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Pozuelo Garcia A, Pons-Vigués M, Casanovas-Guitart C, Torné Vilagrasa E, Reynolds J, Guarga-Rojas A. [Operational planning of health services: How do we make it possible?]. J Healthc Qual Res 2024:S2603-6479(24)00040-X. [PMID: 38797643 DOI: 10.1016/j.jhqr.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/25/2024] [Accepted: 04/24/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION AND OBJECTIVE The Catalan Health Service carries out the operational planning of service delivery and organization. The goal is to describe the methodology and procedure followed to perform these functions. METHODS The process of operational planning in healthcare services (OPHS) is continuous, dynamic, participatory, objective, and adaptable. OPHS can be divided into three stages prior to implementation and evaluation: Service delivery planning, Organization of healthcare resources, and Procurement planning. RESULTS Three examples of projects are presented following the POSS framework. It is essential to adapt the process to the characteristics of each project. CONCLUSIONS The proposed framework is useful to achieve high quality and equity in access to services.
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Affiliation(s)
- A Pozuelo Garcia
- Gerència de Planificació Operativa i Avaluació, Àrea Assistencial, Servei Català de la Salut (CatSalut), Barcelona, España
| | - M Pons-Vigués
- Gerència de Planificació Operativa i Avaluació, Àrea Assistencial, Servei Català de la Salut (CatSalut), Barcelona, España; Departament d'Infermeria, Facultat d'Infermeria, Universitat de Girona, Girona, España.
| | - C Casanovas-Guitart
- Gerència de Planificació Operativa i Avaluació, Àrea Assistencial, Servei Català de la Salut (CatSalut), Barcelona, España
| | - E Torné Vilagrasa
- Gerència de Planificació Operativa i Avaluació, Àrea Assistencial, Servei Català de la Salut (CatSalut), Barcelona, España
| | - J Reynolds
- Gerència de Planificació Operativa i Avaluació, Àrea Assistencial, Servei Català de la Salut (CatSalut), Barcelona, España
| | - A Guarga-Rojas
- Gerència de Planificació Operativa i Avaluació, Àrea Assistencial, Servei Català de la Salut (CatSalut), Barcelona, España
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Liao Z, Yeoh YK, Parumasivam T, Koh WY, Alrosan M, Alu'datt MH, Tan TC. Medium-chain dicarboxylic acids: chemistry, pharmacological properties, and applications in modern pharmaceutical and cosmetics industries. RSC Adv 2024; 14:17008-17021. [PMID: 38808239 PMCID: PMC11130641 DOI: 10.1039/d4ra02598a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Accepted: 05/16/2024] [Indexed: 05/30/2024] Open
Abstract
Succinic (SUA), glutaric (GLA), pimelic (PA), suberic (SUBA), adipic (ADA), azelaic (AZA), and sebacic acids (SA) make up the majority of medium-chain dicarboxylic acids (MCDAs) with chain lengths of C4-C10, and are widely utilised in the chemical, food, textile, pesticide, pharmaceutical, and liquid crystal sectors. The MCDAs' two carboxyl groups provide them with an incredibly broad variety of applications. The focus of significant scientific research now is on the increasingly varied pharmacological effects of MCDAs. However, only a few studies have compared the biological characteristics of MCDAs in the contemporary pharmaceutical and cosmetic sectors and thoroughly examined the most recent research and marketing initiatives for MCDAs. This review's objective is to offer a thorough analysis of academic works on MCDAs, to assess the usefulness of these substances' chemical-pharmacological properties for use in the contemporary pharmaceutical and cosmetic industries, and to investigate the direction of their possible applications in these two disciplines. In addition, this review investigates how these compounds are metabolised in the human body.
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Affiliation(s)
- Zhengrui Liao
- Food Technology Division, School of Industrial Technology, Universiti Sains Malaysia 11800 USM Penang Malaysia
| | - Yu-Kee Yeoh
- School of Housing, Building and Planning, Universiti Sains Malaysia 11800 USM Penang Malaysia
| | | | - Wee Yin Koh
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah Jalan UMS 88400 Kota Kinabalu Sabah Malaysia
| | - Mohammad Alrosan
- College of Health Sciences, QU Health, Qatar University P.O. Box 2713 Doha Qatar
- Applied Science Research Center, Applied Science Private University Al-Arab St. 21 Amman 11931 Jordan
| | - Muhammad H Alu'datt
- Department of Food Science & Nutrition, College of Life Sciences, Kuwait University P.O. Box. 5969 Safat 13060 Kuwait
| | - Thuan-Chew Tan
- Food Technology Division, School of Industrial Technology, Universiti Sains Malaysia 11800 USM Penang Malaysia
- Renewable Biomass Transformation Cluster, School of Industrial Technology, Universiti Sains Malaysia 11800 USM Penang Malaysia +604-653 6375 +604-653 6217
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Lau G, Ang JY, Kim N, Gabbe BJ, Mitra B, Dietze PM, Reeder S, Beck B. Approaches and reporting of alcohol and other drug testing for injured patients in hospital-based studies: A systematic review. Drug Alcohol Rev 2024; 43:897-926. [PMID: 38316529 DOI: 10.1111/dar.13816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 12/18/2023] [Accepted: 01/02/2024] [Indexed: 02/07/2024]
Abstract
ISSUE Hospital alcohol and/or other drug (AOD) testing is important for identifying AOD-related injuries; however, testing methods vary. This systematic review aimed to examine biological AOD testing methods from hospital-based studies of injured patients and quantify what proportion reported key information on those testing methods. APPROACH Observational studies published in English from 2010 onwards involving biological AOD testing for injured patients presenting to hospital were included. Studies examining single injury causes were excluded. Extracted data included concentration thresholds for AOD detection (e.g., lower limits of detection, author-defined cut-offs), test type (e.g., immunoassay, breathalyser) and approach (e.g., routine, clinical discretion), timing of testing, sample type and the proportion of injured cases tested for AODs. KEY FINDINGS Of 83 included studies, 76 measured alcohol and 37 other drugs. Forty-nine studies defined blood alcohol concentration thresholds (ranging from 0 to 0.1 g/100 mL). Seven studies defined concentration thresholds for other drugs. Testing approach was reported in 39/76 alcohol and 18/37 other drug studies. Sample type was commonly reported (alcohol: n = 69/76; other drugs: n = 28/37); alcohol was typically measured using blood (n = 60) and other drugs using urine (n = 20). Studies that reported the proportion of cases tested (alcohol: n = 53/76; other drugs: n = 28/37), reported that between 0% and 89% of cases were not tested for alcohol and 0% and 91% for other drugs. Timing of testing was often unreported (alcohol: n = 61; other drugs: n = 30). IMPLICATIONS AND CONCLUSION Variation in AOD testing methods alongside incomplete reporting of those methods limits data comparability and interpretation. Standardised reporting of testing methods will assist AOD-related injury surveillance and prevention.
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Affiliation(s)
- Georgina Lau
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jia Y Ang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Nayoung Kim
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, UK
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Paul M Dietze
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Disease Elimination Program, Burnet Institute, Melbourne, Australia
- National Drug Research Institute, Curtin University, Perth, Australia
| | - Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Central Clinical School, Monash University, Melbourne, Australia
| | - Ben Beck
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Vila-Vidal M, Estruga-Asbert A, Jam-Gatell R. Use of an assessment system for the allocation of human resources in the intrahospital transport of the patient admitted to an intensive care unit. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00018-1. [PMID: 38679521 DOI: 10.1016/j.enfie.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 02/01/2024] [Indexed: 05/01/2024]
Abstract
INTRODUCTION Currently, in intensive care units (ICUs), the in-hospital transport (HIT) of patients is carried out without a unified criterion of personnel necessary for it. OBJECTIVE To evaluate the concordance of the Patient Assessment System for Transport-ICU (PAST-ICU) with the medical criteria (CM) to determine the Human Resources (HR) and identify Adverse Effects (AE). METHODS Descriptive, cross-sectional and prospective study of the IHT of patients admitted to an area of adult medical-surgical critical patients. The PAST-ICU instrument was created to recommend the HR of HIT. Through the assessment of clinical parameters, the Past-ICU indicates whether the HIT should be performed with (1) a stretcher-bearer (2) Stretcher-bearer/nurse or (3) stretcher-bearer/nurse/doctor. AE were recorded during the hospital transfer. Prior to the IHT, the nurse performed the PAST-ICU and the result was contrasted with the Medical Criteria (MC) responsible for the patient, the latter prevailing. STUDY PERIOD Phase 1: pilot test 2013-2014. Phase 2: 2015-2021. VARIABLES Reason and duration HIT, PAST-ICU sheet, checklist, AE. RESULTS Phase 1: 458 IHT were analyzed. The concordance index between the PAST-ICU and the MC was 84,9% (389 IHT). The Cohen Kappa of 58,5% and p < 0,001. There were a total of 16 AE. Phase 2: 3423 IHT. The Concordance index of 87,2% (2984 TIH). The Cohen Kappa of 63%and the P < 0,001. Registered 49 AE. CONCLUSION The PAST-ICU could be a useful, safe and reliable tool to adapt the necessary HR. There was good concordance between the PAST-ICU vs the MC to determine the HR in the HIT. The percentage of AE was low.
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Affiliation(s)
- M Vila-Vidal
- Área de Críticos, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, Barcelona, Spain
| | - A Estruga-Asbert
- Área de Críticos, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, Barcelona, Spain.
| | - R Jam-Gatell
- Área de Críticos, Parc Taulí Hospital Universitario, Instituto de Investigación e Innovación Parc Taulí (I3PT), Sabadell, Barcelona, Spain
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Raurell-Torredà M, Fernández-Castillo RJ, Rodríguez-Delgado ME, Arias-Rivera S, Basco-Prado L. Best practices for iatrogenic anaemia prevention in the intensive care unit: Blood-sparing techniques. Nurs Crit Care 2024. [PMID: 38654607 DOI: 10.1111/nicc.13084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 10/30/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024]
Abstract
Anaemia is a common issue in patients who are admitted to intensive care units and worsens their condition throughout the stay due to the extraction of blood for diagnostic purposes. It is also well-known that an important amount of the carbon dioxide produced by health services is likely attributable to blood donation, testing and manufacture, storage or distribution of blood components. This must be taken into account to perform nursing interventions consistent with the idea of sustainable health care. In this regard, within patient blood management bundles, with the objective of minimizing the use of blood products, it is recommended to use blood-sparing techniques: small volume tubes (SVT) or closed-blood sampling devices (CBSD). Published studies before 2014 (excepting two more recent ones) have shown that by themselves, both techniques reduce drawn volume but do not decrease haemoglobin reduction and/or need of transfusion. Given the lack of cost-effectiveness studies, it may be easier to implement the use of CBSD as it does not require prior consensus on the discard volume or adaptations in the processing of laboratory tests, as is the case with SVT.
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Affiliation(s)
- Marta Raurell-Torredà
- Departament d'Infermeria Fonamental i Clínica, Universitat de Barcelona, Barcelona, Spain
| | - Rafael-Jesús Fernández-Castillo
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Seville, Spain
- Intensive Care Clinical Unit, University Hospital Virgen Macarena, Seville, Spain
| | | | | | - Luis Basco-Prado
- Departament d'Infermeria Fonamental i Clínica, Universitat de Barcelona, Barcelona, Spain
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Demetriou M, Georgiou AM. Perspective on dysphagia screening, assessment methods, and protocols in intensive care units: an opinion article. Front Hum Neurosci 2024; 18:1375408. [PMID: 38655373 PMCID: PMC11035756 DOI: 10.3389/fnhum.2024.1375408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Affiliation(s)
- Maria Demetriou
- The “Cyprus Rehabilitating Aphasia and Dysphagia” (C-RAD) Lab, Department of Rehabilitation Sciences, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
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Pommée T, Mbagira D, Morsomme D. French-Language Adaptation of the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V). J Voice 2024:S0892-1997(24)00085-7. [PMID: 38582726 DOI: 10.1016/j.jvoice.2024.03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 03/11/2024] [Accepted: 03/12/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVES This study aimed to adapt the Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V) protocol for perceptual voice assessment to the French language. The primary objective was to achieve consensus among an international panel of voice experts on the content of the adapted protocol. METHODS To ensure the relevance and robustness of the French CAPE-V protocol, this study employed a systematic Delphi method and involved an international panel primarily comprising speech therapists and lecturers from France and Belgium. The multi-stage process included an initial panel size of 15 experts. Three rounds of online questionnaires, integrating both quantitative and qualitative data collection, were conducted. Participants provided feedback and ratings on various protocol elements until a consensus was reached. Adaptations targeted the choice of task stimuli (sustained vowel, sentence reading, semi-spontaneous speech), of the rating scales, and vocal quality terminology. RESULTS The Delphi process achieved consensus on all elements of the adapted CAPE-V protocol. Notably, the sustained vowel task saw consensus in favor of the vowel /a/. Sentence adaptations achieved substantial agreement, with the final set unanimously approved. The simple Visual Analog Scale emerged as the preferred rating scale. Agreement on terms for describing vocal qualities marked a crucial step in establishing a shared vocabulary among French-speaking voice experts. CONCLUSIONS The study successfully adapted the CAPE-V protocol for perceptual voice assessment to the French language through a systematic Delphi process. The final protocol closely resembles the original English version, maintaining its structure and core objectives. Consensus on sustained vowel tasks, sentence adaptations, rating scales, and vocal quality terminology indicates the relevance and robustness of the adapted protocol. Ongoing validation studies in France demonstrate the potential clinical utility of the adapted CAPE-V in French-speaking contexts, representing a significant step toward standardized and validated voice assessment tools for clinicians and researchers globally.
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Affiliation(s)
- Timothy Pommée
- Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Speech-Language Pathology, Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada.
| | - Déborah Mbagira
- Research Unit for a Life-Course Perspective on Health and Education, Université de Liège, Liège, Belgium
| | - Dominique Morsomme
- Research Unit for a Life-Course Perspective on Health and Education, Université de Liège, Liège, Belgium
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Mayor-Silva LI, Meneses-Monroy A, Rodriguez-Leal L, Moreno G. An Exploration of Resilience and Positive Affect among Undergraduate Nursing Students: A Longitudinal Observational Study. NURSING REPORTS 2024; 14:871-882. [PMID: 38651479 PMCID: PMC11036258 DOI: 10.3390/nursrep14020067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND The purpose of this study is to analyze the variation in resilience and emotional state scores in nursing students throughout the four years of training for the nursing degree. METHODS This is a longitudinal observational study of a paired and prospective cohort of 176 nursing students who enrolled in the first year of a bachelor's degree in 2019. The study followed up with the students in 2022 and examined several sociodemographic factors, including sex, marital status, date of birth, living arrangements and occupation. Additionally, the study investigated changes in negative affect, positive affect, and resilience. RESULTS A total of 176 students participated in the study. The study found that resilience increased from 68.24 ± 10.59 to 70.87 ± 9.06 (p < 0.001), positive affect increased from 28.16 ± 4.59 to 33.08 ± 8.00 (p < 0.001), and the negative affect score decreased from 25.27 ± 5.12 to 21.81 ± 7.85 (p < 0.001). The study also found that married individuals experienced an increase in negative affect (p = 0.03) compared to singles or those in open relationships. Furthermore, the change in resilience was greater in men than in women (p = 0.01). CONCLUSIONS Throughout their four-year training, nursing students experience an increase in resilience and positive affect, as well as a decrease in negative affect.
