Content, implementation strategies and knowledge assessment tool on venous leg ulcers: An e-Delphi study

Aim: To get consensus on the knowledge and skills that nursing students need to acquire regarding venous leg ulcer care, the strategies that can be applied during education and to design a first draft of a questionnaire to assess knowledge to be validated. Background: Venous leg ulcers’ care is included on undergraduate nursing education programmes but without specifying the content and training implementation strategies. Different tools have been validated to assess knowledge, but have been found inadequate. Design: An e-Delphi study. Methods: The participants were Chronic Wound Care expert nurses. Two questions were constructed and agreed on by the research team to define the problem. To answer the third question, a search was conducted for publications on venous leg ulcers, to help design the questionnaire. A 2-round e-Delphi study was conducted from January to March 2022. A panel of 17 experts participated in both rounds. The data were analysed using statistical and qualitative analysis. Results: Content must fulfil knowledge-skill areas: epidemiology, venous pathophysiology and aetiology, classification scales, knowing how to determine a differential diagnosis, treatment, measures for prevention and care of the venous return circuit, quality-of-life scales. As implementation strategies, proposals were made in four areas: subject profile where training is to be acquired, theoretical teaching, practical teaching in the classroom and clinical practice. The average consensus of the questionnaire proposal was high (>86 %) both in relevance and clarity in both rounds. We thereby obtained a questionnaire with 72 items. Conclusions: Seven categories and eight subcategories were created regarding knowledge/skills that nursing students should acquire. Four categories were recognised as strategies that can be implemented during education. A high level of consensus was reached on the items in the initial versions of the questionnaire.Open Access funding provided by University of Basque Country

Health workers’ knowledge regarding the use of Topical Negative Pressure Therapy in the treatment of wounds

Introducción: Las heridas crónicas representan un problema actual que genera un impacto a muchos niveles y cuyo tratamiento se basa en infinidad de productos disponibles actualmente en el mercado. A medida que avanza la tecnología se desarrollan nuevos dispositivos que mejoran el tratamiento y repercuten en beneficios para los pacientes. La terapia de presión negativa, incluida en las técnicas de curación avanzada, es un ejemplo representativo de ello, pero una correcta utilización de esta requiere de un personal entrenado capaz de hacer un uso adecuado a través de sus conocimientos. Objetivo: El objetivo principal es determinar el nivel actual de conocimientos de los profesionales sanitarios sobre generalidades y manejo de la terapia de presión negativa. Material y método: Se realizó un estudio observacional, descriptivo y analítico en el Hospital General Universitario de Alicante. La población a estudio estuvo formada por 65 profesionales del ámbito de la enfermería y la medicina que trabajaban en las unidades donde se encuentran más familiarizados con su uso, y la recogida de datos se realizó mediante un cuestionario tipo ad hoc. Resultados: El 20% de los profesionales muestran un bajo nivel de conocimientos, el 61,5%, un nivel adecuado y el 18,5%, un nivel de conocimientos alto. Por tanto, un 80% de la población estudiada tiene un nivel adecuado o alto de conocimientos. Conclusiones: Una formación específica mediante la asistencia a cursos y jornadas, el tratamiento de un mayor número de heridas con terapia de presión negativa y el hecho de sentirse capacitados se convierten en requisitos indispensables para una correcta utilización del dispositivo. El nivel de conocimientos actual no exime de la necesidad de crear un protocolo que permita la unificación de criterios entre los profesionales y la necesidad de formación para actualizar los conocimientos.Introduction: Chronic wounds represent a current problem that generates an impact on many levels and whose treatment is based on an infinite number of products available on the market nowadays. As technology progresses, new devices are developed improving the treatment and affecting in benefits for patients. Topical Negative Pressure theraphy, included in the advanced healing techniques, is a representative example of this but a correct use of it requires a trained staff able to use it suitably through their knowledge. Aim: The main objective is to determine the current level of health workers’ knowledge about generalities and the handling of topical negative pressure therapy. Method: An observational, descriptive and analytical study was conducted at the Hospital General Universitario de Alicante. The study population was made up of 65 professionals in the field of nursing and medicine working in units where they are more familiar with their use, carrying out the collection of data by means of a questionnaire type ad hoc. Results: 20% of professionals show a low level of knowledge, 61.5%, an appropriate level and the 18.5%, a high level of expertise. Therefore, 80% of the studied population has an adequate or high level of expertise. Findings: Specific training through attendance at courses and conferences, the treatment of a greater number of injuries with TNP and the fact of being trained become prerequisites for a correct use of the device. The current level of knowledge does not exempt from the need to create a protocol allowing the unification of criteria between the professionals and the need for training to upgrade the expertise

