Opinion on the benefits of nurse prescribing in Catalonia. Consensus of health professionals and managers.

OBJECTIVE: To study the level of agreement among health professionals and managers in Catalonia on the benefits of nurse prescribing (NP). METHOD: An online Real Time Delphi was conducted to collect the level of agreement of health professionals and managers. Participants voted in a 6-point scale (1 low benefit and 6 high benefit) for 12 items describing benefits of NP. A total of 1332 professionals participated. The level of consensus was calculated applying interquartile ranges of scores and standardized mean differences among subgroups using effect sizes (ES) and their corresponding 95% confidence intervals. RESULTS: The scores indicate a general agreement on the perceived benefits of NP among participants. Standardized differences among scores on the perceived benefits among professionals were small to high (ES range between 0.2 and 1.2) between nurses and medical doctors and high between nurses and pharmacists (ES range: 1.2 and 2.4). Differences between scores of nurses and those of managers or other professionals in the present study were smaller for most voted benefits. CONCLUSIONS: The study shows an agreement on the benefits of NP. Nevertheless, when standardized scores are taken into consideration, differences among professionals' perceptions emerged, and aligned with documented barriers identified in the literature such as corporative aspects, cultural limitations, institutional and organisational inertia, beliefs and unawareness of what NP implies.

Opinion on the benefits of nurse prescribing in Catalonia. Consensus of health professionals and managers / Opinión sobre los beneficios de la prescripción enfermera en Cataluña. Consenso de profesionales de la salud y gestores

Objective: To study the level of agreement among health professionals and managers in Catalonia on the benefits of nurse prescribing (NP). Method: An online Real Time Delphi was conducted to collect the level of agreement of health professionals and managers. Participants voted in a 6-point scale (1 low benefit and 6 high benefit) for 12 items describing benefits of NP. A total of 1332 professionals participated. The level of consensus was calculated applying interquartile ranges of scores and standardized mean differences among subgroups using effect sizes (ES) and their corresponding 95% confidence intervals. Results: The scores indicate a general agreement on the perceived benefits of NP among participants. Standardized differences among scores on the perceived benefits among professionals were small to high (ES range between 0.2 and 1.2) between nurses and medical doctors and high between nurses and pharmacists (ES range: 1.2 and 2.4). Differences between scores of nurses and those of managers or other professionals in the present study were smaller for most voted benefits. Conclusions: The study shows an agreement on the benefits of NP. Nevertheless, when standardized scores are taken into consideration, differences among professionals’ perceptions emerged, and aligned with documented barriers identified in the literature such as corporative aspects, cultural limitations, institutional and organisational inertia, beliefs and unawareness of what NP implies.(AU)

Objetivo: Estudiar el nivel de consenso entre profesionales de salud y gestores en Cataluña sobre los beneficios de la prescripción enfermera (PE). Método: Se realizó un Delphi en tiempo real en línea para recoger el nivel de acuerdo de profesionales de la salud y gestores. Las personas participantes votaron en una escala de 6 puntos (1 bajo beneficio y 6 alto beneficio) en 12 ítems que describen los beneficios de la PE. Participaron 1332 profesionales. El nivel de consenso se calculó aplicando rangos intercuartílicos de puntuaciones y diferencias de medias estandarizadas entre subgrupos a partir de tamaños del efecto (ES) y sus correspondientes intervalos de confianza del 95%. Resultados: Las puntuaciones indican un acuerdo general sobre los beneficios percibidos de la PE entre las personas participantes. Las diferencias estandarizadas entre las puntuaciones sobre los beneficios percibidos entre profesionales fueron de pequeñas a altas (rango ES: 0,2 a 1,2) entre enfermeras y médicos, y altas entre enfermeras y farmacéuticos (rango ES: 1,2 a 2,4). Las diferencias entre las puntuaciones de profesionales de enfermería y gestión clínica u otros profesionales en el presente estudio fueron menores para los beneficios más votados. Conclusiones: El estudio muestra un acuerdo sobre los beneficios de la PE. Sin embargo, cuando se tienen en cuenta las puntuaciones estandarizadas se encontraron algunas diferencias entre las percepciones de profesionales y se alinearon con las barreras documentadas identificadas en la literatura, como aspectos corporativos, limitaciones culturales, inercia institucional y organizativa, creencias y desconocimiento de lo que implica la PE.(AU)

Desarrollo de un índice de capacidad estructural para hospitales de agudos con cirugía oncológica / Development of a structural capacity index for oncological surgery in acute hospitals