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Affiliation(s)
- L. Iván Mayor-Silva
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.I.M.-S.); (A.M.-M.)
| | - Alfonso Meneses-Monroy
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.I.M.-S.); (A.M.-M.)
| | - Leyre Rodriguez-Leal
- Red Cross Nursing University College, Autonomous University of Madrid, 28003 Madrid, Spain
| | - Guillermo Moreno
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (L.I.M.-S.); (A.M.-M.)
- Grupo de Investigación Cardiovascular Multidisciplinar Traslacional (GICMT), Área de Investigación Cardiovascular, Instituto de Investigación Hospital 12 de Octubre (imas12), 28041 Madrid, Spain
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Robleda-Font G, López-López C, Latorre-Marco I, Pozas-Peña J, Alonso-Crespo D, Vallés-Fructuoso O, Castanera-Duro A. Appropriateness of behavioural scales in the monitoring of pain in the critically ill patient unable to self-report. ENFERMERIA INTENSIVA 2024; 35:e17-e22. [PMID: 38538437 DOI: 10.1016/j.enfie.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/22/2023] [Indexed: 05/25/2024]
Abstract
Appropriateness is a dimension of quality that evaluates the effective use of technologies, resources or interventions in specific situations or populations, assessing whether our interventions do more benefit than harm. The evidence regarding pain monitoring in the critically ill patient points to the periodic assessment of pain using appropriate tools, with the aim of improving pain management and more efficient use of analgesics in the intensive care unit. The first step would be to assess the patient's ability to communicate or self-report and, based on this, to select the most appropriate pain assessment tool. In patients who are unable to self-report, behavioural pain assessment tools are recommended. When we talk about the suitability of behavioural scales for pain monitoring in critically ill patients unable to self-report, we refer to their use with a clear clinical benefit, i.e. using the right tool for pain assessment to be effective, efficient and consistent with bioethical principles. To our knowledge, there are no published data on the suitability of pain assessment tools in unable to self-report critically ill patients, so, in the framework of continuous quality improvement in pain care, new research should incorporate this approach by integrating the best scientific evidence with current clinical practice.
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Affiliation(s)
- G Robleda-Font
- Campus Docent Sant Joan de Déu, Universidad de Barcelona, Sant Boi de Llobregat, Spain; Centro Cochrane Iberoamericano, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain
| | - C López-López
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Unidad de Cuidados Intensivos de Trauma y Emergencias, Hospital Universitario 12 de Octubre, Madrid, Spain; Grupo de Investigación en Cuidados (InveCuid), Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.
| | - I Latorre-Marco
- Unidad de Cuidados Intensivos, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain; Grupo de Investigación en Enfermería y Cuidados de Salud, Instituto de Investigación Sanitaria Puerta de Hierro-Segovia de Arana, Madrid, Spain
| | - J Pozas-Peña
- Campus Docent Sant Joan de Déu, Universidad de Barcelona, Sant Boi de Llobregat, Spain; Unidad de Cuidados Intensivos, Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Patología Crítica (GREPAC), Instituto de Investigación Hospital del Mar, Barcelona, Spain
| | - D Alonso-Crespo
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Unidad de Cuidados Intensivos, Hospital Álvaro Cunqueiro, Vigo, Spain; Grupo de Investigación Traslacional en Cuidados, Hospital Álvaro Cunqueiro, Vigo, Spain
| | - O Vallés-Fructuoso
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Unidad de Cuidados Intensivos, Hospital Vall d'Hebrón, Barcelona, Spain; Coordinadora del Grupo de Trabajo Analgesia, Sedación y Delirium de la Sociedad Catalana de Medicina Intensiva, Barcelona, Spain
| | - A Castanera-Duro
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Área del Paciente Crítico, Reanimación y Anestesia, Hospital Universitario de Girona Dr. Josep Trueta, Girona, Spain; Departamento de Enfermería Universitat de Girona (UdG), Girona, Spain
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Chandra Prabhakar M, Halder P. Reliability and accuracy of bedside capillary blood glucose measurement by glucometers compared to venous blood glucose in critically ill patients: A facility based cross-sectional study. Clin Nutr ESPEN 2024; 60:24-30. [PMID: 38479916 DOI: 10.1016/j.clnesp.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 12/04/2023] [Accepted: 01/06/2024] [Indexed: 04/12/2024]
Abstract
BACKGROUND The traditional reference standard, venous blood glucose requires venipuncture and laboratories usually return the test results after 60 min. Our aim was to determine the agreement accuracy of glucose (capillary) levels obtained by POC glucometers with glucose (venous) values by standard laboratory method (glucose-oxidase) and to assess whether and to what extent the glucometers perform uniformly well across the entire range of blood glucose values. METHODS We compared the diagnostic accuracy of two-point of care glucometers with laboratory venous glucose, the reference standard using Bland-Altman plots and Clark error grid method to analyse the results. RESULTS This study included a total of 110 patients (38[34 %] women; mean age 52.1 years (SD, 17.3); range 14-85 years. Fourteen patients (12 %) were known to have diabetes. The mean glucose value (glucometer 1) was 152.9 mg/dL (SD 83.1); range = 48-501 mg/dL; that by glucometer 2 was 152.2 mg/dL (SD 76.2); range = 30-458 mg/dL and by the laboratory was 148.6 mg/dL (SD 81.5); range = 52-480 mg/dL. Of the 110 subjects, 2(2 %) had blood glucose below 70 mg/dL; 85(77 %) between 70 and 180 mg/dL and 23(21 %) had blood glucose exceeding 180 mg/dL. The Bland-Altman plot showed a bias of 4 mg% (95%CI -9.8 to +1.1); and the limits of agreement were -63 and + 54 mg%. The area under the receiver operating characteristic curve for the two glucometers was 0.92 and 0.93 respectively. CONCLUSIONS Point of care glucose, measured by glucometers was in agreement with the venous glucose estimation. Both glucometers were equally accurate and performed uniformly well across the wide range of blood glucose values.
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Affiliation(s)
- Manish Chandra Prabhakar
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Research, Sector 12, pin-160012, Chandigarh, India
| | - Pritam Halder
- Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Research, Sector 12, pin-160012, Chandigarh, India.
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Arias-Rivera S, Sánchez-Sánchez MM, Romero de-San-Pío E, Santana-Padilla YG, Juncos-Gozalo M, Via-Clavero G, Moro-Tejedor MN, Raurell-Torredà M, Andreu-Vázquez C. Predictive validity of the Clinical Frailty Scale-España on the increase in dependency after hospital discharge. ENFERMERIA INTENSIVA 2024; 35:79-88. [PMID: 38001020 DOI: 10.1016/j.enfie.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 07/23/2023] [Accepted: 07/31/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION The frailty present at hospital admission and the stressors to which patients are subjected during their stay may increase dependency at hospital discharge. OBJECTIVES To assess the predictive validity of the Clinical Frailty Scale-España (CFS-Es) on increased dependency at 3 and 12 months (m) after hospital discharge. METHODOLOGY Multicentre cohort study in 2020-2022. Including patients with >48 h stay in intensive care units (ICU) and non-COVID-19. VARIABLES pre-admission frailty (CFS-Es). Sex, age, days of stay (ICU and hospital), dependency on admission and at 3 m and 12 m after discharge (Barthel index), muscle weakness (Medical Research Council Scale sum score <48), hospital readmissions. STATISTICS descriptive and multivariate analysis. RESULTS 254 cases were included. Thirty-nine per cent were women and the median [Q1-Q3] age was 67 [56-77] years. SAPS 3 on admission (median [Q1-Q3]): 62 [51-71] points. Frail patients on admission (CFS-Es 5-9): 58 (23%). Dependency on admission (n = 254) vs. 3 m after hospital discharge (n = 171) vs. 12 m after hospital discharge (n = 118): 1) Barthel 90-100: 82% vs. 68% vs. 65%. 2) Barthel 60-85: 15% vs. 15% vs. 20%. 3) Barthel 0-55: 3% vs. 17% vs. 15%. In the multivariate analysis, adjusted for the variables recorded, we observed that frail patients on admission (CFS-Es 5-9) are 2.8 times (95%CI: 1.03-7.58; p = 0.043) more likely to increase dependency (Barthel 90-100 to <90 or Barthel 85-60 to <60) at 3 m post-discharge (with respect to admission) and 3.5 times (95%CI: 1.18-10.30; p = 0.024) more likely to increase dependency at 12 m post-discharge. Furthermore, for each additional CFS-Es point there is a 1.6-fold (95%CI: 1.01-2.23; p = 0.016) greater chance of increased dependency in the 12 m following discharge. CONCLUSIONS CFS-Es at admission can predict increased dependency at 3 m and 12 m after hospital discharge.
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Affiliation(s)
- S Arias-Rivera
- Investigación de Enfermería, Hospital Universitario de Getafe, Madrid, Spain
| | - M M Sánchez-Sánchez
- Unidad de Cuidados Intensivos, Hospital Universitario de Getafe, Madrid, Spain
| | - E Romero de-San-Pío
- Unidad de Cuidados Intensivos, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Y G Santana-Padilla
- Unidad de Cuidados Intensivos, Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
| | - M Juncos-Gozalo
- Unidad de Cuidados Intensivos, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - G Via-Clavero
- Unidad de Cuidados Intensivos, Hospital Universitario de Bellvitge, Barcelona, Spain, Escuela de Enfermería, Facultad de Medicina y Ciencias de la Salud, Universitat de Barcelona, Grupo de Investigación en Enfermería (GRIN-IDIBELL), Barcelona, Spain
| | - M N Moro-Tejedor
- Unidad de Apoyo a la Investigación en Enfermería, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Escuela Universitaria de Enfermería de la Cruz Roja, Universidad Autónoma de Madrid, Madrid, Spain
| | - M Raurell-Torredà
- Departamento de Enfermería Fundamental y Médico Quirúrgica, Universidad de Barcelona, Barcelona, Spain.
| | - C Andreu-Vázquez
- Facultad de Ciencias Biomédicas y de la Salud, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
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Guerrero-Toapanta FM, Herrera-Parra YDC. Chlorhexidine and ventilator-associated pneumonia. Med Intensiva 2024; 48:241. [PMID: 38008692 DOI: 10.1016/j.medine.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
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Raurell-Torredà M, Arias-Rivera S, Rodríguez-Delgado ME, Campos-Asensio C, Fernández-Castillo RJ. Effectiveness of closed blood sampling systems in intensive care patients: a scoping review. ENFERMERIA INTENSIVA 2024; 35:133-145. [PMID: 37423775 DOI: 10.1016/j.enfie.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/10/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND Anemia associated with blood extraction for diagnostic purposes is a highly prevalent entity in intensive care units (ICU) for adults. The evidence recommends its prevention through different strategies, among which we can find the use of closed blood sampling systems (CBSS). Different experimental studies support the use of these devices. OBJECTIVE To identify knowledge gaps regarding the effectiveness of CBSS in ICU patients. METHODS Scoping review with search in PubMed, CINAHL, Embase, Cochrane Library and Joanna Briggs Institute databases, between September-2021 and September-2022. No time, language, or other limits were applied to ensure the recovery of all relevant studies. Gray literature sources: DART-Europe, OpenGrey and Google Scholar. Two researchers independently reviewed titles and abstracts and assessed full texts against the inclusion criteria. The following data was extracted for each study: design and sample, inclusion and exclusion criteria, variables, type of CBSS, results and conclusions. RESULTS 18 articles were included in the final review, 11 clinical trials (RCTs) published between 1992 and 2014. Three systematic reviews were found, but they only analyzed the effect of CBSS in reducing blood loss, hemoglobin stabilization, and the need for transfusion. Five of the RCTs analyzed the risk of infection, one catheter complications, and two alterations in blood pressure readings. CONCLUSIONS The use of CBSS is recommended to reduce blood loss in ICUs. However, there are discrepancies about their ability to prevent anemia and/or the need for blood transfusion. Its use does not increase catheter-related infection rates or alter the measurement of mean arterial pressure.
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Affiliation(s)
- M Raurell-Torredà
- Departament Infermeria Fonamental i Medicoquirúrgica, Universitat de Barcelona, Barcelona, Spain
| | - S Arias-Rivera
- Enfermera Investigación, Hospital Universitario de Getafe, Madrid, Spain
| | - M E Rodríguez-Delgado
- Unidad de Cuidados Intensivos. Hospital Universitario Clínico San Cecilio, Granada, Spain.
| | | | - R-J Fernández-Castillo
- Unidad de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
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Soto S, Adasme R, Vivanco P, Figueroa P. Efficacy of the "Start to move" protocol on functionality, ICU-acquired weakness and delirium: A randomized clinical trial. Med Intensiva 2024; 48:211-219. [PMID: 38402053 DOI: 10.1016/j.medine.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 02/26/2024]
Abstract
OBJECTIVE To evaluate the efficacy of the Start to move protocol compared to conventional treatment in subjects over 15 years of age hospitalized in the ICU on an improvement in functionality, decrease in ICU-acquired weakness (DAUCI), incidence of delirium, days of mechanical ventilation (MV), length of stay in ICU and mortality at 28 days. DESIGN randomized controlled clinical trial. SETTING Intensive Care Unit. PARTICIPANTS Includes adults older than 15 years with invasive mechanical ventilation more than 48h, randomized allocation. INTERVENTIONS Start to move protocol and conventional treatment. MAIN VARIABLES OF INTEREST Functionality, incidence of ICU-acquired weakness, incidence of delirium, days on mechanical ventilation, ICU stay and mortality-28 days, ClinicalTrials.gov number, NCT05053724. RESULTS 69 subjects were admitted to the study, 33 to the Start to move group and 36 to conventional treatment, clinically and sociodemographic comparable. In the "Start to move" group, the incidence of IUCD at ICU discharge was 35.7% vs. 80.7% in the "conventional treatment" group (p=0.001). Functionality (FSS-ICU) at ICU discharge corresponds to 26 vs. 17 points in favor of the "Start to move" group (p=0.001). The difference in Barthel at ICU discharge was 20% in favor of the "Start to move" group (p=0.006). There were no significant differences in the incidence of delirium, days of mechanical ventilation, ICU stay and 28-day mortality. The study did not report adverse events or protocol suspension. CONCLUSIONS The application of the "Start to move" protocol in ICU showed a reduction in the incidence of IUAD, an increase in functionality and a smaller decrease in Barthel score at discharge.