Prevention of pressure ulcers and repositioning. An integrative review

Objetivo: El objetivo que se plantea en este trabajo de revisión es responder a la pregunta: ¿Son los cambios posturales efectivos en la prevención de las úlceras por presión? Metodología: Revisión integrativa de la literatura mediante la identificación de documentos en las principales bases de datos relacionadas con las ciencias de la salud: MEDLINE, CINAHL, sciELO, Cochrane y CUIDEN, y mediante búsqueda inversa en los artículos identificados. Se incluyeron estudios prospectivos, revisiones sistemáticas u otro tipo de estudios, que evaluaran la efectividad de los cambios posturales. No hubo restricciones en fechas de publicación hasta diciembre de 2014, pacientes, contexto, estado de la publicación o idioma. Resultados: De 108 artículos, potencialmente relevantes para la revisión, se incluyeron 13: 6 ensayos clínicos, 1 estudio de cohortes, 4 revisiones sistemáticas y una histórica, además de un estudio cualitativo. No se encuentran evidencias sólidas para recomendar los cambios posturales cada 2 horas, pero si hay evidencia que apoya los cambios posturales cada 4 horas combinados con una superficie de apoyo viscoelástica. Conclusiones: No existen estudios que comparen la efectividad, solamente, de los cambios posturales frente a la no realización de estos cambios. La conjunción de una superficie viscoelástica con cambios posturales cada 3-4 horas dispone de la mejor evidencia. Los pacientes en decúbito lateral de 90 grados tienen una tasa casi 4 veces superior de lesiones que los que están a 30 grados. La investigación cualitativa es casi inapreciable en los estudios sobre cambios posturales.Aim: to answer the question: Are repositioning effective in preventing pressure ulcers? Methods: Integrative review of the literature through identification of papers in the main databases related to health sciences: MEDLINE, CINAHL, sciELO, COCHRANE and CUIDEN, and by reverse search on identified articles. We included prospective studies, systematic reviews or other types of studies that evaluated the effectiveness of repositioning. There were no restrictions on publication dates until December 2014, patients, context, publication status or language. Results: From 108 articles, potentially relevant for the review, 13 were included: 6 clinical trials, 1 cohort study, 4 systematic reviews and one historical review, as well as a qualitative study. There is no solid evidence to recommend postural changes every 2 hours. But there is evidence that supports repositioning every 4 hours combined with a viscoelastic support surface. Conclusions: There are no studies that compare the effectiveness of repositioning versus non-repositioning. The combination of a viscoelastic surface with repositioning every 3-4 hours has the best evidence. Patients in 90 degrees lateral decubitus have a rate almost 4 times higher than those who are at 30 degrees

Does hidradenitis suppurativa affect the patient's quality of life? A review of the literature

