitions of each item and its value-form. Conclusions: we get a scale with, a priori, content validity by expert’s assessment

Validación para Colombia del índice RESVECH 2.0 para la valoración de cicatrización en heridas crónicas

Objective. To validate in Colombia the RESVECH 2.0 index to assess and evaluate the healing process in chronic wounds. Materials and methods. Validation study carried out in three hospitals of III - IV complexity level of attention between 2013 and 2016. Population: 120 patients with any of the injuries included in the study Statistically the sphericity test of Barlett was used, the adequacy test of the KaiserMeyer-Olkin sample, the Cronbach alpha coefficient and the Reliability test-test. Results. The RESVECH 2.0 measurement index is an instrument that allows the assessment of chronic wounds at the foot of bed in a simple way and has adequate psychometric measures. Conclusions. The RESVECH 2.0 index has high reliability and validity, reasons to be recommended to use it in clinical guidelines for the care of patients with chronic wounds.Objetivo. Validar en Colombia el índice RESVECH 2.0 para valorar y evaluar el proceso de cicatrización en heridas crónicas. Materiales y métodos. Estudio de validación realizado en tres hospitales de III - IV nivel de complejidad durante los años 2013 y 2016. Población: 120 pacientes con alguna de las lesiones incluidas en el estudio Estadísticamente se utilizaron la prueba de esfericidad de Barlett, la prueba de adecuación de la muestra de KaiserMeyer-Olkin, el Coeficiente alfa de Cronbach y la Confiabilidad test-test. Resultados. el índice de medida RESVECH 2.0 es un instrumento que permite la valoración de las heridas crónicas a pie de cama de manera sencilla y que cuenta con adecuadas medidas psicométricas. Conclusiones. El índice RESVECH 2.0 cuenta con alta fiabilidad y validez, por lo que se recomienda usarlo en guías clínicas de cuidado de pacientes con heridas crónicas en población colombiana

High all-cause mortality and increasing proportion of older adults with tuberculosis in Texas, 2008–2020

Pulmonary tuberculosis (PTB) elimination efforts must consider the global growth of the ageing population. Here we used TB surveillance data from Texas, United States (2008–2020; total n = 10656) to identify unique characteristics and outcomes in older adults (OA, ≥65 years) with PTB, compared to young adults (YA, 18–39 years) or middle-aged adults (40–64 years). We found that the proportion of OA with PTB increased from 15% in 2008 to 24% in 2020 (trend p \u3c 0.05). Diabetes was highly prevalent in OA (32%) but not associated with adverse outcomes. Death was 13-fold higher in OA compared to YA and was 7% at the time of diagnosis which suggests diagnostic delays. However, once TB was suspected, we found no differences in culture, smear, or nucleic acid detection of mycobacteria (although less lung cavitations) in OA. During treatment, OA had less drug-resistant TB, few adverse reactions and adhered with TB treatment. We recommend training healthcare workers to ‘think TB’ in OA, for prompt treatment initiation to diminish deaths. Furthermore, OA should be added as a priority group to the latent TB treatment guidelines by the World Health Organization, to prevent TB disease in this highly vulnerable group

Pulmonary Tuberculosis in Older Adults, Texas, 2008 - 2020: Trends and adverse outcomes