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Affiliation(s)
- Sebastián Soto
- Unidad del Paciente Crítico, Hospital Félix Bulnes, Cerro Navia, Santiago, Chile.
| | - Rodrigo Adasme
- Equipo de Terapia Respiratoria, Hospital Clínico Red Salud Christus-UC, Chile; Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andrés Bello, Santiago, Chile
| | - Paulina Vivanco
- Unidad del Paciente Crítico, Hospital de Urgencia Asistencia Pública, Estación Central, Santiago, Chile; Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andrés Bello, Santiago, Chile
| | - Paola Figueroa
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andrés Bello, Santiago, Chile
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Via-Clavero G, Acevedo Nuevo M, Gil-Castillejos D, Rodríguez Mondéjar JJ, Alonso Crespo D. Non-pharmacological interventions to reduce physical restraints in critical care units. ENFERMERIA INTENSIVA 2024; 35:e8-e16. [PMID: 38461127 DOI: 10.1016/j.enfie.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/23/2023] [Indexed: 03/11/2024]
Abstract
Physical restraint use in critical care units is a frequent low-value care practice influenced by numerous factors creating a local culture. The translation of evidence-based recommendations into clinical practice is scarce so, the analysis of interventions to de-adopt this practice is needed. This update aims to describe and identify nonpharmacological interventions that contribute to minimising the use of physical restraints in adult critically ill patients. Interventions are classified into two groups: those that include education alone and those that combine training with one or more components (multicomponent interventions). These components include less restrictive restraint alternatives, use of physical and cognitive stimulation, decision support tools, institutional multidisciplinary committees, and team involvement. The heterogeneity in the design of the programmes and the low quality of the evidence of the interventions do not allow us to establish recommendations on their effectiveness. However, multicomponent interventions including training, physical and cognitive stimulation of the patient and a culture change of professionals and the organisations towards making restraints visible might be the most effective. The implementation of these programmes should underpin on a prior analysis of each local context to design the most effective-tailored combination of interventions to help reduce or eliminate them from clinical practice.
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Affiliation(s)
- G Via-Clavero
- Enfermera Clínica, Área del Paciente Crítico, Hospital Universitari de Bellvitge-GRIN-IDIBELL, Spain; Profesora Asociada, Departamento de Enfermería Fundamental y Clínica, Facultad de Enfermería, Universitat de Barcelona, Barcelona, Spain; Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain.
| | - M Acevedo Nuevo
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; UCI Médica y Unidad Coronaria, Hospital Universitario Puerta de Hierro, Majadahonda, Spain; Grupo de Investigación en Cuidados de la Fundación de Investigación de Puerta de Hierro Majadahonda, Spain
| | - D Gil-Castillejos
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; Enfermera Clínica, Área del Paciente Crítico, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain; Profesora Asociada, Departamento de Enfermería, Universitat Rovira i Virgili, Tarragona, Spain; Grupo de investigación Sepsia, Inflamación y Seguridad del Paciente Crítico/Inteligencia Artificial (SIS/IA)"(AGAUR SGR 01414), Spain
| | - J J Rodríguez Mondéjar
- Grupo de Trabajo de Analgesia, Sedación, Contenciones y Delirio de la Sociedad Española de Enfermería Intensiva y Unidades Coronarias (GT-ASCyD-SEEIUC), Spain; UME-2, Gerencia de Urgencias y Emergencias Sanitarias 061 Región de Murcia, Servicio Murciano de Salud, Murcia, Spain; Facultad de Enfermería, Universidad de Murcia, Campus Mare Nostrum, Murcia, Spain; Instituto Murciano de Investigación Biosanitaria Pascual Parrilla (IMIB-Arrixaca), Murcia, Spain
| | - D Alonso Crespo
- Grupo de Investigación en Cuidados de la Fundación de Investigación de Puerta de Hierro Majadahonda, Spain; UCI, Hospital Álvaro Cunqueiro, Vigo, Spain; Grupo de Investigación Traslacional en Cuidados, Hospital Álvaro Cunqueiro, Vigo, Spain
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Vaisman A, Guiloff R, Contreras M, Casas-Cordero JP, Calvo R, Figueroa D. Over 50% of self-reported burnout among Latin American orthopaedic surgeons: A cross-sectional survey on prevalence and risk factors. J ISAKOS 2024; 9:128-134. [PMID: 38036044 DOI: 10.1016/j.jisako.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 11/10/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023]
Abstract
OBJECTIVE Assess the prevalence of self-reported burnout and identify risk and protective factors based on demographic and life quality aspects, among Latin American orthopaedic surgeons. METHODS This study employed a cross-sectional analytical design. An original design survey was developed using multiple-choice and Likert-scale questions to gather self-reported burnout, demographic, work-related, social, personal, and mood-related data. The survey was electronically distributed to the Chilean Orthopaedic Surgery Society and the Latin American Society of Arthroscopy, Knee Surgery, and Sports Medicine members. Statistical analysis included Chi-square and Fisher's exact tests to determine associations between self-reported burnout and other variables. Subsequently, a multivariate logistic regression was carried out to identify key risk and protective factors (p < 0.05). RESULTS The survey's response rate was 20 % (n = 358) out of the 1779 invitations that were sent. The most representative age range was 41-60 years (50 %) and 94 % were men. Of those surveyed, 50 % reported a burnout episode more than once per year, 60 % depersonalization when treating patients at least yearly, 13 % anhedonia, 11 % a depressive mood more than half of the month or almost every day, and 61 % weariness at the end of a working day. Burnout was statistically associated with age under 40 years old (p = 0.012), fewer years as a specialist (p = 0.037), fear of lawsuits (p < 0.001), a non-healthy diet (p = 0.003), non-doing recreational activities (p = 0.004), depersonalization when treating their patients (p < 0.001), weariness (p < 0.001), anhedonia (p < 0.001), depressive mood (p < 0.001), and career dissatisfaction (p < 0.001). The logistic regression demonstrated that fear of lawsuits (p < 0.001), weariness at the end of a workday (p = 0.016), and anhedonia (p = 0.019) were those variables with stronger direct associations with self-reported burnout. A healthy diet was the strongest protective variable (p < 0.001). CONCLUSION Over 50 % of the Latin American orthopaedic surgeons who participated in the survey reported experiencing burnout episodes more than once a year, along with depersonalization when treating their patients at least once a year. Additionally, nearly 10 % of respondents experienced weekly depressive symptoms. Among the noteworthy risk factors for self-reported burnout were fear of lawsuits, weariness at the end of the workday, and anhedonia. Conversely, maintaining a healthy diet emerged as the most potent protective factor. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Alex Vaisman
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile
| | - Rodrigo Guiloff
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile.
| | - Martín Contreras
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Av. Plaza 680, 7610658, Las Condes, Santiago, Chile
| | - Juan Pablo Casas-Cordero
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Av. Plaza 680, 7610658, Las Condes, Santiago, Chile
| | - Rafael Calvo
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile
| | - David Figueroa
- Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Departamento Traumatología, Av. Vitacura 5951, 7650568, Santiago, Chile
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Xie Q, Xu H, Luo Z, Gong A, Wang L, Zhou J. Influencing factors of inter-nursing lateral violence: A qualitative systematic review. J Clin Nurs 2024. [PMID: 38500013 DOI: 10.1111/jocn.17120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 02/22/2024] [Accepted: 03/11/2024] [Indexed: 03/20/2024]
Abstract
BACKGROUND Lateral violence is a global social problem that has attracted considerable attention in the field of public health. This has seriously affected the quality of care, the safety of patients' lives and the career development of nurses. OBJECTIVE To systematically evaluate the factors influencing of nursing lateral violence and provide evidence for preventing and reducing inter-nursing lateral violence. METHODS A systematic review of qualitative study was performed in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines. We collected qualitative studies on the factors influencing of inter-nursing lateral violence by searching PubMed, EMbase, The Cochrane Library, Web of Science, CINAHL, Science Direct, WanFang Data, China National Knowledge Infrastructure (CNKI), Chinese Scientific Journal Database (VIP) and Chinese Biomedical Literature Database (CBM). Data from inception to September 2023. Literature screening and data extraction were independently conducted by two reviewers. The Critical Appraisal Skills Program (CASP) scale was employed to assess the quality of the studies, including objectives, methodologies, designs, results and contributions. RESULTS A total of 25 studies involving 882 participants were included. The results of the thematic analysis indicated that inter-nursing lateral violence was influenced by hospital management, perpetrators, victims and sociodemographic factors. CONCLUSION Inter-nursing lateral violence was influenced by multidimensional factors. To reduce the occurrence of horizontal violence among nurses, hospitals need to explore the establishment and improvement of a horizontal violence resolution mechanism, and schools should pay attention to the joint support and education of nursing students, create a good working environment and harmonious nursing culture, and promote mutual respect among nurses. RELEVANCE TO CLINICAL PRACTICE This review emphasises the importance of the influencing factors of horizontal violence among nurses, analyses the importance of influencing factors from different perspectives, and proposes corresponding measures to reduce inter-nursing lateral violence. NO PATIENT OR PUBLIC CONTRIBUTION This study was mostly a literature review; neither patients nor pertinent staff were involved in either the design or conduct of the investigation.
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Affiliation(s)
- Qiulin Xie
- Health Science Center, Yangtze University, Jingzhou, China
| | - Honglin Xu
- Department of Critical Care Medicine, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, China
| | - Zongting Luo
- Department of Nursing, The Third People's Hospital of Chengdu, Chengdu, China
| | - Aiping Gong
- Health Science Center, Yangtze University, Jingzhou, China
| | - Li Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Yangtze University, Jingzhou, China
| | - Jian Zhou
- Department of Orthopedics, School of Clinical Medicine & the First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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Pérez-Ortega S, Parellada-Vendrell M, Querol E, Prats J, Venturas M, Zabalegui A. Gender perspective in the implementation of hygiene in cardiology intensive care. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00015-6. [PMID: 38493071 DOI: 10.1016/j.enfie.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 12/05/2023] [Indexed: 03/18/2024]
Abstract
INTRODUCTION Hygiene in critical patients is an essential daily care, provided under safe conditions, to promote comfort and maintain the integrity of skin and mucous membranes, however, it can generate feelings of dependence and vulnerability in patients. The aim of this post hoc study is to know the differences in satisfaction and lived experience regarding bed hygiene in an intensive care unit according to biological sex and gender perspective. METHODS Observational, descriptive and prospective study in which an ad hoc questionnaire was administered to 148 conscious and oriented patients of legal age. The questionnaire was completed 24-48 hours after admission to the unit, once the initial bed hygiene had been performed. RESULTS Males experienced conformism (51%), embarrassment (31%) and relief (9%); Women felt conformism (35.4%), embarrassment (18.8%) and relief (29.2%) (p < 0.05). Women experienced a feeling of cleanliness in 89.1% compared to 56.1% of men (p < 0.05). Men were offered to wash their genitals in 72.9% compared to 35.7% of women (p < 0.05). 34.3% of men would prefer a family member to assist them during hygiene (62.9% by their wives), compared to 27.1% of women who would prefer a family member (84.6% by their daughters). CONCLUSION Women tolerate bed hygiene better than men and appreciate more the feeling of cleanliness. Women are identified as caregivers, both professionally and in the family, and patients prefer them to collaborate in the performance of hygiene, being wives preferred by men and daughters preferred by women.
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Affiliation(s)
- S Pérez-Ortega
- Unidad Cuidados Cardiológicos Agudos, Hospital Clínic Barcelona, Barcelona, Spain; Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain.
| | - M Parellada-Vendrell
- Unidad Cuidados Cardiológicos Agudos, Hospital Clínic Barcelona, Barcelona, Spain
| | - E Querol
- Instituto Clínico Cardiovascular, Hospital Clínic Barcelona, Barcelona, Spain
| | - J Prats
- Instituto Clínico Cardiovascular, Hospital Clínic Barcelona, Barcelona, Spain
| | - M Venturas
- Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain; Instituto Clínico Cardiovascular, Hospital Clínic Barcelona, Barcelona, Spain
| | - A Zabalegui
- Facultad de Enfermería, Universidad de Barcelona, Barcelona, Spain; Dirección Enfermería, Hospital Clínic Barcelona, Barcelona, Spain
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López de Audícana-Jimenez de Aberasturi Y, Vallejo-De la Cueva A, Aretxabala-Cortajarena N, Rodriguez-Nuñez C, Pelegrin-Gaspar PM, Gil-Garcia ZI, Rodriguez-Borrajo MJ, Margüello-Fernandez AA, Parraza-Diez N. The pupillary dilation reflex to a nociceptive stimulus as a tool for analgesia management: A diagnostic study. Aust Crit Care 2024; 37:230-235. [PMID: 37573155 DOI: 10.1016/j.aucc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 06/12/2023] [Accepted: 06/18/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND More than 70% of patients demonstrate pain after endotracheal aspiration. Tools are needed to objectify the need for analgesia in non-communicative critically ill patients. OBJECTIVE The objective of this study was to identify the lowest intensity electrical stimulus for detecting pain before daily care interventions. METHODS Study of diagnostic tests to assess pupillometry to detect pain through the pupillary dilation response to noxious stimuli versus the Behavioural Pain Scale. Patients older than 18 years, under analgosedation, subjected to invasive ventilation, baseline Behavioural Pain Scale of 3, and Richmond Agitation-Sedation Scale between -1 and -4 were studied. We assessed the Behavioural Pain Scale and the pupillary dilation response to 10, 20, 30, and 40 mA stimuli. We studied the diagnostic performance based on sensitivity and specificity, negative predictive value, positive predictive value, and accuracy of the selected points after the different stimulations. AlgiScan® Pupillometer measured the pupillary dilation response. The presence of pain was considered as a Behavioural Pain Scale score of ≥4. Significance was defined as p <0.05. RESULTS Measurements were performed on 31 patients. In the 20 mA stimulus, we found an area under the curve of 0.85 (0.69-1.0). The cut-off point of pupillary dilation was 11.5%, with a sensitivity of 100% (34.2-100) and a specificity of 75.9% (57.9-87.8). This point had an accuracy of 77.4 (60.2-88.6) and a Youden's Index of 0.8. CONCLUSIONS Pupillary variation measurement during a 20 mA stimulus could help assess the need for analgesia before potentially painful interventions. Further studies are needed to confirm this. REGISTRATION Phase 1 of the project PUPIPAIN ClinicalTrials.gov Identifier: NCT04078113.