La hidradenitis supurativa es una enfermedad autoinmune crónica debida a la obstrucción de un folículo piloso, que da lugar a la formación de nódulos. Se desconoce la etiología concreta. Algunos factores desencadenantes son los antecedentes familiares, la obesidad, el hábito tabáquico, la ropa ajustada y los factores hormonales e inmunológicos, entre otros. La sintomatología típica es dolor, supuración, prurito y mal olor, y puede llegar a generar cicatrices, fístulas y tunelizaciones. Las localizaciones de las lesiones típicas son en axilas, zona inguinal, perianal y zona mamaria. Cursa con brotes y no es contagiosa. Dependiendo del estadio existen diferentes tratamientos para esta. El diagnóstico se basa en una entrevista sobre los antecedentes familiares, la localización de las lesiones, las manifestaciones clínicas y la alta recurrencia de la enfermedad. Afecta a un 1% de la población mundial, con mayor incidencia a las mujeres. Objetivos: Investigar si la patología afecta a la calidad de vida de los pacientes y averiguar las repercusiones en esta. Metodología: Se realizó mediante una revisión sistemática de los últimos 5 años, tanto de la hidradenitis supurativa como de la pregunta a estudio en las siguientes bases de datos: Google Académico, PubMed, CINAHL, Web of Science, Scopus y Cochrane. Resultados: Los pacientes refieren tener una peor calidad de vida debido a síntomas de la hidradenitis supurativa, como el dolor, prurito y mal olor. Estos afectan en su vida diaria, vida laboral y relaciones sociales, entre otros. Conclusiones: Tras la búsqueda, se afirma la pregunta de estudio. La calidad de vida del paciente con hidradenitis supurativa está disminuida y deteriorada debido a los síntomas que la cursan. Además, conlleva una serie de comorbilidades tanto psicológicas como personales.Objectives: Hidradenitis suppurativa is a chronic autoimmune disease due to the obstruction of a hair follicle leading to the formation of nodules. The specific etiology is unknown. Some triggers are family history, obesity, smoking, tight clothing, hormonal and immunological factors, among others. The typical symptomatology is pain, suppuration, itching, bad smell and can generate scars, fistulas and tunnels. Typical lesion locations are in the armpits, inguinal, perianal, and mammary areas. It has outbreaks and is not contagious. Depending on the stage there are different treatments for it. The diagnosis is based on an interview on the family history, location of the lesions, clinical manifestations and high recurrence of the disease. It affects 1% of the world population, with a higher incidence in women. Objectives: Investigate whether the pathology affects the quality of life of patients and find out the repercussions on it. Methods: It was carried out through a systematic review of the last five years of both hidradenitis suppurativa and the question under study in the following databases: Google Scholar, PubMed, CINAHL, Web of Science, Scopus and Cochrane. Results: Patients reported having a poorer quality of life due to symptoms of hidradenitis suppurativa such as pain, itching and a bad smell. These affect their daily life, work life, social relationships, among others. Conclusions: After the search, the study question is affirmed. The quality of life of the patient with hidradenitis suppurativa is diminished and deteriorated due to the symptoms that occur. In addition, it carries a series of psychological and personal comorbidities

2nd National Study of Pressure Ulcer Prevalence in Spain, 2005: epidemiology and definitory wound and patient variables