Background: After two decades of 2% annual declines in the global incidence of TB, there was a 3.6% increase between 2020 and 2021. The World Health Organization’s (WHO) ‘End TB Strategy’ is aimed at reducing TB incidence by 80% and TB deaths by 90% by 2030, compared with 2015, but its goals will not be reached at the current pace. Reacceleration of TB elimination efforts must take into consideration the changing epidemiology of TB, including an aging global population. The older adult population, aged 65 and older, is growing faster than all other age groups, and in the United States, they will outnumber children under the age of 18 for the first time by 2034. Older adults have the highest prevalence of latent TB and are prone to immune-suppressive conditions that predispose them to reactivation or new TB infection. In this study, we aimed to examine sociodemographics and clinical findings unique to older patients, when compared to younger adults, with pulmonary TB (PTB) and identify risk factors that predict adverse PTB outcomes in this age group. Methods: Pulmonary TB surveillance data from Texas, 2008 – 2020 (n=10,656), was evaluated for patient characteristics, outcomes, and trends in older (OA, ≥65 y.) vs. young (YA, 18 to 39 y.) or middle-aged (MAA, 40 to 64 y.) adults. Multivariable logistic regression models were used to identify risk factors for treatment noncompletion and all-cause death. Results: The OA group grew from 15% in 2008 to 24% in 2020 with the proportion of OA patients born in a country other than the U.S. or Mexico, also increasing during the surveillance period, trend P \u3c .001. Long-term care facility residence, diabetes, and dead at diagnosis increased with age (P for trend \u3c .001 for each) while cavities on chest x-ray and performing TB infection tests, tuberculin skin test (TST) or interferon-gamma release assays (IGRAs), decreased with age (P for trend \u3c .001 for each). Older age was not associated with failure to complete TB treatment. However, birth in a country other than the U.S. or Mexico (aOR 2.27, 95% CI 1.27, 4.08) and homeless (aOR 4.33, 95% CI 1.63, 11.53) were associated with treatment noncompletion in the OA. The odds of death during TB treatment doubled for OA patients with an MTB positive culture (aOR 2.31, 95% CI 1.55, 3.44), while birth in Mexico (aOR 0.74, 95% CI 0.56, 0.99) or other country other than the U.S. or Mexico (aOR 0.48, 95% CI 0.33, 0.68) was protective against death. Conclusion: In Texas, there has been an increase in the proportion of older adults with TB over the past decade and this age group is at higher risk of all-cause mortality. We recommend including older adults as a priority group in latent TB treatment guidelines to prevent the development of TB in this highly-vulnerable age group

Fibromyalgia. What should nursing professionals know and evaluate?

ABSTRACT: In the current text a theoretical fibromyalgia review is made. Disease of unknown etiology, characterized by localized pain, usually in muscles, tendon, joint and visceral zones. Physiopathology, evaluation, diagnosis and interventions of the disease are reviewed, aiming to strengthen the empiric pattern of knowledge, and improve the patient care under the nursing perspective.RESUMEN: Se hace una revisión sobre el tema de la fibromialgia, enfermedad de etiología desconocida caracterizada por la presencia de dolor localizado usualmente en zonas musculares, tendinosas, articulares y viscerales. En este artículo se examinan aspectos de la fisiopatología, valoración, diagnósticos e intervenciones, con el propósito de fortalecer el patrón empírico de conocimientos y mejorar el cuidado a estos pacientes bajo la perspectiva disciplinar de enfermería

Tuberculosis presentation and outcomes in older Hispanic adults from Tamaulipas, Mexico

Older people are at high risk of developing and dying from pulmonary infections like tuberculosis (TB), but there are few studies among them, particularly in Hispanics. To address these gaps, we sought to identify host factors associated with TB and adverse treatment outcomes in older Hispanics by conducting a cross-sectional study of TB surveillance data from Tamaulipas, Mexico (2006–2013; n = 8381). Multivariable logistic regressions were assessed for older adults (OA ≥65 years) when compared to young (YA, 18–39 years) and middle-aged adults (40–64 years). We found that the OA had features associated with a less complicated TB (e.g., lower prevalence of extra-pulmonary TB and less likely to abandon treatment or have drug resistant TB), and yet, were more likely to die during TB treatment (adj-OR 3.9, 95% 2.5, 5.25). Among the OA, excess alcohol use and low body mass index increased their odds of death during TB treatment, while a higher number of reported contacts (social support) was protective. Diabetes was not associated with adverse outcomes in OA. Although older age is a predictor of death during TB disease, OA are not prioritized by the World Health Organization for latent TB infection screening and treatment during contact investigations. With safer, short-course latent TB infection treatment available, we propose the inclusion of OA as a high-risk group in latent TB management guidelines

Uso de instrumentos clínicos para la evaluación de pacientes y resultados de tratamiento en trastornos por uso de sustancias (TUS)