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Affiliation(s)
- Yolanda López de Audícana-Jimenez de Aberasturi
- Vitoria-Gasteiz School of Nursing, University of the Basque Country (UPV/EHU), Jose Atxotegi, 01009 Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Jose Atxotegi, 01009 Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Jose Atxotegi, 01009 Vitoria-Gasteiz, Spain.
| | - Ana Vallejo-De la Cueva
- Bioaraba Health Research Institute, Jose Atxotegi, 01009 Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Jose Atxotegi, 01009 Vitoria-Gasteiz, Spain.
| | | | - Cesar Rodriguez-Nuñez
- Osakidetza Basque Health Service, Araba University Hospital, Jose Atxotegi, 01009 Vitoria-Gasteiz, Spain.
| | | | - Zuriñe Itsaso Gil-Garcia
- Osakidetza Basque Health Service, Araba University Hospital, Jose Atxotegi, 01009 Vitoria-Gasteiz, Spain.
| | - Mª Jose Rodriguez-Borrajo
- Vitoria-Gasteiz School of Nursing, University of the Basque Country (UPV/EHU), Jose Atxotegi, 01009 Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Jose Atxotegi, 01009 Vitoria-Gasteiz, Spain.
| | | | - Naiara Parraza-Diez
- Bioaraba Health Research Institute, Jose Atxotegi, 01009 Vitoria-Gasteiz, Spain; Osakidetza Basque Health Service, Araba University Hospital, Jose Atxotegi, 01009 Vitoria-Gasteiz, Spain; REDISSEC, Health Services Research on Chronic Patients Network, Madrid, Spain.
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Yun S, Park HA, Na SH, Yun HJ. Effects of communication team training on clinical competence in Korean Advanced Life Support: A randomized controlled trial. Nurs Health Sci 2024; 26:e13106. [PMID: 38452799 DOI: 10.1111/nhs.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 02/21/2024] [Accepted: 02/23/2024] [Indexed: 03/09/2024]
Abstract
We conducted a randomized controlled trial to study the effects of interprofessional communication team training on clinical competence in the Korean Advanced Life Support provider course using a team communication framework. Our study involved 73 residents and 42 nurses from a tertiary hospital in Seoul. The participants were randomly assigned to the intervention or control group, forming 10 teams per group. The intervention group underwent interprofessional communication team training with a cardiac arrest simulation and standardized communication tools. The control group completed the Korean Advanced Life Support provider course. All participants completed a communication clarity self-reporting questionnaire. Clinical competence was assessed using a clinical competency scale comprising technical and nontechnical tools. Blinding was not possible due to the educational intervention. Data were analyzed using a Mann-Whitney U test and a multivariate Kruskal-Wallis H test. While no significant differences were observed in communication clarity between the two groups, there were significant differences in clinical competence. Therefore, the study confirmed that the intervention can enhance the clinical competence of patient care teams in cardiopulmonary resuscitation.
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Affiliation(s)
- Soyeon Yun
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyeoun-Ae Park
- College of Nursing, Seoul National University, Seoul, Republic of Korea
| | - Sang-Hoon Na
- Seoul National University Hospital, Seoul, Republic of Korea
| | - Hee Je Yun
- Seoul National University Hospital, Seoul, Republic of Korea
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71
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Liu K, Tronstad O, Flaws D, Churchill L, Jones AYM, Nakamura K, Fraser JF. From bedside to recovery: exercise therapy for prevention of post-intensive care syndrome. J Intensive Care 2024; 12:11. [PMID: 38424645 PMCID: PMC10902959 DOI: 10.1186/s40560-024-00724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/17/2024] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND As advancements in critical care medicine continue to improve Intensive Care Unit (ICU) survival rates, clinical and research attention is urgently shifting toward improving the quality of survival. Post-Intensive Care Syndrome (PICS) is a complex constellation of physical, cognitive, and mental dysfunctions that severely impact patients' lives after hospital discharge. This review provides a comprehensive and multi-dimensional summary of the current evidence and practice of exercise therapy (ET) during and after an ICU admission to prevent and manage the various domains of PICS. The review aims to elucidate the evidence of the mechanisms and effects of ET in ICU rehabilitation and highlight that suboptimal clinical and functional outcomes of ICU patients is a growing public health concern that needs to be urgently addressed. MAIN BODY This review commences with a brief overview of the current relationship between PICS and ET, describing the latest research on this topic. It subsequently summarises the use of ET in ICU, hospital wards, and post-hospital discharge, illuminating the problematic transition between these settings. The following chapters focus on the effects of ET on physical, cognitive, and mental function, detailing the multi-faceted biological and pathophysiological mechanisms of dysfunctions and the benefits of ET in all three domains. This is followed by a chapter focusing on co-interventions and how to maximise and enhance the effect of ET, outlining practical strategies for how to optimise the effectiveness of ET. The review next describes several emerging technologies that have been introduced/suggested to augment and support the provision of ET during and after ICU admission. Lastly, the review discusses future research directions. CONCLUSION PICS is a growing global healthcare concern. This review aims to guide clinicians, researchers, policymakers, and healthcare providers in utilising ET as a therapeutic and preventive measure for patients during and after an ICU admission to address this problem. An improved understanding of the effectiveness of ET and the clinical and research gaps that needs to be urgently addressed will greatly assist clinicians in their efforts to rehabilitate ICU survivors, improving patients' quality of survival and helping them return to their normal lives after hospital discharge.
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Affiliation(s)
- Keibun Liu
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia.
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia.
- Non-Profit Organization ICU Collaboration Network (ICON), Tokyo, Japan.
| | - Oystein Tronstad
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
| | - Dylan Flaws
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Metro North Mental Health, Caboolture Hospital, Caboolture, Australia
- School of Clinical Science, Queensland University of Technology, Brisbane, Australia
| | - Luke Churchill
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Physiotherapy Department, The Prince Charles Hospital, Brisbane, Australia
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Alice Y M Jones
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kensuke Nakamura
- Department of Critical Care Medicine, Yokohama City University Hospital, Kanagawa, Japan
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, 627 Rode Road, Chermside, QLD, 4032, Australia
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, Australia
- Queensland University of Technology, Brisbane, Australia
- St. Andrews War Memorial Hospital, Brisbane, Australia
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72
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Alrimali AM, Alreshidi NM. Evaluating ICU nurses' education, practice, and competence in palliative and end-of-life care in Saudi Arabia: A cross-sectional study. BELITUNG NURSING JOURNAL 2024; 10:23-30. [PMID: 38425678 PMCID: PMC10900060 DOI: 10.33546/bnj.3040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 11/22/2023] [Accepted: 01/11/2024] [Indexed: 03/02/2024] Open
Abstract
Background In palliative and end-of-life (PEOL) care, especially within intensive care units (ICUs), nurses' unique skills are critical, yet their expertise remains under-explored, particularly in Saudi Arabia. Objective This study aimed to evaluate the education, practice, and perceived competence of adult ICU nurses in Saudi Arabia regarding PEOL care and to pinpoint key factors that influence this aspect of healthcare delivery. Methods A cross-sectional design was utilized in this study. Participants were recruited from five public hospitals and one specialized center in Hail, Saudi Arabia. Data were gathered in September 2023 using the PEOL Care Index, which measures various care dimensions on a Likert scale in Arabic and English. IBM SPSS Statistics 29.0 was used for statistical analysis, particularly to conduct ANOVA, t-test, and multiple regression. Results 142 out of the targeted 171 ICU nurses completed the survey, yielding a response rate of 83.04%. Although 81% of the nurses had experience caring for dying patients, only 30.3% had received in-service PEOL care training. Those with this training demonstrated significantly higher scores in education, clinical practice, and perceived competence than their counterparts (p <0.05). Mean scores across these areas were 69.67, 71.01, and 71.61, respectively. In-service training positively correlated with these metrics (p <0.05). Multiple regressions also revealed that in-service training, job satisfaction, and communication authority are strong influencers, explaining 21.6% of the variation in clinical practice and 16.9% in perceived competence. Conclusion The study highlighted the proficiency of ICU nurses in PEOL care, emphasizing that in-service training, job satisfaction, and the authority to communicate effectively with patients and their families significantly improved clinical practice and nurses' competence in PEOL care. This underlines the critical need for healthcare institutions to acknowledge and address these key factors to optimize patient care outcomes.
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Fernando JMG, Marçal MMG, Ferreira ÓR, Oliveira C, Pedreira L, Baixinho CL. Nursing Interventions for Client and Family Training in the Proper Use of Noninvasive Ventilation in the Transition from Hospital to Community: A Scoping Review. Healthcare (Basel) 2024; 12:545. [PMID: 38470656 PMCID: PMC10930648 DOI: 10.3390/healthcare12050545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/17/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Noninvasive ventilation is an increasingly disseminated therapeutic option, which is explained by increases in the prevalence of chronic respiratory diseases, life expectancy, and the effectiveness of this type of respiratory support. This literature review observes that upon returning home after hospital discharge, there are difficulties in adhering to and maintaining this therapy. The aim of this study is to identify nursing interventions for client and family training in the proper use of noninvasive ventilation in the transition from hospital to community. A scoping review was carried out by searching MEDLINE, CINAHL, Scopus, and Web of Science. The articles were selected by two independent reviewers by applying the predefined eligibility criteria. Regarding transitional care, the authors opted to include studies about interventions to train clients and families during hospital stay, hospital discharge, transition from hospital to home, and the first 30 days after returning home. The eight included publications allowed for identification of interventions related to masks or interfaces, prevention of complications associated with noninvasive ventilation, leakage control, maintenance and cleaning of ventilators and accessories, respiratory training, ventilator monitoring, communication, and behavioral strategies as transitional care priority interventions to guarantee proper training in the transition from hospital to community.
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Affiliation(s)
| | - Margarida Maria Gaio Marçal
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
| | - Óscar Ramos Ferreira
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal
| | - Cleoneide Oliveira
- Medical School Estácio Idomed Quixadá, University Center Estacio do Cearà, Fortaleza 60035-111, Brazil;
| | - Larissa Pedreira
- Nursing School, Federal University of Bahia, Salvador 40170-110, Brazil;
| | - Cristina Lavareda Baixinho
- Department of Fundamentals of Nursing, Escola Superior de Enfermagem de Lisboa, Nursing School of Lisbon, 1600-190 Lisbon, Portugal; (M.M.G.M.); (Ó.R.F.)
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), 1900-160 Lisbon, Portugal
- Center of Innovative Care and Health Technology (ciTechCare), 2414-016 Leiria, Portugal
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Mateos-Arroyo JA, Zaragoza-García I, Sánchez-Gómez R, Posada-Moreno P, García-Almazán S, Ortuño-Soriano I. Gender Differences among Nurses in Managing Arterial Puncture-Related Pain: A Multicenter Cross-Sectional Study. Healthcare (Basel) 2024; 12:531. [PMID: 38470641 PMCID: PMC10931307 DOI: 10.3390/healthcare12050531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/10/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
There is evidence that healthcare can be executed differentially depending on the gender of patients, researchers, and clinicians. The aim was to analyze the possible existence of nursing gender differences in pain management produced by arterial puncture for blood gas analysis. A cross-sectional, multicenter study designed was conducted in Castilla-la Mancha (Spain). Variables of interest were collected from nurses in the public health system of a European region through a questionnaire. Data were collected for four months; the primary outcome was the use of any intervention to reduce pain and the explanatory variable was the nurse's gender. Bivariate analysis was carried out to assess associations between gender and pain-reducing interventions and a multivariate model was created with those factors that were relevant using logistic regression. A significantly higher proportion of men reported using some form of intervention (45% vs. 30%) and had more specific training (45.9% vs. 32.4%). The adjusted probability of using pain-reducing interventions by men was 71% higher than women. Thus, we found gender differences in the management of pain caused by arterial punctures performed by nurses as the main healthcare providers.
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Affiliation(s)
| | - Ignacio Zaragoza-García
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, 28040 Madrid, Spain; (R.S.-G.); (P.P.-M.); (I.O.-S.)
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (Imas12), InveCuid Group, 28041 Madrid, Spain
| | - Rubén Sánchez-Gómez
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, 28040 Madrid, Spain; (R.S.-G.); (P.P.-M.); (I.O.-S.)
- Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (FIBHCSC), Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Paloma Posada-Moreno
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, 28040 Madrid, Spain; (R.S.-G.); (P.P.-M.); (I.O.-S.)
- Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (FIBHCSC), Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
| | - Sara García-Almazán
- Intensive Care Unit, Hospital General Nuestra Señora del Prado, 45600 Talavera de la Reina, Spain;
| | - Ismael Ortuño-Soriano
- Department of Nursing, Faculty of Nursing, Physiotherapy and Podology, University Complutense of Madrid, 28040 Madrid, Spain; (R.S.-G.); (P.P.-M.); (I.O.-S.)
- Fundación para la Investigación Biomédica del Hospital Clínico San Carlos (FIBHCSC), Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain
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Elsehrawy MG, Saleh AM. Psychosocial Predictors of Ventilator weaning Outcomes among patients in intensive care units. Heliyon 2024; 10:e24385. [PMID: 38314282 PMCID: PMC10837475 DOI: 10.1016/j.heliyon.2024.e24385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 02/06/2024] Open
Abstract
Background Ventilator weaning is a process of discontinuing mechanical ventilation and transitioning patients to independent breathing after a period of mechanical support. Weaning outcomes among the critically ill in intensive care units (ICUs) vary significantly among individuals, leading to considerable variation in healthcare costs, length of hospital stay, morbidity and mortality. Addressing psychosocial aspects of care can improve weaning outcomes. Objective This study aimed to determine the effect of psychosocial factors (social support, family/significant other support, ability to communicate) on weaning outcome within intensive care patients. This research hypothesized that psychological and social factors play a role in determining ventilator weaning outcomes among ICU patients. Methods This study used a longitudinal, retrospective research design to analyze positive and negative psychosocial predictors of ventilator weaning outcomes. Data collection methods include interviews and questionnaires with patients and their families, as well as clinical data from the patient's medical records. Results presence of anxiety, depression, and hallucinations, have a negative relationship with weaning outcomes regarding a patient's psychological characteristics (rs = -0.207, -0.163, -0.158), while communication with a patient during mechanical ventilation have a positive relationship with weaning outcomes regarding a patient's psychological characteristics (rs = 0.152; p ≤ 0.05). Moreover patients who have fear during weaning trials, feeling neglected, and feeling insecurity have a negative relationship with weaning outcomes while gaining family support during mechanical ventilation have a positive relationship with weaning outcomes (rs = 0.144; p ≤ 0.05).Significance of results, the findings suggests that psychosocial factors, such as anxiety, depression, patient's perception of their illness, motivation to wean, and family involvement can influence the success of ventilator weaning among patients in ICUs.