Desde el año 1999 el GNEAUPP consideró de vital interés para rescatar y mantener el valor real del problema de las úlceras por presión (UPP), la constitución de un observatorio permanente de la evolución epidemiológica de estos procesos, cuyo siguiente paso ha sido el desarrollo de este 2º Estudio Nacional de Prevalencia que presentamos. Se definieron como objetivos de la investigación obtener indicadores epidemiológicos que permitiesen dimensionar el problema de las UPP en España, así como algunos aspectos relacionados con las tendencias de prevención de las mismas en instituciones de Atención Primaria, atención hospitalaria y asistencia sociosanitaria. Elaboramos un cuestionario postal para estimar la prevalencia puntual y media de UPP a partir de una muestra no aleatoria. En estos cuestionarios se solicitaba a los profesionales de Atención Primaria que informasen acerca de su lista de usuarios mayores de 14 años (Unidades básicas asistenciales de Medicina General) y a los profesionales de unidades de hospitalización o de centros sociosanitarios que informasen acerca de los pacientes de sus respectivas unidades. Se definió la prevalencia como “prevalencia puntual” (información en un solo momento del tiempo). Se calculó la prevalencia cruda (PC) y media (PM). Los cuestionarios contenían preguntas para obtener datos sobre los pacientes con UPP (numerador del indicador), sobre el total de pacientes de esa unidad a estudio (denominador del indicador), sobre las lesiones mismas, así como información de las tendencias de prevención de UPP en las instituciones de los receptores de los cuestionarios. Se reportaron 1.791 pacientes con UPP (39% en hospital, 27% en Atención Primaria y 34% en centros sociosanitarios). En Atención Primaria la PC fue de 3,73% y la PM de 9,11% ± 10,9% para los pacientes mayores de 14 años incluidos en el programa de atención domiciliaria; en las unidades de hospital, la PC fue de 8,24% y la PM de 8,91% ± 12,20%, y en los centros sociosanitarios la PC fue de 6,10% y la PM de 10,9% ± 11,9%. En todos los niveles asistenciales, el grupo de población mayoritariamente afecto era el de los mayores de 65 años (84,7%). Los cuestionarios recibidos proporcionaron información sobre 2.837 lesiones: 23,2% de estadio I, 37,5% de estadio II, 27,0% de estadio III, 11,8% de estadio IV y un 0,5% sin estadiar. La localización más frecuente fue el sacro seguido de los talones, en todos los niveles asistenciales. Puede concluirse que las UPP siguen constituyendo, todavía, un importante problema de salud pública que afecta de manera primordial a personas mayores.Since 1999, GNEAUPP considered it vital to create a permanent observatory of the epidemiological evolution of these processes, in order to rescue and maintain the real value of the problem of Pressure Ulcers, which has given way to the next step, the 2nd National Prevalence Study we now present. The objectives set forth in this study were to obtain epidemiological indicators that would allow us to find the extent of the pressure ulcer problem in Spain, as well as some aspects related to the prevention of such in primary care centers, hospitals and socio-sanitary institutions. We sent out a questionnaire in order to estimate the punctual and average prevalence of PU (initials UPP in Spanish) using non-random sampling. Primary Care professionals were asked to give information about their patients who were over 14 years of age (General Practitioner Surgeries) and professionals from Hospital Units and socio-sanitary centers were asked about their patients respectively. Prevalence was defined as ‘punctual prevalence’ (information in a specific moment in time). The crude prevalence (initials PC in Spanish) and average prevalence (PM) were calculated. The questionnaires only included questions on patients with PU (numerator of the indicator) over the total of patients of the unit being studied (denominator of the indicator) about the wounds caused as well as information on PU prevention in the institutions where each respondant worked. 1,791 patients were reported to have pressure ulcers (39% in hospital, 27% in primary care centers and 34% in socio-sanitary centers). In Primary Care, the PC was 3.73% and the PM was 9.11% ± 10.9% for patients over 14 years who were included in the home care program. In the hospital units, the PC was 8.24% and the PM was 8.91% ± 12.20% and in the socio-sanitary centers, the PC was 6.10% and the PM was 10.9% ± 11.9%. The group most affected of each health care level was the one over 65 years of age (84.7%). The completed questionnaires provided information about 2,837 wounds: 23.2% were stage I, 37.5% stage II, 27.0% stage III, 11.8% stage IV and 0.5% did not state the stage. PU most frequently affected the sacral region, followed by the heels, in all health care levels. It can be concluded that PU are still an important public health problem that affect mainly elderly people

Diagnosis of cardiac surgery-associated acute kidney injury: State of the art and perspectives