Introducción. En la actualidad resulta imprescindible contar con instrumentos que permitan evaluar los resultados de tratamiento en pacientes con trastornos por uso de sustancias.Objetivo. Revisar la literatura científica de los últimos 10 años relacionada con la validación y el uso de instrumentos o de otros indicadores de resultado para la evaluación de tratamientos de trastornos por uso de sustancias.Materiales y métodos. Se realizó una búsqueda de artículos científicos publicados entre 2005 y 2015 que abordaran el tema de instrumentos de medida de los trastornos por uso de sustancias y la efectividad de los tratamientos. Se utilizó la base de datos MEDLINE y se limitó la búsqueda a títulos, resúmenes y textos completos disponibles.Resultados. Se seleccionaron 21 estudios de validación de instrumentos, 14 de evaluación de resultados utilizando instrumentos, 5 revisiones narrativas y 2 sistemáticas.Conclusiones. Los instrumentos encontrados exploran diferentes áreas según el tipo de tratamiento y los objetivos propuestos, sin embargo no hay una prueba única que permita evaluar de manera íntegra los resultados del tratamiento debido a la complejidad del tema. Se recomienda continuar con el desarrollo y validación de instrumentos específicos para tratamientos complejos en instituciones que trabajan con modelos terapéuticos integrales.Introduction: Having tools to assess the outcomes of treatment in patients with substance use disorders is highly important.Objective: To review the last 10 years of scientific literature related to the validation and use of instruments or other performance measures in treatment evaluation.Materials and methods: A search of scientific papers, published between 2005 and 2015, addressing measurement instruments for substance use disorders and effectiveness of treatments was performed. The MEDLINE database was used and the search was limited to titles, abstracts and full texts available.Results: 21 instrument validation studies, 14 performance evaluations using instruments, 5 narrative reviews and 2 systematic reviews were selected.Conclusions: The found instruments explore different areas depending on the type of treatment and proposed objectives; however, there is not a unique test to fully assess the results of treatment due to the complexity of the topic. It is recommended to continue the development and validation of specific tools for complex treatments in institutions working with comprehensive therapeutic models

Development and validation of Multimodal Scale for results of treatment in disorders caused by substance use

Objetivo: Describir el proceso de desarrollo y validación de un instrumento creado para la evaluación de los resultados de tratamiento en los trastornos por uso de sustancias. Materiales y métodos: Este fue llevado a cabo en tres fases. Fase 1: revisión de la literatura en las principales bases de datos de ciencias de la salud sobre escalas o instrumentos para evaluación de resultados de tratamiento en trastornos por uso de sustancias. Fase 2: desarrollo de un instrumento de novo y validación por expertos mediante técnica Delphi modificada a 2 fases. Fase 3: estudio de validación clínica en el que participaron 100 usuarios de una institución pública. Resultados: La escala de evaluación de tratamiento multimodal (EETM) obtuvo, luego de su análisis de contenido, unos resultados apropiados en términos de pertinencia y relevancia; adicionalmente mostró coeficientes de alpha de Cronbach entre 0,799 y 0,963 y similitudes entre los resultados del evaluador y el paciente. Conclusiones: Se concluye que la EETM demostró ser un instrumento válido para la evaluación de los resultados de tratamiento en instituciones con intervenciones integrales en los trastornos por uso de sustancias y durante el período de internamiento.Objective: to describe the process of development and validation of an instrument created for the evaluation of treatment results in disorders caused by substance use. Materials and methods: The study was carried out in three phases. Phase 1: review of the literature in the main health science databases about scales or instruments for evaluation of treatment results in disorders caused by substance use; Phase 2: de novo instrument development and validation by experts using a modified 2-phase Delphi technique; Phase 3: clinical validation study involving 100 users of a public institution. Results: The “Escala de evaluación de tratamiento multimodal” (EETM), after its content analysis, obtained appropriate results in terms of pertinence and relevance. Additionally, it showed Cronbach’s Alpha coefficients between 0.799 and 0.963 and similarities between the evaluator and the patient results. Conclusions: It was concluded that the EETM proved to be a valid instrument for the evaluation of treatment results in institutions with comprehensive interventions in disorders caused by substance use and during the admission period