Introducción El estudio del impacto de la estructura sobre los resultados se ha basado principalmente en el número de intervenciones. El objetivo de este trabajo fue desarrollar un índice de capacidad estructural para hospitales de agudos con cirugía oncológica. Métodos Estudio transversal por encuesta, relativa a las características estructurales de los centros que habían realizado alguna intervención quirúrgica de oncología digestiva en Cataluña en 2004. Se desarrolló un índice sobre la base de la maximización de la fiabilidad, y se seleccionaron las variables por sus características métricas y también conceptuales. Resultados De los 45 centros seleccionados se obtuvo respuesta válida de 37. El conjunto de variables incluidas en el índice (relacionadas con la docencia, la gestión de casos y la tecnología) presentó buenas propiedades métricas (alfa de Cronbach: 0,92 y correlación ítem-total >0,7).Conclusiones El índice desarrollado permite clasificar los centros hospitalarios atendiendo a sus especificidades tecnológicas, organizativas y de gestión (AU)

Introduction The study of the impact of structure on outcomes has mainly been focused on the number procedures. The aim of our study was to develop a structure capacity index for hospitals for oncological surgery. Methods Cross-sectional study by means of a questionnaire related to the structural characteristics of hospitals that had performed gastrointestinal oncological surgery in Catalonia during 2004. Variables were considered for the index according to their measurement and conceptual properties. Results A response was obtained from 37 out of 48 hospitals. Variables with good conceptual and measurement properties (Cronbach alpha 0.92 and Item-Total correlation >0.7) were included in the index. These variables were related to teaching, management and technology. Conclusions The index has acceptable levels of reliability and validity, and can be a useful tool to classify hospitals according to their technological characteristics and management strategies (AU)

[Development of a structural capacity index for oncological surgery in acute hospitals]. / Desarrollo de un índice de capacidad estructural para hospitales de agudos con cirugía oncológica.

INTRODUCTION: The study of the impact of structure on outcomes has mainly been focused on the number procedures. The aim of our study was to develop a structure capacity index for hospitals for oncological surgery. METHODS: Cross-sectional study by means of a questionnaire related to the structural characteristics of hospitals that had performed gastrointestinal oncological surgery in Catalonia during 2004. Variables were considered for the index according to their measurement and conceptual properties. RESULTS: A response was obtained from 37 out of 48 hospitals. Variables with good conceptual and measurement properties (Cronbach alpha 0.92 and Item-Total correlation >0.7) were included in the index. These variables were related to teaching, management and technology. CONCLUSIONS: The index has acceptable levels of reliability and validity, and can be a useful tool to classify hospitals according to their technological characteristics and management strategies.

Metaanálisis de ensayos clínicos / Meta-analysis of clinical trials

Los metaanálisis son trabajos síntesis de la evidencia científica que hacen explícitas todas las decisiones que se toman en el proceso de revisión (desde los criterios de selección de los artículos originales a los métodos estadísticos para combinar los resultados), sistematizan el proceso de revisión con el objetivo de obtener resultados más exhaustivos y menos susceptibles a sesgos y, además, presentan los resultados de la síntesis de forma cuantitativa, lo que contribuye a una mayor objetividad en su interpretación. Su metodología permite revisar críticamente y combinar estadísticamente por métodos estadísticos formales los resultados de distintos estudios originales con objetivos y características similares o comparables, de modo que pueden dar una respuesta definitiva aún cuando ninguno de los estudios individuales ha podido aportar unos resultados concluyentes a una pregunta de investigación concreta. A estas ventajas se le añaden otras que se presentan en este artículo.También se discuten sus principales limitaciones, se presentan las etapas fundamentales de su metodología (con especial énfasis a la obtención de estimadores combinados del efecto, sus intervalos de confianza y sus pruebas de hipótesis), así como los principales elementos para su correcta interpretación (AU)

Metaanalysis are synthesis works of scientific evidence that make explicit all the decision taken in a review process (from selection criteria of original articles to statistical methods to combine the results), systematize the review process in order to obtain more comprehensive results less and less susceptible to bias, and also present the results of this synthesis in a quantitative form what contributes to a greater objectivity on its interpretation. Its methodology permits critically review and statistically combine, by using formal statistic methods, the results of different original studies with similar or comparable objectives and characteristics, so they can provide a definite reply when none of the individual studies were able to provide concluding a results to a research question. To these advantages, other presented in this paper can be added. Also, the major limitations are discussed, the major methodology stages are presented (with special emphasis in obtaining effect combined estimations, confidence intervals and its hypothesis proofs), so as the principals elements for its correct interpretation (AU)