ABSTRACT
BACKGROUND: Dementia patients often show neuropsychiatric symptoms, known as behavioral and psychological symptoms of dementia (BPSD). These are a common motive for medical consultations, hospitalizations, and nursing home stays. Various studies have suggested that the high prevalence of psychotropic drug use to treat BPSD in institutionalized dementia patients may lead to impaired cognitive capacity, rigidity, somnolence, and other complications during the course of the illness. The aim of this study was to design a consensus-based intervention between care levels to optimize and potentially reduce prescription of psychotropic drugs in institutionalized patients with dementia and assess the changes occurring following its implementation. METHODS: Design: Prospective, quasi-experimental, pre/post intervention, multicenter study. SCOPE: 7 nursing homes associated with a single primary care team. INCLUSION CRITERIA: Institutionalized patients diagnosed with dementia and under treatment with 1 or more psychotropic drugs for at least 3 months. SAMPLE: 240 individuals; mean age, 87 years (SD: 6.795); 75% (180) women. INTERVENTION: Creation of evidence-based therapeutic guidelines for psychotropic drug use in the treatment of BPSD by consensus between reference professionals. Joint review (primary care and geriatric care nursing home professionals) of the medication based on the guidelines and focusing on individual patient needs. Primary variable: Number of psychotropic drugs used per patient. ASSESSMENT: Preintervention, immediate postintervention, and at 1 and 6 months. RESULTS: Overall, the number of psychotropic drugs prescribed was reduced by 28% (from 636 before to 458 after the intervention). The mean number of psychotropic drugs prescribed per patient decreased from 2.71 at baseline to 1.95 at 1 month postintervention and 2.01 at 6 months (p < 0.001 for both time points). Antipsychotics were the drug class showing the highest reduction rate (49.66%). Reintroduction of discontinued psychotropic drugs was 2% at 1 month following the intervention and 12% at 6 months. CONCLUSIONS: A consensus guidelines-based therapeutic intervention with a patient-centered medication review by a multidisciplinary team led to a reduction in prescription of psychotropic drugs in institutionalized dementia patients.
Subject(s)
Dementia/drug therapy , Evidence-Based Medicine/trends , Homes for the Aged/trends , Medication Reconciliation/trends , Nursing Homes/trends , Psychotropic Drugs/therapeutic use , Aged , Aged, 80 and over , Antipsychotic Agents/therapeutic use , Consensus , Dementia/psychology , Drug Prescriptions , Evidence-Based Medicine/methods , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Medication Reconciliation/methods , Prospective StudiesABSTRACT
El objetivo principal es determinar la sobrecarga, la prevalencia de ansiedad y depresión y su relación con la sobrecarga en cuidadores. Estudio descriptivo transversal. Variables: edad, sexo, parentesco, patología del paciente, ansiedad y depresión del cuidador. Se utilizó la escala de Zarit para determinar el grado de sobrecarga. Se incluyeron 48 cuidadores y 48 pacientes. Se obtuvieron diferencias estadísticamente significativas entre sobrecarga y el sexo del cuidador (p = 0,037). Un 87% de mujeres sufrían sobrecarga intensa. La prevalencia de ansiedad y depresión es menor que en otros estudios, aunque el grado de sobrecarga es mayor. La diferencia estadísticamente significativa puede deberse a que la mujer asume tradicionalmente el rol de cuidadora, mientras que los hombres buscan ayuda social antes. Este estudio ayudará a programar intervenciones para prevenir la sobrecarga, priorizando a las cuidadoras femeninas y de más edad (AU)
The main objective is to determine the degree of burden of caregivers, describe the prevalence of anxiety and depression and the relationship among these pathologies and burden. Descriptive cross-sectional study. Variables: age, sex, relationship, patient's diseases, caregiver's anxiety and depression. We use the Zarit scale to determine the degree of burden. 48 caregivers and 48 patients were included. Statistical significant differences were obtained between burden and caregiver's sex (p = 0.037).Women have greater burden (87%). Anxiety and depression's prevalence is smaller than other studies. The significant difference between burden and sex can be due to the traditional caregiver's rol among women. (Men search social help before.) The burden degree is bigger than other studies. This study can help to develop intervention programs to prevent burden and to give priority to female and age caregivers (AU)
Subject(s)
Humans , Caregivers/psychology , Depression/epidemiology , Anxiety/epidemiology , Workload/statistics & numerical data , Home Nursing/methodsABSTRACT
BACKGROUND: Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in intensive care units (ICUs). Most published studies have analysed nurses' theoretical knowledge about a specific procedure; however, the transfer of this knowledge to the practice has received little attention. AIM: To assess the impact of training session on nurses' knowledge regarding VAP, compliance with VAP preventive measures, VAP incidence and determining whether nursing workload affects compliance. METHOD: A prospective, quasiexperimental, pre- and post-study of the nursing team in a 16-bed medical/surgical ICU. Pre-intervention phase: a questionnaire to assess nurses' knowledge of VAP prevention measures, direct observation and review of clinical records to assess compliance. Intervention phase: eight training sessions for nurses. The post-intervention phase mirrored the pre-intervention phase. FINDINGS: Nurses answered more questions correctly on the post-intervention questionnaire than on the pre-intervention (17·87 ± 2·69 versus 15·91 ± 2·68, p = 0·002). Compliance with the following measures was better during the post-intervention period (p = 0·001): use of the smallest possible nasogastric tube, controlled aspiration of subglottic secretions and endotracheal tube cuff pressure, use of oral chlorhexidine and recording the endotracheal tube fixation number. VAP incidence remained unchanged throughout the study. However, a trend towards lower incidence of late (>4 days after intubation) VAP was observed (4·6 versus 3·1 episodes/1000 ventilation days, p = 0·37). CONCLUSION: The programme improved both knowledge of and compliance with VAP preventive measures, although improved knowledge did not always result in improved compliance.