Development of a wound healing index for chronic wounds

Objetivos: revisar sistemáticamente la literatura sobre instrumentos de medida de la cicatrización. Adaptar y/o desarrollar una escala de medida de la evolución hacia la cicatrización de todo tipo de heridas crónicas. Material y método: el Estudio se lleva a cabo en dos fases: Fase 1: Revisión sistemática de la literatura en las principales bases de datos de ciencias de la salud (MEDLINE, CINAHL, CUIDEN, SCIELO, LILACS, COCHRANE, IME) desde el inicio de las bases de datos hasta el año 2009. Las palabras incluidas en la estrategia de búsqueda fueron: instrument, tool, ulcer, chronic wound, healing, assessment, validation, reliability, así como las mismas en español, con sus correspondientes formulaciones booleanas utilizando AND, OR y el término de truncamiento para algunas de ellas. La búsqueda se llevó a cabo inicialmente en los tesauros y si la palabra no existía en texto libre. No se tuvo en cuenta para la inclusión el diseño del estudio. Se utilizó el sistema GRADE para evaluar la calidad de las publicaciones. Fase 2: Estudio Delphi modificado con un grupo de expertos en heridas crónicas, para llegar al consenso sobre las variables que pudieran medir la dimensión “evolución hacia la cicatrización”. En la primera ronda se partió con todas las variables de la herida y el paciente encontradas en los diferentes instrumentos de la revisión sistemática. En la segunda ronda se enviaron los ítems que habían obtenido mayor puntuación. Finalmente, se envió la versión final y se preguntó a los expertos que puntuaran en una escala del 1 al 4 para obtener el índice de validez de contenido (CVI). Aquellas variables que hubieran obtenido un CVI superior al 80% fueron incluidas. Resultados: la revisión sistemática revela un número de ocho instrumentos de medida de cicatrización recogidos en 20 artículos (10 artículos sobre el PUSH, tres del PSST, uno de DESIGN, uno de PWAT, uno de la Escala Sessing, uno de la Escala Sussman, uno de WHS, uno de CODED y, finalmente, una revisión literaria que recoge cuatro de los anteriores). Independientemente del número de artículos por escala, la escala PSST tiene la mejor investigación sobre validez y fiabilidad. No obstante, la mayoría son instrumentos de medida exclusivos de úlceras por presión. Solo presentan estudios de validez y fiabilidad cuatro escalas (PUSH, PSST, DESIGN y CODED). La única escala que se ha validado también para úlceras venosas ha sido el PUSH, al idioma inglés y portugués. La única escala encontrada en español es CODED, desarrollada en el País Vasco en el año 2000, pero solo presenta un estudio parcial. Es por ello que se decide desarrollar una escala de novo para todo tipo de heridas crónicas. La escala desarrollada, que recibe el nombre provisional de “RESVECH V1.0. Resultados esperados de la valoración y evolución de la cicatrización de las heridas crónicas”, obtiene puntuaciones del CVI, por parte de los expertos superiores al 80% en todos los ítems que la componen. Queda definida, a espera del estudio de validez y fiabilidad, en nueve ítems: dimensiones de la lesión, profundidad/tejidos afectados, bordes, maceración perilesional, tunelizaciones, tipo de tejido en el lecho de la herida, exudado, infección/inflamación (signos de biofilm), frecuencia del dolor (en últimos 10 días). La escala se puntúa numéricamente y se puede obtener una puntuación que oscila entre 0 y 40 puntos, herida cicatrizada o la peor herida posible respectivamente. Además, se acompaña de las definiciones operacionales de cada ítem y su forma de valorarlos. Conclusiones: se obtiene una escala con validez de contenido, a priori, mediante la valoración de un grupo de expertos.Objectives: to systematically review the literature on healing measurement tools. To develop a scale for measuring progress towards healing for chronic wounds. Material and methods: the study was conducted in two phases: Phase 1: Systematic review in major databases of health sciences (MEDLINE, CINAHL, WIDEN, SCIELO, LILACS, COCHRANE, IME) from the start of the database until 2009. Search strategy: instrument, tool, ulcer, chronic wound, healing, assessment, validation, reliability, and the same in Spanish, with their corresponding formulations using Booleans AND, OR and truncation term for some of them. The search took place initially in the thesauri and if the word did not exist, in free text. Study design not was taken. GRADE system was used to quality appraisal. Phase 2: modified Delphi study with a group of experts in chronic wounds, to reach consensus on variables that could measure the dimension of “progress towards healing”. In the first round started with all variables of the wound and the patient found in the different instruments of the systematic review. In the second round sent the items that had obtained the highest score. Finally sent the final version and experts were asked to rate on a scale of 1 to 4 to obtain the content validity index (CVI). Those variables that had obtained more than 80% CVI were included. Results: the systematic review revealed a number of 8 healing tools as set out in 20 articles (10 articles about PUSH, 3 PSST, 1 DESIGN, 1 PWAT, 1 Sessing Scale, 1 Scale Sussman, 1 WHS, CODED 1, and finally, a literature review to collect 4 of the above). Regardless of the number of items per scale, scale PSST has the best research on validity and reliability. However, most are for pressure ulcers. Only 4 papers studied validity and reliability of scales (PUSH, PSST, DESIGN and CODED). The only scale that has been validated for venous ulcers has also been the PUSH, in English and Portuguese. The only scale found in Spanish is coded, developed in the Basque Country in 2000, but only presents a partial survey. That is why they decided to develop a “de novo” scale for all types of chronic wounds. The scale developed, receives the provisional name of “RESVECH V1.0. Expected results of the assessment and evolution in the healing of chronic wounds”. CVI scores obtained by the experts above 80% on all items compose. Is defined, pending the study of validity and reliability, 9 items: size of the lesion, depth/tissue concerned, edges, maceration, perilesional, tunneling, type of tissue in the wound bed, exudate, infection/inflammation, frequency of pain (in last 10 days). The scale is scored numerically and can score ranging from 0 to 40 points, wound healed and the worst possible lesion respectively. Also accompanied by operational definitions of each item and its value-form. Conclusions: we get a scale with, a priori, content validity by expert’s assessment