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Affiliation(s)
- Mohamed Gamal Elsehrawy
- Department of Nursing Administration and Education, Prince Sattam Bin Abdulaziz University, College of Nursing, Kingdom of Saudi Arabia
- Nursing Administration, Nursing Faculty, Port-Said University, Egypt
| | - Ahmad M. Saleh
- Department of Nursing Administration and Education, Prince Sattam Bin Abdulaziz University, College of Nursing, Kingdom of Saudi Arabia
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Huang M, Yang L, Zhang C, Gan X. Glucose management in critically ill adults: A qualitative study from the experiences of health care providers. Heliyon 2024; 10:e24545. [PMID: 38322901 PMCID: PMC10845247 DOI: 10.1016/j.heliyon.2024.e24545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 02/08/2024] Open
Abstract
Aims and objective To explain the components and elements of glucose management in critically ill adult patients from the healthcare providers' experiences. Background Critically ill adults are highly susceptible to stress-induced hyperglycaemia due to glucose metabolic disorders. Healthcare workers play a key role in the glycaemic management of critically ill patients. However, there is a lack of qualitative studies on the content and elements of glycaemic management and healthcare workers' perceptions about glycaemic management in China. Design Qualitative study that followed the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. Methods Individual semi-structured interviews were conducted from January to April 2022. Fifteen physicians and nurses were recruited from ten hospitals in mainland China. Data were analysed using inductive thematic analysis. Results Glucose management in critically ill adult patients from their experiences included two parts: the inner ring (practice behaviours) and the external space (methods and drivers). The practice behaviours of glucose management include five elements, while the methods and drivers of glucose management focus on three elements. The content covered under each element was identified. Conclusion This study developed a glycaemic management model for critically ill adult patients, clarified its elements based on the perceptions of healthcare providers and elaborated on the methods and drivers covered under each element to provide a reference for physicians and nurses to develop a comprehensive glycaemic management guideline for critically ill adult patients. Relevance to clinical practice Our study proposed a glucose management practice model for critically ill adult patients, and the elements and components included in this model can provide a reference for physicians and nurses when performing glucose management in critically ill patients.
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Affiliation(s)
- Miao Huang
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
- School of Nursing, Chongqing Medical University, Chongqing, China
| | - Li Yang
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Chuanlai Zhang
- Gneral ICU, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiuni Gan
- Department of Nursing, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Guanter-Peris L, Alburquerque-Medina E, Solà-Pola M, Pla M. Towards a set of competencies in palliative care nursing in Spain: what's getting in the way of consensus? BMC Palliat Care 2024; 23:41. [PMID: 38350955 PMCID: PMC10865715 DOI: 10.1186/s12904-024-01359-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 01/18/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Spain currently lacks a competency framework for palliative care nursing. Having such a framework would help to advance this field in academic, governmental, and health management contexts. In phase I of a mixed-methods sequential study, we collected quantitative data, proposing 98 competencies to a sample of palliative care nurses. They accepted 62 of them and rejected 36. METHODS Phase II is a qualitative phase in which we used consensus techniques with two modified nominal groups to interpret the quantitative findings with the objective of understanding of why the 36 competencies had been rejected. Twenty nurses from different areas of palliative care (direct care, teaching, management, research) participated. We conducted a thematic analysis using NVivo12 to identify meaning units and group them into larger thematic categories. RESULTS Participants attributed the lack of consensus on the 36 competencies to four main reasons: the rejection of standardised nursing language, the context in which nurses carry out palliative care and other factors that are external to the care itself, the degree of specificity of the proposed competency (too little or too great), and the complexity of nursing care related to the end of life and/or death. CONCLUSIONS Based on the results, we propose reparative actions, such as reformulating the competencies expressed in nursing terminology to describe them as specific behaviours and insisting on the participation of nurses in developing institutional policies and strategies so that competencies related to development, leadership and professional commitment can be implemented. It is essential to promote greater consensus on the definition and levels of nursing intervention according to criteria of complexity and to advocate for adequate training, regulation, and accreditation of palliative care expert practice. Locally, understanding why the 36 competencies were rejected can help Spanish palliative care nurses reach a shared competency framework. More broadly, our consensus methodology and our findings regarding the causes for rejection may be useful to other countries that are in the process of formalising or reviewing their palliative care nursing model.
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Affiliation(s)
- Lourdes Guanter-Peris
- Catalan Institute of Oncology (ICO), Hospital Duran I Reynals, Avinguda de La Gran Via de L'Hospitalet,199-203, 08908, Barcelona, L'Hospitalet de Llobregat, Spain.
| | - Eulàlia Alburquerque-Medina
- Catalan Institute of Oncology (ICO), Hospital Duran I Reynals, Avinguda de La Gran Via de L'Hospitalet,199-203, 08908, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Montserrat Solà-Pola
- Faculty of Nursing, University of Barcelona, S/N Feixa LLarga, Pavelló de Govern 3a Planta, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
| | - Margarida Pla
- Faculty of Nursing, University of Barcelona, S/N Feixa LLarga, Pavelló de Govern 3a Planta, 08907, Barcelona, L'Hospitalet de Llobregat, Spain
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Fernandes HMDLG, Silva DD, Tarifa RR, Guirardello EDB. Construction and validation of an instrument for evaluating Lean Healthcare in healthcare institutions. Rev Gaucha Enferm 2024; 45:e20230061. [PMID: 38359279 DOI: 10.1590/1983-1447.2024.20230061.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 09/08/2023] [Indexed: 02/17/2024] Open
Abstract
OBJECTIVE To build and validate an instrument to evaluate Lean Healthcare in healthcare institutions. METHOD Methodological study conducted in three stages: 1) Instrument construction; 2) Content validity using the Delphi technique with 14 experts; and 3) Construct validation using Structural Equation Modeling with sample consisted of 113 professionals with experience in Lean Healthcare. Data collection carried out from October/2020 to January/2021 using a digital form. Data analysis performed with the SmartPLS2.0/M3 software. RESULTS Items were developed after an integrative review and divided into the dimensions Structure, Process and Outcome, according to Donabedian's theoretical framework. Content validation in two rounds of the Delphi technique. Final instrument, after model adjustment, containing 16 items with Cronbach's alpha of 0.77 in Structure, 0.71 in Process and 0.83 in Outcome. CONCLUSION The instrument presented evidence of validity and reliability, enabling its use in healthcare institutions to evaluate Lean Healthcare.
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Affiliation(s)
- Hellen Maria de Lima Graf Fernandes
- Universidade Estadual de Campinas (UNICAMP). Faculdade de Enfermagem. Campinas, São Paulo, Brasil
- Faculdade Anhanguera. Graduação em Enfermagem. Joinville, Santa Catarina, Brasil
- Associação Educacional Luterana Bom Jesus (IELUSC). Graduação em Enfermagem. Joinville, Santa Catarina, Brasil
| | - Dirceu da Silva
- Universidade Estadual de Campinas (UNICAMP). Faculdade de Educação. Campinas, São Paulo, Brasil
| | - Rosana Ribeiro Tarifa
- Universidade Estadual de Campinas (UNICAMP). Colégio Técnico de Campinas. Campinas, São Paulo, Brasil
- Faculdade Anhanguera de Sumaré (FSU). Graduação em Enfermagem. Sumaré, São Paulo, Brasil
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Magdas TM, David M, Hategan AR, Filip GA, Magdas DA. Geographical Origin Authentication-A Mandatory Step in the Efficient Involvement of Honey in Medical Treatment. Foods 2024; 13:532. [PMID: 38397509 PMCID: PMC10887874 DOI: 10.3390/foods13040532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024] Open
Abstract
Nowadays, in people's perceptions, the return to roots in all aspects of life is an increasing temptation. This tendency has also been observed in the medical field, despite the availability of high-level medical services with many years of research, expertise, and trials. Equilibrium is found in the combination of the two tendencies through the inclusion of the scientific experience with the advantages and benefits provided by nature. It is well accepted that the nutritional and medicinal properties of honey are closely related to the botanical origin of the plants at the base of honey production. Despite this, people perceive honey as a natural and subsequently a simple product from a chemical point of view. In reality, honey is a very complex matrix containing more than 200 compounds having a high degree of compositional variability as function of its origin. Therefore, when discussing the nutritional and medicinal properties of honey, the importance of the geographical origin and its link to the honey's composition, due to potential emerging contaminants such as Rare Earth Elements (REEs), should also be considered. This work offers a critical view on the use of honey as a natural superfood, in a direct relationship with its botanical and geographical origin.
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Affiliation(s)
- Tudor Mihai Magdas
- Department of Anatomy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 3-5 Clinicilor Street, 400006 Cluj-Napoca, Romania; (T.M.M.); (G.A.F.)
| | - Maria David
- National Institute for Research and Development of Isotopic and Molecular Technologies, 67-103 Donat Street, 400293 Cluj-Napoca, Romania; (M.D.); (A.R.H.)
| | - Ariana Raluca Hategan
- National Institute for Research and Development of Isotopic and Molecular Technologies, 67-103 Donat Street, 400293 Cluj-Napoca, Romania; (M.D.); (A.R.H.)
| | - Gabriela Adriana Filip
- Department of Anatomy, “Iuliu Hatieganu” University of Medicine and Pharmacy, 3-5 Clinicilor Street, 400006 Cluj-Napoca, Romania; (T.M.M.); (G.A.F.)
| | - Dana Alina Magdas
- National Institute for Research and Development of Isotopic and Molecular Technologies, 67-103 Donat Street, 400293 Cluj-Napoca, Romania; (M.D.); (A.R.H.)
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Aguayo-Estremera R, Membrive-Jiménez MJ, Albendín-García L, Gómez-Urquiza JL, Romero-Bejar JL, De la Fuente-Solana EI, Cañadas GR. Analyzing Latent Burnout Profiles in a Sample of Spanish Nursing and Psychology Undergraduates. Healthcare (Basel) 2024; 12:438. [PMID: 38391813 PMCID: PMC10888431 DOI: 10.3390/healthcare12040438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024] Open
Abstract
There is abundant literature suggesting that university students in helping professions experience high levels of stress, leading to an increased risk of developing burnout. The objective of this study was to identify burnout profiles in a sample of 1162 Spanish nursing and psychology undergraduates using latent profile analysis, a person-oriented statistical method that can identify hidden homogenous subgroups within a heterogeneous population. We expected to replicate in university students the five-profile structure (burnout, overextended, disengaged, ineffective, and engagement) proposed by Leiter and Maslach using the burnout dimensions (emotional exhaustion, cynicism, and inefficacy) as indicators. The results showed that burnout, overextended, and engagement profiles were adequately replicated. Given that levels of inefficacy and cynicism were medium to low, the ineffective and disengaged profiles somewhat deviated from those identified by Leiter and Maslach. We found differences between the five latent profiles in several psychological variables, such as depression and anxiety. These results suggest that psychosocial factors (e.g., workload) are significant among students and may adversely impact their health, leading to psychosomatic and emotional disorders. Hence, designing effective interventions to prevent health problems associated with burnout seems advisable, considering the specific burnout profile that a student exhibits.
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Affiliation(s)
- Raimundo Aguayo-Estremera
- Department of Psychobiology and Methodology in Behavioral Sciences, Complutense University of Madrid, Campus de Somosaguas, 28223 Pozuelo de Alarcón, Spain
| | | | - Luis Albendín-García
- Casería de Montijo Health Center, Granada Metropolitan District, Andalusian Health Service, Calle Joaquina Eguaras nº 2, Edificio 2 1ª Planta, 18013 Granada, Spain
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain
| | - José L Gómez-Urquiza
- Ceuta Faculty of Health Sciences, Campus Universitario de Ceuta, University of Granada, 51001 Ceuta, Spain
| | - José Luis Romero-Bejar
- Instituto de Investigación Biosanitaria (ibs.GRANADA), 18012 Granada, Spain
- Department of Statistics and Operations Research, University of Granada, Av. de Fuente Nueva, s/n, 18071 Granada, Spain
- Institute of Mathematics, University of Granada (IMAG), 18016 Granada, Spain
| | | | - Gustavo R Cañadas
- Department of Didactic of Mathematics, Faculty of Education, University of Granada, Campus Universitario de la Cartuja, 18071 Granada, Spain
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Salamon E, Fodor É, Földesi E, Hauser P, Kriván G, Csanádi K, Garami M, Kovacs G, Csóka M, Tiszlavicz LG, Kiss C, Dergez T, Ottóffy G. The Impact of Qualification and Hospice Education on Staff Attitudes during Palliative Care in Pediatric Oncology Wards-A National Survey. CHILDREN (BASEL, SWITZERLAND) 2024; 11:178. [PMID: 38397290 PMCID: PMC10886866 DOI: 10.3390/children11020178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/16/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Our knowledge about the attitudes of healthcare staff to palliative care in pediatric oncology is scarce. We aimed to assess their perceptions of palliative care in Hungary and find answers to the question of how to provide good palliative care for children. METHOD Physicians (n = 30) and nurses (n = 43) working in the field of pediatric oncology (12 of them specialized in hospice care) were interviewed. Palliative care practice (communication, integration of palliative care, professionals' feelings and attitudes, and opportunities for improvement) was assessed by semi-structured interviews evaluated in a mixed quantitative and qualitative way by narrative categorical content analysis and thematic analysis. RESULTS All providers displayed high negative emotions, positive evaluations, and used many active verbs. Nurses showed higher levels of denial, more self-references, and were more likely to highlight loss. Physicians emphasized the importance of communication regarding adequate or inadequate palliative care. Hospice specialists showed a higher passive verb rate, a lower self-reference, a lower need for psychological support, and a greater emphasis on teamwork and professional aspects. CONCLUSION Our results show that nurses are more emotionally stressed than doctors in palliative care in pediatric oncology. To our knowledge, a study comparing doctors and nurses in this field has yet to be carried out. Our results suggest that pediatric oncological staff can positively evaluate a child's palliative care despite the emotional strain. Regarding hospices, professional practice in palliative care may be a protective factor in reducing emotional distress and achieving professional well-being.
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Affiliation(s)
- Eszter Salamon
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Pécs Medical School, József A. Street 7, 7623 Pécs, Hungary; (É.F.); (G.O.)
| | - Éva Fodor
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Pécs Medical School, József A. Street 7, 7623 Pécs, Hungary; (É.F.); (G.O.)
| | - Enikő Földesi
- Institute of Behavioural Sciences, Semmelweis University, Nagyvárad tér 4, 1089 Budapest, Hungary
| | - Peter Hauser
- Pediatric Center, Semmelweis University, Tűzoltó utca 7–9, 1094 Budapest, Hungary; (P.H.)