Producción CientíficaDiagnosis of cardiac surgery-associated acute kidney injury (CSA-AKI), a syndrome of sudden renal dysfunction occurring in the immediate post-operative period, is still sub-optimal. Standard CSA-AKI diagnosis is performed according to the international criteria for AKI diagnosis, afflicted with insufficient sensitivity, specificity, and prognostic capacity. In this article, we describe the limitations of current diagnostic procedures and of the so-called injury biomarkers and analyze new strategies under development for a conceptually enhanced diagnosis of CSA-AKI. Specifically, early pathophysiological diagnosis and patient stratification based on the underlying mechanisms of disease are presented as ongoing developments. This new approach should be underpinned by process-specific biomarkers including, but not limited to, glomerular filtration rate (GFR) to other functions of renal excretion causing GFR-independent hydro-electrolytic and acid-based disorders. In addition, biomarker-based strategies for the assessment of AKI evolution and prognosis are also discussed. Finally, special focus is devoted to the novel concept of pre-emptive diagnosis of acquired risk of AKI, a premorbid condition of renal frailty providing interesting prophylactic opportunities to prevent disease through diagnosis-guided personalized patient handling. Indeed, a new strategy of risk assessment complementing the traditional scores based on the computing of risk factors is advanced. The new strategy pinpoints the assessment of the status of the primary mechanisms of renal function regulation on which the impact of risk factors converges, namely renal hemodynamics and tubular competence, to generate a composite and personalized estimation of individual risk.Instituto de Salud Carlos III y Fondo Europeo de Desarrollo Regional (FEDER) - (grant PI18/00996, PI21/01226), Unión Europea, Red de Investigación Renal (Enfermedad Renal) - (grant RICORS2040)Unión Europea–NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR) - (grant RD21/0005/0004)Junta de Castilla y León (Consejería de Educación) y Fondo Europeo de Desarrollo Regional (FEDER) - (grant IES160P20

HELCOS. Integrated system for the handling of wounds. About a case

El uso de las tecnologías de la información y comunicación es cada vez más extendido en las prácticas de salud-enfermedad y, por ende, también en el cuidado de las heridas. Son muchas las aplicaciones que se han desarrollado en este sentido pero pocas se han evaluado respecto a su utilidad. En este artículo se presenta, a modo de caso, HELCOS, sistema integrado para el manejo de heridas y los resultados obtenidos hasta ahora.The use of information and communication technologies is increasingly widespread in health-disease practices and, therefore, also in wound care area. There are many applications that have been developed in this regard but few have been evaluated regarding their usefulness. In this article we present, as a case, HELCOS, an integrated system for the management of wounds and the results obtained so far

A contribution to the historic framework of pressure ulcers

A través de una revisión narrativa, los autores revisan elementos clave relacionados con la historia de las úlceras por presión y su contexto, desde la Edad Antigua, el Renacimiento, el siglo XIX hasta la edad moderna.Through a narrative review, the authors review key facts related with the history of pressure ulcers and their framework, from ancient age, Renaissance, XIX’s century up to the modern age

Genomic characterization of individuals presenting extreme phenotypes of high and low risk to develop tobacco-induced lung cancer

Single nucleotide polymorphisms (SNPs) may modulate individual susceptibility to carcinogens. We designed a genome-wide association study to characterize individuals presenting extreme phenotypes of high and low risk to develop tobacco-induced non-small cell lung cancer (NSCLC), and we validated our results. We hypothesized that this strategy would enrich the frequencies of the alleles that contribute to the observed traits. We genotyped 2.37 million SNPs in 95 extreme phenotype individuals, that is: heavy smokers that either developed NSCLC at an early age (extreme cases); or did not present NSCLC at an advanced age (extreme controls), selected from a discovery set (n = 3631). We validated significant SNPs in 133 additional subjects with extreme phenotypes selected from databases including >39,000 individuals. Two SNPs were validated: rs12660420 (pcombined  = 5.66 × 10-5 ; ORcombined  = 2.80), mapping to a noncoding transcript exon of PDE10A; and rs6835978 (pcombined  = 1.02 × 10-4 ; ORcombined  = 2.57), an intronic variant in ATP10D. We assessed the relevance of both proteins in early-stage NSCLC. PDE10A and ATP10DmRNA expressions correlated with survival in 821 stage I-II NSCLC patients (p = 0.01 and p < 0.0001). PDE10A protein expression correlated with survival in 149 patients with stage I-II NSCLC (p = 0.002). In conclusion, we validated two variants associated with extreme phenotypes of high and low risk of developing tobacco-induced NSCLC. Our findings may allow to identify individuals presenting high and low risk to develop tobacco-induced NSCLC and to characterize molecular mechanisms of carcinogenesis and resistance to develop NSCLC.This work was supported by the Spanish Society of Medical Oncology; Fundación SEOM and Fundación Salud 2000; and Government of Navarra.S