Measure healing in pressure ulcers: what do we have?

El presente artículo corresponde a una puesta al día de los métodos e instrumentos de medida de las heridas hacia la cicatrización. La forma en que las heridas son medidas a menudo es subjetiva, lo que hace que evaluar la eficacia de los tratamientos se haga de manera errónea y se llegue a la parcialidad. En el mismo escrito, se exponen los métodos de medida más usados en el ámbito clínico y de investigación, para valorar el progreso o retroceso de las heridas crónicas hacia la cicatrización. Aunque, en su mayoría, los instrumentos y herramientas que se mencionan hacen referencia sólo a las úlceras por presión y sólo algunos han sido utilizados en otro tipo de heridas, lo que genera un vacío al tratar de valorar los demás tipos de heridas que se encuentran en este mismo proceso. El aumento de la demanda en la práctica basada en la evidencia hace que lograr resultados óptimos en la valoración, el tratamiento y coste-efectividad se haya vuelto una prioridad. Esto, sumado a la poca validez de los instrumentos existentes, hace necesaria la adopción de un enfoque común en el que se estandarice un método fiable, que posea sensibilidad al cambio y que sea válido, de manera que permita a los clínicos tomar decisiones rápidas y concretas en la herida que están tratando.This paper is an update of the methods and instruments to measure wound healing. The way in which wounds are measured, often seems subjective, which makes assessing the effectiveness of treatments biased. In that article, we present the most widely used measurement methods in clinical and research fields to assess progress or regression of chronic wounds healing. While most of the instruments and tools listed refer only to pressure ulcers and only some have been used in other types of wounds, creating a void when trying to evaluate other wound types. Increased demand in the evidence-based practice makes optimal results in the assessment, treatment and cost effectiveness has become a priority. This coupled with the lack of validity for existing instruments, makes necessary to adopt a common approach to standardize a reliable method, with sensitivity to change and valid, in a way that allows clinicians to make quick and concrete decisions on the wound treated