- Velkey László Child’s Health Center, Borsod-Abaúj-Zemplén County Central Hospital and University Teaching Hospital, Szentpéteri kapu 72–76, 3526 Miskolc, Hungary
| | - Gergely Kriván
- Department for Pediatric Hematology and Hemopoietic Stem Cell Transplantation, Central Hospital of Southern Pest, National Institute of Hematology and Infectious Diseases, 1097 Budapest, Hungary
| | - Krisztina Csanádi
- Hemato-Oncology Unit, Heim Pál National Pediatric Institute, 1089 Budapest, Hungary;
| | - Miklós Garami
- Pediatric Center, Semmelweis University, Tűzoltó utca 7–9, 1094 Budapest, Hungary; (P.H.)
| | - Gabor Kovacs
- Pediatric Center, Semmelweis University, Tűzoltó utca 7–9, 1094 Budapest, Hungary; (P.H.)
| | - Monika Csóka
- Pediatric Center, Semmelweis University, Tűzoltó utca 7–9, 1094 Budapest, Hungary; (P.H.)
| | | | - Csongor Kiss
- Department of Pediatrics, Faculty of Medicine, University of Debrecen, 4032 Debrecen, Hungary;
| | - Tímea Dergez
- Institute of Bioanalysis, University of Pécs, 7624 Pécs, Hungary;
| | - Gábor Ottóffy
- Division of Pediatric Hematology and Oncology, Department of Pediatrics, University of Pécs Medical School, József A. Street 7, 7623 Pécs, Hungary; (É.F.); (G.O.)
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Salleras-Duran L, Fuentes-Pumarola C, Fontova-Almató A, Roqueta-Vall-Llosera M, Cámara-Liebana D, Ballester-Ferrando D. Pain and Satisfaction Perceptions of Ultrasound-Guided Versus Conventional Peripheral Intravenous Catheterization: A Randomized Controlled Trial. Pain Manag Nurs 2024; 25:e37-e44. [PMID: 37633742 DOI: 10.1016/j.pmn.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 05/31/2023] [Accepted: 07/29/2023] [Indexed: 08/28/2023]
Abstract
BACKGROUND While many emergency department (ED) patients need peripheral vascular catheterization, diagnosis and treatment are often delayed by difficult intravenous access (DIVA). AIMS This study of ED patients with DIVA was designed to evaluate ultrasound (US)-guided peripheral intravenous (IV) catheterization, compare it with conventional catheterization, and analyse patient pain and satisfaction regarding catheterization. DESIGN Randomized controlled clinical trial. METHODS Adult patients treated in the ED who scored >3 on the Adult-Difficult Venous Catheterization scale were randomly assigned to either US-guided or conventional peripheral IV catheterization. Data were collected from April to December 2016. Study variables were catheter insertion success, number of catheterization attempts, time required to perform the procedure, catheter length and calibre, puncture site, complications, and catheter functioning. Pain and patient satisfaction were also analysed for each group and the full sample. RESULTS 120 and 138 patients were recruited for the US-guided and conventional peripheral IV catheterization groups, respectively. For the US-guided compared to the conventional procedure, insertion success was greater (91.75% versus 89.9%; p=0.04), the mean (SD) number of attempts was lower (1.29 (0.59) versus 1.81 (1.28); p<0.001), mean (SD) satisfaction was greater (7.59 (2.04) versus 6.69 (2.28); p=0.03), and the mean (SD) required time in minutes was greater (7.89 (7.13) versus 5.1 (3.69); p=0.045). Mean (SD) pain was moderate in both groups (4.6 (2.75) versus 4.33 (2.91) (p=0.32). Logistic regression for the full sample indicated that more attempts and greater pain were both associated with reduced satisfaction, while use of higher-calibre catheters was associated with greater satisfaction. CONCLUSION US-guided compared to conventional peripheral IV catheterization in patients with DIVA was more successful, required fewer attempts, enabled use of longer and higher-calibre catheters, and led to greater patient satisfaction. Patients who underwent US-guided intravenous catheterization reported moderate pain, similar to that reported for the conventional procedure. CLINICAL IMPLICATIONS US-guided peripheral intravenous catheterization improves ED patient care, as it requires fewer catheterization attempts. It is especially recommended for patients with DIVA.
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Affiliation(s)
- Laia Salleras-Duran
- From the Hospital of Figueras, Salut Empordà Foundation. Health, Gender and Aging Research Group, Department of Nursing, University of Girona, Spain.
| | | | | | | | - David Cámara-Liebana
- Quality of Life Research Institute, Department of Nursing, University of Girona, Spain
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Yan L, Pu H, Shi X, Yu Q, Wang Z, Hu Y, Zhang Y, Zhang X. Construction of key quality indicators for aged care facilities in China: A two-tier Delphi study: Key aged care quality indicators in ACF by Delphi method. J Clin Nurs 2024; 33:752-767. [PMID: 37994245 DOI: 10.1111/jocn.16917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/27/2023] [Accepted: 10/17/2023] [Indexed: 11/24/2023]
Abstract
AIM To construct key quality indicators for aged care facilities in China. BACKGROUND Evaluating the care quality in aged care facilities is problematic. Evaluation of nursing care quality is important for improving nursing and self-supervision in aged care facilities. However, a few regulations and studies regarding care quality evaluation have been implemented in China. DESIGN AND METHOD This two-tier Delphi study aimed to achieve consensus on key quality indicators for aged care facilities in China. The entry pool was determined by literature review and research team discussion, followed by a discussion by a panel of experts to establish the items of the Delphi study. Finally, key care quality indicators were established through a two-round Delphi study. This study followed the SQUIRE 2.0 guidelines. RESULTS The initial 16 quality indicators of the entry pool was developed based on a literature review and a group discussion. Sixteen quality indicators were reduced to eight after the expert discussion. After two rounds of expert consultation, the eight quality indicators became nine, which were then evaluated for importance, formula rationality, and operability using Kendall's harmony coefficients (first round: 0.150, 0.143 and 0.169, respectively; second round: 0.209, 0.159 and 0.173, respectively). CONCLUSIONS Key quality indicators provide quantifiable evidence for evaluating the care quality in aged care facilities, but their applicability needs continuous improvement. RELEVANCE TO CLINICAL PRACTICE Nine key quality indicators were selected from numerous indicators for measuring the care quality in aged care facilities, supporting the evaluation of the care quality and self-supervision for aged care facilities. ELDERLY OR PUBLIC CONTRIBUTION No elderly or public contribution.
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Affiliation(s)
- Lichun Yan
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Haixu Pu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Xiaoyin Shi
- Zhangjiajie College of Jishou University, Zhangjiajie, China
| | - Qian Yu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Zhiyi Wang
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Yajing Hu
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
| | - Yinhua Zhang
- School of Nursing, Hunan University of Chinese Medicine, Changsha, China
- Affiliated Changde Hospital of Hunan University of Chinese Medicine, Changde, China
| | - Xiaoqin Zhang
- School of Marxism, Hunan University of Chinese Medicine, Changsha, China
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84
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Görücü S, Gürol Arslan G. The Investigation of Death Anxiety and Spiritual Well-Being Levels of Family Members of Patients Admitted to Intensive Care Unit. J Caring Sci 2024; 13:20-26. [PMID: 38659436 PMCID: PMC11036169 DOI: 10.34172/jcs.2024.33069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/12/2023] [Indexed: 04/26/2024] Open
Abstract
Introduction This study aimed to investigate the death anxiety (DA) and spiritual well-being (SWB) levels of first-degree family members of patients hospitalized in the intensive care unit (ICU). Methods The data of this descriptive correlational type of study were collected through a faceto-face interview and survey with 308 family members who came to visit family members treated in the ICU of a public hospital in the western province of Turkey. Results were analyzed with SPSS software version 22. Results The average Death Anxiety Scale (DAS) score of the family members is 7.99 (3.15), which is above the middle value (min/max; 0-15), and the average Spiritual Well-Being Scale (SWBS) score is 121.83 (12.91), which is relatively high (min/max; 29-145). A positive, weak, and significant correlation existed between DAS and SWBS mean scores (r=0.20; P<0.05). Conclusion As a result, the DA levels of family members increase with the thought of losing their patients in the ICU. During this period, family members of patients need spirituality more than ever to cope with increasing DA. In this study, a positive and significant correlation was found between the DA levels and SWB levels of the family members. According to this result, as family members' DA increases, their spiritual needs also increase.
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Affiliation(s)
- Selçuk Görücü
- Department of Nursing Fundamentals, Kumluca Faculty of Health Sciences, Akdeniz University, Antalya, Turkey
| | - Gülşah Gürol Arslan
- Department of Nursing Fundamentals, Faculty of Nursing, Dokuz Eylül University, Izmir, Turkey
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Altintaş S, Çelik S, Karahan E. The effects of ergonomic sleep mask use on sleep quality and comfort in intensive care patients. J Sleep Res 2024; 33:e13966. [PMID: 37332245 DOI: 10.1111/jsr.13966] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/02/2023] [Accepted: 05/26/2023] [Indexed: 06/20/2023]
Abstract
This study was conducted to determine the effects of the use of ergonomic sleep mask on sleep quality and comfort in intensive care patients. This randomised controlled experimental study was completed with 128 surgical intensive care patients (control = 64, experimental = 64). During the second night of their stay in the unit, ergonomic sleep masks were given to the patients in the experimental group, and earplugs and eye masks were given to the patients in the control group. A Patient information form, Visual analogue scale for discomfort, and the Richard-Campbell sleep questionnaire were used to collect data. While 51.6% of the patients were female, the mean age of the patients was 63.87 ± 14.94 years. The highest rates of patients had undergone cardiovascular surgery (28.9%) and general anaesthesia (57.8%). It was determined that the sleep quality of the patients in the experimental group was statistically and clinically significantly higher after the intervention (50.86 ± 21.46 vs 37.64 ± 14.97, t = -5.355, Cohen's d = 0.450, p < 0.001). Likewise, the patients who used ergonomic sleep masks had a statistically significantly lower mean VAS for Discomfort score, and their comfort level was higher (p < 0.001), but the difference was not clinically significant (Cohen's d = 0.208). The results of this study showed that the use of ergonomic sleep masks in surgical intensive care patients had a more positive effect on both the sleep quality and comfort levels of patients compared with earplugs and eye masks. The use of an ergonomic sleep mask is recommended in the early period to facilitate sleep and rest in surgical intensive care patients.
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Affiliation(s)
- Sibel Altintaş
- Department of Nursing, Bartın University Faculty of Health Sciences, Bartın, Turkey
| | - Sevim Çelik
- Department of Nursing, Bartın University Faculty of Health Sciences, Bartın, Turkey
| | - Elif Karahan
- Department of Nursing, Bartın University Faculty of Health Sciences, Bartın, Turkey
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Tamayo Medel G, Ramasco Rueda F, Ferrando Ortolá C, González de Castro R, Ferrandis Comes R, Pastorini C, Méndez Hernández R, García Fernández J. Description of Intensive Care and Intermediate Care resources managed by Anaesthesiology Departments in Spain and their adaptation capacity during the COVID-19 pandemic. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2024; 71:76-89. [PMID: 38280420 DOI: 10.1016/j.redare.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/18/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION It is essential to understand the strategic importance of intensive care resources in the sustainable organisation of healthcare systems. Our objective has been to identify the intensive and intermediate care beds managed by Anaesthesiology and Resuscitation Services (A-ICU and A-IMCU) in Spain, their human and technical resources, and the changes made to these resources during the COVID-19 pandemic. MATERIAL AND METHODS Prospective observational study performed between December 2020 and July 2021 to register the number and characteristics of A-ICU and A-IMCU beds in hospitals listed in the catalogue published by the Spanish Ministry of Health. RESULTS Data were obtained from 313 hospitals (98% of all hospitals with more than 500 beds, 70% of all hospitals with more than 100 beds). One hundred and forty seven of these hospitals had an A-ICU with a total of 1702 beds. This capacity increased to 2107 (124%) during the COVID-19 pandemic. Three hundred and eight hospitals had an A-IMCU with a total of 3470 beds, 52.9% (2089) of which provided long-term care. The hospitals had 1900 ventilators, at a ratio of 1.07 respirators per A-ICU; 1559 anaesthesiologists dedicated more than 40% of their working time to intensive care. The nurse-to-bed ratio in A-ICUs was 2.8. DISCUSSION A large proportion of fully-equipped ICU and IMCU beds in Spanish hospitals are managed by the anaesthesiology service. A-ICU and A-IMCUs have shown an extraordinary capacity to adapt their resources to meet the increased demand for intensive care during the COVID-19 pandemic.
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Affiliation(s)
- G Tamayo Medel
- Hospital Universitario Cruces, ISS BioCruces, Bizkaia, Spain.
| | | | - C Ferrando Ortolá
- Hospital Clínic, Institut d'Investigació August Pi i Sunyer, Barcelona, Spain; CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
| | | | - R Ferrandis Comes
- Hospital Universitari i Politècnic La Fe, Valencia, Spain; Facultad de Medicina, Universidad de Valencia, Valencia, Spain
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Saavedra-Mitjans M, Frenette AJ, McCredie VA, Burry L, Arbour C, Mehta S, Charbonney E, Wang HT, Albert M, Bernard F, Williamson D. Physicians' beliefs and perceived importance of traumatic brain injury-associated agitation in critically ill patients: a survey of Canadian intensivists. Can J Anaesth 2024; 71:264-273. [PMID: 38129356 DOI: 10.1007/s12630-023-02666-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 12/23/2023] Open
Abstract
PURPOSE Agitation is a common behavioural problem following traumatic brain injury (TBI). Intensive care unit (ICU) physicians' perspectives regarding TBI-associated agitation are unknown. Our objective was to describe physicians' beliefs and perceived importance of TBI-associated agitation in critically ill patients. METHODS Following current standard guidance, we built an electronic, self-administrated, 42-item survey, pretested it for reliability and validity, and distributed it to 219 physicians working in 18 ICU level-1 trauma centres in Canada. We report the results using descriptive statistics. RESULTS The overall response rate was 93/219 (42%), and 76/93 (82%) respondents completed the full survey. Most respondents were men with ten or more years of experience. Respondents believed that pre-existing dementia (90%) and regular recreational drug use (86%) are risk factors for agitation. Concerning management, 91% believed that the use of physical restraints could worsen agitation, 90% believed that having family at the bedside reduces agitation, and 72% believed that alpha-2 adrenergic agonists are efficacious for managing TBI agitation. Variability was observed in beliefs on epidemiology, sex, gender, age, socioeconomic status, and other pharmacologic options. Respondents considered TBI agitation frequent enough to justify the implementation of management protocols (87%), perceived the current level of clinical evidence on TBI agitation management to be insufficient (84%), and expressed concerns about acute and long-term detrimental outcomes and burden to patients, health care professionals, and relatives (85%). CONCLUSION Traumatic brain injury-associated agitation in critically ill patients was perceived as an important issue for most ICU physicians. Physicians agreed on multiple approaches to manage TBI-associated agitation although agreement on epidemiology and risk factors was variable.
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Affiliation(s)
- Mar Saavedra-Mitjans
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada.
- Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montreal, QC, Canada.
| | - Anne Julie Frenette
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montreal, QC, Canada
- Pharmacy Department, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Victoria A McCredie
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, University Health Network and Sinai Health System, Toronto, ON, Canada
- Krembil Research Institute, Toronto, ON, Canada
| | - Lisa Burry
- Department of Pharmacy, Mount Sinai Hospital, Toronto, ON, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Caroline Arbour
- Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montreal, QC, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Sangeeta Mehta
- Department of Medicine, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
- Department of Medicine, Sinai Health, Toronto, ON, Canada
| | - Emmanuel Charbonney
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Han Ting Wang
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Medicine, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
- Research Centre, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Martin Albert
- Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Francis Bernard
- Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
- Department of Medicine, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - David Williamson
- Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada
- Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux du Nord-de-l'île-de-Montréal, Montreal, QC, Canada
- Pharmacy Department, Hôpital du Sacré-Cœur de Montréal, Montreal, QC, Canada
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Lou J, Fan Y, Cui S, Huang N, Jin G, Chen C, Zhang C, Li J. Development and validation of a nomogram to predict hypothermia in adult burn patients during escharectomy under general anesthesia. Burns 2024; 50:93-105. [PMID: 37821272 DOI: 10.1016/j.burns.2023.06.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 04/13/2023] [Accepted: 06/12/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND It is very common for burn patients to have hypothermia during escharectomy under general anesthesia, which increases the blood transfusion demand of burn patients, and may lead to blood coagulation disorder or even increase the mortality of patients. It is important to predict the occurrence of hypothermia in advance, but we lack a prognostic prediction model. Our study aimed to develop a nomogram to predict the incidence of hypothermia in adult burn patients undergoing escharectomy under general anesthesia to intervention the hazards associated with hypothermia early. METHODS This retrospective study included 978 adult burn patients who underwent simple escharectomy under general anesthesia during hospitalization between January 2017 and December 2022, they were further divided into a training cohort and a validation cohort. The clinical data were recorded in electronic medical record system and a self-made collection table of intraoperative hypothermia. The preliminary predictive factors for hypothermia which undergoing simple escharectomy under general anesthesia in burn patients were determined using least absolute shrinkage and selection operator (LASSO) at first, then the final predictive factors determined using binary logistic regression analyses and a nomogram to predict the occurrence of hypothermia was established. The index of concordance(C-index), calibration curves, receiver operating characteristic (ROC) curve, and decision curve analysis (DCA) were used to evaluate the performance of the model. RESULTS A total of 211 patients with hypothermia and 767 patients without hypothermia were selected. Least absolute shrinkage and selection operator regression analysis and binary logistic regression results concluded that burn index, urinary volume, blood transfusion volume and irrigation volume were significantly associated with hypothermia in burn patients undergoing escharectomy under general anesthesia. The nomogram based on these four variables had good predictive efficiency for hypothermia in adult burn patients during escharectomy under general anesthesia, the C-index in the training cohort was 0.903, areas under the receiver operating characteristic curves (AUROC) of for the training cohort (95 % CI 0.877-0.920) and 0.875 for the validation cohort (95 % CI 0.852-0.897) indicated satisfactory discriminative ability of the nomogram, and the calibration curves for the training cohort and the validation cohort also fit as well, indicating that the nomogram had good clinical application value. CONCLUSIONS Hypothermia in burn patients during escharectomy under general anesthesia is associated with burn index, urinary volume, blood transfusion volume and irrigation volume. We successfully developed a practical nomogram to accurately predict hypothermia, which is a practical method helping clinicians rapidly and conveniently diagnose and guide the treatment of hypothermia in burn patients during escharectomy under general anesthesia.
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Affiliation(s)
- Jiaqi Lou
- Burn Department, Ningbo No. 2 Hospital, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China.
| | - Youfen Fan
- Burn Department, Ningbo No. 2 Hospital, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
| | - Shengyong Cui
- Burn Department, Ningbo No. 2 Hospital, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
| | - Neng Huang
- Burn Department, Ningbo No. 2 Hospital, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
| | - Guoying Jin
- Burn Department, Ningbo No. 2 Hospital, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
| | - Cui Chen
- Burn Department, Ningbo No. 2 Hospital, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
| | - Chun Zhang
- Burn Department, Ningbo No. 2 Hospital, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China
| | - Jiliang Li
- Burn Department, Ningbo No. 2 Hospital, No. 41 Northwest Street, Haishu District, Ningbo 315010, Zhejiang Province, China.
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Lee PJ, Hampton T. Smartphone applications for measuring noise in the intensive care unit: A feasibility study. J Crit Care 2024; 79:154435. [PMID: 37757672 DOI: 10.1016/j.jcrc.2023.154435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023]
Abstract
PURPOSE This study aims to explore the suitability of using smartphone applications with low-cost external microphones in measuring noise levels in intensive care units. METHODS Four apps and two external microphones were tested in a laboratory by generating test signals at five noise levels. The average noise levels were measured using the apps and a professional device (i.e. a sound level meter). A field test was performed in an intensive care unit with two apps and one microphone. Noise levels were measured in terms of average and maximum noise levels according to the World Health Organisation's guidance. All the measurements in both tests were conducted after acoustic calibration using a sound calibrator. RESULTS Overall, apps with low-cost external microphones produced reliable results of averaged noise levels in both the laboratory and field settings. The differences between the apps and the sound level meter were within ±2 dB. In the field test, the best combination of app and microphone showed negligible difference (< 2 dB) compared to the sound level meter in terms of the average noise level. However, the maximum noise level measured by the apps exhibited significant differences from those measured by the sound level meter, ranging from -0.9 dB to -4.7 dB. CONCLUSION Smartphone apps and low-cost external microphones can be used reliably to measure the average noise level in the intensive care unit after acoustic calibration. However, professional equipment is still necessary for accurate measurement of the maximum noise level.
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Affiliation(s)
- Pyoung Jik Lee
- Acoustics Research Unit, School of Architecture, University of Liverpool, Liverpool, UK.
| | - Thomas Hampton
- ENT Department, Alder Hey Children's Hospital, Liverpool, UK; Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
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90
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Gil-Almagro F, García-Hedrera FJ, Carmona-Monge FJ, Peñacoba-Puente C. From Anxiety to Hardiness: The Role of Self-Efficacy in Spanish CCU Nurses in the COVID-19 Pandemic. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:215. [PMID: 38399503 PMCID: PMC10890432 DOI: 10.3390/medicina60020215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/21/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: Evidence shows that throughout the COVID-19 pandemic, nurses suffered from emotional symptoms, yet in spite of this, few studies within "positive psychology" have analyzed the emergence/promotion of positive traits, such as hardiness. In this context, the present study aimed to test a model regarding the mediating role of self-efficacy between anxiety experienced at the beginning of the COVID-19 pandemic and hardiness assessed six months later among nurses in critical care units (CCU) in Spain. Materials and Methods: An observational, descriptive, prospective longitudinal study with two data collection periods: (1) from the 1 to the 21 June 2020 (final phase of the state of alarm declared in Spain on 14 March) in which socio-demographic and occupational variables, anxiety (Depression, Anxiety and Stress Scale, DASS-21), self-efficacy (General Self-Efficacy Scale, GSES) and basal resilience (Resilience Scale-14, RS-14) were assessed, and (2) a follow-up 6 months later (January-March 2021) in which hardiness (Occupational Hardiness Questionnaire, OHQ) was evaluated. To analyze the data, multivariate regressions were performed using the PROCESS macro (simple mediation, model 4). Results: A total of 131 Spanish nurses from CCUs, with a mean age of 40.54 years (88.5% women) participated in the study. Moderate and severe levels of anxiety were observed in 19.1% of the sample. Significant and positive correlations were observed between self-efficacy, hardiness and resilience (all p < 0.001). Significant negative correlations were observed between anxiety and self-efficacy (p < 0.001), hardiness (p = 0.027) and resilience (p = 0.005). The indirect effect of anxiety on hardiness through self-efficacy was significant (Effect (SE) = -0.275 (0.100); LLCI = -0.487, ULCI = -0.097), contributing to 28% of the variance, including resilience (p = 0.015), age (p = 0.784), gender (p = 0.294) and years of experience (p = 0.652) as covariates. A total mediation was observed (non-significant anxiety-hardiness direct effect; Effect (SE) = -0.053 (0.215), t = 0.248, p = 0.804, LLCI = -0.372, ULCI = 0.479). Conclusions: The results suggest that in Spanish CCU nurses, anxiety experienced at the beginning of the COVID-19 pandemic may contribute to the development of hardiness through positive resources such as self-efficacy.
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Affiliation(s)
- Fernanda Gil-Almagro
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
- Hospital Universitario Fundación Alcorcón, 28922 Alcorcón, Spain;
| | | | | | - Cecilia Peñacoba-Puente
- Departamento de Psicología, Facultad de Ciencias de la Salud, Universidad Rey Juan Carlos, 28922 Alcorcón, Spain;
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91
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López-Jardón P, Martínez-Fernández MC, García-Fernández R, Martín-Vázquez C, Verdeal-Dacal R. Utility of Intermediate Care Units: A Systematic Review Study. Healthcare (Basel) 2024; 12:296. [PMID: 38338181 PMCID: PMC10855835 DOI: 10.3390/healthcare12030296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Intermediate care units (IMCUs) have become increasingly important in the care of critical and semi-critical patients, particularly during the COVID-19 pandemic. However, there is still no clear definition of their structural characteristics, specialties, types of patients, and the benefits they provide. The aim of this work is to describe the current state of implementation and operation of IMCUs in hospitals and patient care. To achieve this goal, a systematic review was conducted in the Web of Science, Scopus and CINAHL databases, along with a hand search. The research yielded 419 documents, of which 26 were included in this review after applying inclusion and exclusion criteria. The results were highly diverse and were categorized based on the following topics: material resources, human resources, continuity of care, and patient benefits. Despite the different objectives outlined in the studies, all of them demonstrate the numerous benefits provided by an IMCU, along with the increased relevance of this type of unit in recent years. Therefore, this systematic review highlights the benefits of IMCUs in the care of critical patients, as well as the role of health workers in these units.
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Affiliation(s)
| | - María Cristina Martínez-Fernández
- SALBIS Research Group, Faculty of Health Sciences, Department of Nursing and Physiotherapy, Campus de Ponferrada, Universidad de León, 24401 León, Spain;
| | - Rubén García-Fernández
- SALBIS Research Group, Faculty of Health Sciences, Department of Nursing and Physiotherapy, Campus de Ponferrada, Universidad de León, 24401 León, Spain;
- Nursing Research, Innovation and Development Centre of Lisbon (CIDNUR), Nursing School of Lisbon, 1600-190 Lisbon, Portugal
| | - Cristian Martín-Vázquez
- Department of Nursing and Physiotherapy, Campus de Ponferrada, Universidad de León, 24401 León, Spain;
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92
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Andoulsi Y, Hue O, Brousseau M, Hill J, Alleyne J, Blanchette V. Competency Framework for Podiatric Medicine Training: A Validation Report Based on an Adapted E-Delphi Across Canada. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241234974. [PMID: 38415024 PMCID: PMC10898292 DOI: 10.1177/23821205241234974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/21/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES Competency-based medical education has been introduced into many health professional curricula. Based on CanMEDs, a framework has recently been developed for podiatric medicine education in Canada. This study aimed to validate the framework through a consensus of various podiatric medicine experts across Canada. METHODS An adapted Delphi method was used for content validation. Two structured online questionnaires were used to gather expert opinions and agreement on the roles and core competencies described in the framework previously developed. The validation consensus threshold was set at a minimum of 80% agreement. The summary of comments and suggestions was used to reformulate certain items after the research team reached a consensus. RESULTS Out of the 51 experts invited from the Canadian Podiatric Medicine Association, 19 completed the first-round questionnaire (mean podiatric experience = 24.5 years; standard deviation 17.6). After the first round, "Podiatric Expert", "Communicator" and "Scholar" roles have been modified. After these modifications, a consensus was obtained at the second round completed by 13 experts. Overall, 95% of the experts agreed that the competency framework was relevant even if some indicators would need to be adapted to suit the requirements of each province and territory. CONCLUSION This validated framework supports the excellence and the quality of our podiatric educational program. It also promotes the adoption of a uniform education of podiatrists in Canada and worldwide.
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Affiliation(s)
- Yassin Andoulsi
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Olivier Hue
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Martine Brousseau
- Occupational Therapy Department, Université du Québec à Trois-Rivières, Trois-Rivieres, Canada
| | | | - Joel Alleyne
- Canadian Podiatric Medical Association,Ontario, Canada
- Faculty of Information, University of Toronto, Toronto, Canada
| | - Virginie Blanchette
- Department of Human Kinetics and Podiatric Medicine, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
- VITAM - Sustainable Health Research Centre, Québec, Canada
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93
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Zaragoza-García I. Invisible hunger in the Intensive Care Unit: Care strategies and essential considerations. ENFERMERIA INTENSIVA 2024; 35:1-4. [PMID: 38388073 DOI: 10.1016/j.enfie.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/28/2023] [Indexed: 02/24/2024]
Affiliation(s)
- I Zaragoza-García
- Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, Spain.
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Fernández-Castillo RJ, González-Caro MD, Arroyo-Muñoz FJ, Garnacho-Montero J. National survey on changes in visitation, communication and end-of-life care policies in intensive care units through the different COVID-19 pandemic's waves (COVIFAUCI study). ENFERMERIA INTENSIVA 2024; 35:35-44. [PMID: 37558544 DOI: 10.1016/j.enfie.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/06/2023] [Accepted: 04/11/2023] [Indexed: 08/11/2023]
Abstract
INTRODUCTION The pandemic derived from the SARS-CoV-2 infection led to changes in care for both relatives and intensive care patients during the different waves of incidence of the virus. The line of humanization followed by the majority of the hospitals was seriously affected by the restrictions applied. As an objective, we propose to know the modifications suffered during the different waves of the SARS-CoV-2 pandemic in Spain regarding the policy of visits to patients in the ICU, monitoring at the end of life, and the use of new technologies. of communication between family members, patients and professionals. METHODS Multicenter cross-sectional descriptive study through a survey of Spanish ICUs from February to April 2022. Statistical analysis methods were performed on the results as appropriate. The study was endorsed by the Spanish Society of Intensive Nursing and Coronary Units. RESULTS 29% of the units contacted responded. The daily visiting minutes of relatives dropped drastically from 135 (87.5-255) to 45 (25-60) in the 21.2% of units that allowed their access, improving slightly with the passing of the waves. In the case of bereavement, the permissiveness was greater, increasing the use of new technologies for patient-family communication in the case of 96.5% of the units. CONCLUSIONS The family of patients admitted to the ICU during the different waves of the COVID-19 pandemic have suffered restrictions on visits and a change from face-to-face to virtual communication techniques. Access times were reduced to minimum levels during the first wave, recovering with the advance of the pandemic but never reaching initial levels. Despite the implemented solutions and virtual communication, efforts should be directed towards improving the protocols for the humanization of healthcare that allow caring for families and patients whatever the healthcare context.
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Affiliation(s)
- R-J Fernández-Castillo
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain; Departamento de Enfermería, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, Sevilla, Spain
| | - M-D González-Caro
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - F-J Arroyo-Muñoz
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - J Garnacho-Montero
- Unidad Clínica de Cuidados Intensivos, Hospital Universitario Virgen Macarena, Sevilla, Spain
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95
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Liu Q, Zhang M, Guo X, Zhang Y, Qin T, Wang Y, Gai Y. The Chinese Version of the Palliative Nursing Care Quality Scale: Translation, Cross-Cultural Adaptation, and Validity. J Palliat Care 2024; 39:47-57. [PMID: 37828752 DOI: 10.1177/08258597231204593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Nurses play an important role in palliative care, and high-quality assessment tools can help standardize palliative-related nursing behaviors, but there are no such tools in China. OBJECTIVE This study aimed to revise, cross-culturally adapt, and validate the Palliative Nursing Care Quality Scale (PNCQS) to provide an effective tool that can help nurses in mainland China assess the quality of palliative care. METHODS This study involved a 2-steps process. First, the PNCQS was translated, back-translated, and cross-cultural adapted using Brislin's translation model. Second, a cross-sectional study was used to evaluate the reliability and validity of the revised scale. From January to February 2023, 367 nurses engaged in palliative care-related nursing from 3 tertiary A general hospitals were surveyed with the revised scale. The evaluation methods used in this study included item analysis, test-retest reliability, internal consistency, criterion-related validity, content validity, and construct validity. RESULTS The PNCQS-Chinese included 20 items. In this study, the item-total correlation coefficients ranged from 0.67 to 0.83 (P < .01), and the critical ratio value of the items was 12.10 to 23.34 (P < .01). The scale-level content validity index was 0.98, and the item-level content validity ranged from 0.86 to 1.00. The total Cronbach's α and test-retest reliability of the scale were 0.96 and 0.79, respectively. Factor analysis of 20 items extracted 1 factor, and the contribution rate of cumulative variance was 60.03%. CONCLUSIONS PNCQS-Chinese shows acceptable validity and reliability for assessing the quality of palliative care-related nursing in mainland China.
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Affiliation(s)
- Qingwei Liu
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Meng Zhang
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xiaojing Guo
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yuchen Zhang
- Department of Nursing, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tong Qin
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Ying Wang
- Department of Oncology, Qingdao MUnicipal Hospital, Qingdao, China
| | - Yubiao Gai
- Department of Critical Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China
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Jørgensen JB, Clement SL. Validation of the Danish version of the knowledge and attitudes survey regarding pain. Scand J Pain 2024; 24:sjpain-2023-0140. [PMID: 38452355 DOI: 10.1515/sjpain-2023-0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 03/09/2024]
Abstract
OBJECTIVES Pain management is critical for nurses; therefore, knowledge assessment is also critical. The Knowledge and Attitudes Survey Regarding Pain (KASRP), designed for testing pain management knowledge among nurses, finds widespread use internationally; yet, key validity evidence according to American Psychological Association standards is missing. Therefore, this study aimed to translate and test the psychometric traits of KASRP based on an item response theory model. METHODS Cronbach's α was included to assess internal consistency, and the Kolmogorov-Smirnov test was included to assess the total score normal distribution goodness of fit. KASRP was tested using the Kaiser-Meyer-Olkin (KMO) test for sphericity to examine its suitability for factor analysis and exploratory factor analysis to examine construct evidence. The Kruskal-Wallis H test was used to assess discriminant evidence. The correlation between KASRP and the Brockopp-Warden Pain Knowledge Questionnaire (BWPKQ) was included as a measure of convergent validity evidence, and correlation with self-assessed knowledge was tested as a divergent validity measure. RESULTS The questionnaire was translated using back-forth and parallel translation. The KMO test for sphericity was 0.49 for all items and 0.53 for the adjusted scale without items 30, 33, and 36, with factor analysis explaining 70.42% of the variation suggesting unacceptable construct validity evidence. Cronbach's α was 0.75, suggesting acceptable reliability evidence; the Kolmogorov-Smirnov test revealed an insignificant skewness of -0.195 and a kurtosis of 0.001, while the Kruskal-Wallis H test revealed a significance of p < 0.001. The correlation between KASRP and the BWPKQ was 0.69 (p = 0.0001), suggesting acceptable convergent validity evidence. A correlation between KASRP and self-assessed knowledge of -0.59 was also found, which suggests acceptable divergent validity evidence. CONCLUSIONS The translated KASRP passed six out of seven tests based on the given sample.
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Affiliation(s)
- Jacob Brauner Jørgensen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Sanne Lund Clement
- Institut for Politik og Samfund, Aalborg University, Fibigerstræde 1, 57, 9220 Aalborg Ø, Denmark
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Mohammad EB, Al Eleiwah AA, Qurdahji BT, Rayan A, Alshraideh JA, Al Hadid LA, Al Kharabsheh MS, Hudhud HN, Jakalat S. Oral Care and Positioning to Prevent Ventilator-Associated Pneumonia: A Systematic Review. SAGE Open Nurs 2024; 10:23779608241271699. [PMID: 39130054 PMCID: PMC11311145 DOI: 10.1177/23779608241271699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 06/14/2024] [Accepted: 06/28/2024] [Indexed: 08/13/2024] Open
Abstract
Introduction Ventilator-associated pneumonia (VAP) is one of the most common nosocomial infections in critical patients. The negative impacts of VAP on patient outcomes emphasize the importance of effective preventive measures such as oral care and patient positioning. The aim of this review was to investigate the impact of oral care and positioning on the prevention of VAP among patients in the intensive care unit. Methods This review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed. The methodological quality of included studies was appraised using Joanna Briggs Institute checklists. Results In total 13 studies were included, all of them were randomized controlled trials. Six out of nine studies about oral care have significant results on VAP incidence. Regarding the position, Patients positioned at a 45-degree were less likely to develop VAP than those positioned at a 30-degree and those in a supine position. Conclusion Although patients positioned at 45-degree angle were less likely to develop VAP than those at 30-degree, it is necessary to individualize this practice before recommending it, once there are some contraindications, such as neurocritical patients. Regarding oral care to prevent VAP, considering the current guidelines' recommendation not to use oral chlorexidine, further studies evaluating alternatives are needed.
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Affiliation(s)
- Eslam Bani Mohammad
- Department of Nursing/Faculty of Nursing, Al-Balqa Applied University, Al-Salt, Jordan
| | | | - Banan T. Qurdahji
- Department of Nursing, School of Nursing, University of Jordan, Amman, Jordan
| | - Ahmad Rayan
- Faculty of Nursing, Zarqa University, Zarqa, Jordan
| | - Jafar A. Alshraideh
- Clinical Nursing Department, School of Nursing, University of Jordan, Amman, Jordan
| | | | - Muna S. Al Kharabsheh
- Department of Nursing/Faculty of Nursing, Al-Balqa Applied University, Al-Salt, Jordan
| | - Heba N. Hudhud
- Department of Nursing/Faculty of Nursing, Al-Balqa Applied University, Al-Salt, Jordan
| | - Suad Jakalat
- Midwifery Department, School of Nursing, Al-Balqa Applied University, Al-Salt, Jordan
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Li B, Yue L, Nie H, Cao Z, Chai X, Peng B, Zhang T, Huang W. The effect of intelligent management interventions in intensive care units to reduce false alarms: An integrative review. Int J Nurs Sci 2024; 11:133-142. [PMID: 38352290 PMCID: PMC10859571 DOI: 10.1016/j.ijnss.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/03/2023] [Accepted: 12/11/2023] [Indexed: 02/16/2024] Open
Abstract
Objective In intensive care units (ICU), frequent false alarms from medical equipment can cause alarm fatigue among nurses, which might lead to delayed or missed responses and increased risk of adverse patient events. This review was conducted to evaluate the effectiveness of intelligent management interventions to reduce false alarms in ICU. Method Following the framework of Whitmore and Knafl, the reviewers systematically searched six databases: PubMed, EMBASE, CINAHL, OVID, Cochrane Library, and Scopus, and studies included intelligent management of clinical alarms published in the English or Chinese language from the inception of each database to December 2022 were retrieved. The researchers used the PICOS framework to formulate the search strategy, developed keywords, screened literature, and assessed the studies' quality using the Joanna Briggs Institute-Meta-Analysis of Statistics, Assessment, and Review Instrument (JBI-MAStARI). The review was preregistered on PROSPERO (CRD42023411552). Results Seven studies met the inclusion criteria. The results showed that different interventions for intelligent management of alarms were beneficial in reducing the number of false alarms, the duration of alarms, the response time to important alarms for nurses, and the alarm fatigue levels among nurses. Positive results were found in practice after the application of the novel alarm management approaches. Conclusion Intelligent management intervention may be an effective way to reduce false alarms. The application of systems or tools for the intelligent management of clinical alarms is urgent in hospitals. To ensure more effective patient monitoring and less distress for nurses, more alarm management approaches combined with artificial intelligence will be needed in the future to enable accurate identification of critical alarms, ensure nurses are responding accurately to alarms, and make a real difference to alarm-ridden healthcare environments.
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Affiliation(s)
- Bingyu Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Liqing Yue
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Huiyu Nie
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ziwei Cao
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoya Chai
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Bin Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Tiange Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan, China
| | - Weihong Huang
- “Mobile Health” Ministry of Education - China Mobile Joint Laboratory, Xiangya Hospital of Central South University, Changsha, Hunan, China
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Georgakis S, Dragioti E, Gouva M, Papathanakos G, Koulouras V. The Complex Dynamics of Decision-Making at the End of Life in the Intensive Care Unit: A Systematic Review of Stakeholders' Views and Influential Factors. Cureus 2024; 16:e52912. [PMID: 38406151 PMCID: PMC10893775 DOI: 10.7759/cureus.52912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
A lack of consensus resulting in severe conflicts is often observed between the stakeholders regarding their respective roles in end-of-life (EOL) decision-making in the ICU. Since the burden of these decisions lies upon the individuals, their opinions must be known by medical, judicial, legislative, and governmental authorities. Part of the solution to the issues that arise would be to examine and understand the views of the people in different societies. Hence, in this systematic review, we assessed the attitudes of the physicians, nurses, families, and the general public toward who should be involved in decision-making and influencing factors. Toward this, we searched three electronic databases, i.e., PubMed, CINAHL (Cumulative Index to Nursing & Allied Health), and Embase. A matrix was developed, discussed, accepted, and used for data extraction by two independent investigators. Study quality was evaluated using the Newcastle-Ottawa Scale. Data were extracted by one researcher and double-checked by a second one, and any discrepancies were discussed with a third researcher. The data were analyzed descriptively and synthesized according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Thirty-three studies met our inclusion criteria. Most involved healthcare professionals and reported geographic variations in different timeframes. While paternalistic features have been observed, physicians overall showed an inclination toward collaborative decision-making. Correspondingly, the nursing staff, families, and the public are aligned toward patient and relatives' participation, with nurses expressing their own involvement as well. Six categories of influencing factors were identified, with high-impact factors, including demographics, fear of litigation, and regulation-related ones. Findings delineate three key points. Firstly, overall stakeholders' perspectives toward EOL decision-making in the ICU seem to be leaning toward a more collaborative decision-making direction. Secondly, to reduce conflicts and reach a consensus, multifaceted efforts are needed by both healthcare professionals and governmental/regulatory authorities. Finally, due to the multifactorial complexity of the subject, directly related to demographic and regulatory factors, these efforts should be more extensively sought at a regional level.
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Affiliation(s)
- Spiros Georgakis
- Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, GRC
| | - Elena Dragioti
- Research Laboratory Psychology of Patients, Families & Health Professionals, University of Ioannina, Ioannina, GRC
| | - Mary Gouva
- Research Laboratory Psychology of Patients, Families & Health Professionals, University of Ioannina, Ioannina, GRC
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Lima J, Foletto E, Cardoso RCB, Garbelotto C, Frenzel AP, Carneiro JU, Carpes LS, Barbosa-Silva TG, Gonzalez MC, Silva FM. Ultrasound for measurement of skeletal muscle mass quantity and muscle composition/architecture in critically ill patients: A scoping review on studies' aims, methods, and findings. Clin Nutr 2024; 43:95-110. [PMID: 38016244 DOI: 10.1016/j.clnu.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/24/2023] [Accepted: 11/06/2023] [Indexed: 11/30/2023]
Abstract
AIMS This scoping review aimed to identify, explore, and map the objectives, methodological aspects, and results of studies that used ultrasound (US) to assess skeletal muscle (SM) in critically ill patients. METHODS A scoping review was conducted according to the Joanna Briggs Institute's methodology. All studies that evaluated SM parameters from the US in patients admitted to the intensive care unit (ICU) were considered eligible. We categorized muscle thickness and cross-sectional area as parameters for assessing SM quantity, while echogenicity, fascicle length, and pennation angle analysis were used to evaluate muscle "quality" (composition/architecture). A literature search was conducted using four databases for articles published until December 2022. Independent reviewers selected the studies and extracted data. Descriptive statistics were calculated to present the results. RESULTS A total of 107 studies were included, the majority of which were prospective cohort studies (59.8 %) conducted in general ICUs (49.5 %). The most frequent objective of the studies was to evaluate SM quantity depletion during the ICU stay (25.2 %), followed by determining whether a specific intervention would modify SM (21.5 %). Most studies performed serial SM evaluations (76.1 %). The rectus femoris muscle thickness was evaluated in most studies (67.9 %), followed by the rectus femoris cross-sectional area (54.3 %) and the vastus intermedius muscle thickness (40.2 %). The studies demonstrated the feasibility and reproducibility of US for SM evaluation, especially related to quantitative parameters. Most studies (70.3 %) reported significant SM quantity depletion during hospitalization. However, the accuracy of the US in measuring SM varied across the studies. CONCLUSIONS The lack of detailed description and standardization in the protocols adopted by the studies included in this scoping review precludes the translation of the evidence related to US for SM assessment into clinical practice.
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Affiliation(s)
- Júlia Lima
- Nutrition Science Graduate Program, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Estéfani Foletto
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Rafaella C B Cardoso
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Charlles Garbelotto
- Nutrition Course, Department, Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Aline P Frenzel
- Postgraduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas Brazil
| | - Juliana U Carneiro
- Multiprofessional Residency Program: Intensive Care. Federal University of Health Sciences of Porto Alegre, Porto Alegre Brazil
| | - Larissa S Carpes
- Santa Casa de Misericórdia de Porto Alegre Hospital, Porto Alegre Brazil
| | - Thiago G Barbosa-Silva
- Department of General Surgery, Faculty of Medicine, Federal University of Pelotas, Pelotas Brazil
| | | | - Flávia M Silva
- Nutrition Department and Nutrition Science Graduate Program. Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre Brazil.
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