Subject(s)
Clinical Competence , Critical Care/methods , Cross Infection/etiology , Cross Infection/prevention & control , Education, Nursing, Continuing/methods , Pneumonia, Ventilator-Associated/complications , Pneumonia, Ventilator-Associated/prevention & control , Guideline Adherence , Humans , Practice Guidelines as Topic , Program Evaluation , Prospective Studies , Surveys and QuestionnairesABSTRACT
OBJECTIVE: To evaluate the effectiveness of the "Care of the Elderly" program developed by primary care teams in improving the quality of life of frail elderly individuals with a diagnosis of chronic obstructive pulmonary disease (COPD) living in Sabadell (Spain) compared with that of patients receiving routine care. METHOD: A quasi-experimental study with an experimental and a control group was performed in the nursing consultation service of 6 randomly selected primary care centers in Sabadell. The variables studied were quality of life measured by the EuroQuol (EQ-5D), the impact of COPD on health status measured by the St. George's respiratory questionnaire (SGRQ), the number of visits to the center and the emergency department, and hospital admissions. The study was performed over a 2-year period. RESULTS: The mean age of the 203 patients studied was 74.94 years (standard deviation [SD] = 6.11). The intervention was not effective in improving quality of life as measured by the EQ-5D, or in reducing the impact of COPD on health status measured by the SGRQ, or the number of visits to the center and hospital admissions. A statistically significant impact was found on the number of visits to the emergency department (p = 0.03). CONCLUSIONS: The "Care of the Elderly" program in frail elderly individuals with COPD was not effective. The present study is of use in identifying aspects that are ineffective so that nurses designing future programs and studies can include new aspects such as treatment adherence, smoking cessation, and patient satisfaction.
Subject(s)
Frail Elderly , Program Evaluation , Pulmonary Disease, Chronic Obstructive/therapy , Aged , Humans , Primary Health Care , SpainABSTRACT
Objetivo. Conocer la efectividad del programa "Atenció a la Gent Gran", desarrollado por los equipos de atención primaria, en la calidad de vida de la población de mayores de 65 años frágiles diagnosticados de enfermedad pulmonar obstructiva crónica (EPOC) y residentes en Sabadell, frente a la de los pacientes con atención habitual. Método. Estudio cuasi experimental con grupo experimental y grupo control realizado en las consultas de enfermería de 6 centros de atención primaria de Sabadell elegidos de forma aleatoria. Las variables de estudio fueron el índice de calidad de vida medido con el cuestionario euroqol 5D (EQ-5D), el impacto de la EPOC sobre el estado de salud medido con el cuestionario respiratorio St. George (SGRQ), el número de visitas al centro y a urgencias, y los ingresos hospitalarios. El estudio tuvo una duración de 2 años. Resultados. La edad media de los 203 pacientes estudiados fue de 74,94 años (desviación estándar [DE] = 6,11). La intervención no se mostró efectiva al valorar la calidad de vida medida con el EQ 5-D, el impacto de la EPOC sobre el estado de salud medido a partir del SGRQ, el número de visitas al centro e ingresos hospitalarios. Tuvo impacto estadísticamente significativo sobre el número de visitas a urgencias (p = 0,03) Conclusiones. El programa "Atenció a la Gent Grant" en personas frágiles diagnosticadas de EPOC no ha sido efectivo. Esta revisión debe servir a las enfermeras para diseñar programas y estudios que tengan en cuenta los aspectos en los que no se ha demostrado efectivo y que contemplen nuevos aspectos como la adherencia al tratamiento, dejar de fumar y la satisfacción de los pacientes
Objective. To evaluate the effectiveness of the "Care of the Elderly" program developed by primary care teams in improving the quality of life of frail elderly individuals with a diagnosis of chronic obstructive pulmonary disease (COPD) living in Sabadell (Spain) compared with that of patients receiving routine care. Method. A quasi-experimental study with an experimental and a control group was performed in the nursing consultation service of 6 randomly selected primary care centers in Sabadell. The variables studied were quality of life measured by the EuroQuol (EQ-5D), the impact of COPD on health status measured by the St. George's respiratory questionnaire (SGRQ), the number of visits to the center and the emergency department, and hospital admissions. The study was performed over a 2-year period. Results. The mean age of the 203 patients studied was 74.94 years (standard deviation [SD] = 6.11). The intervention was not effective in improving quality of life as measured by the EQ-5D, or in reducing the impact of COPD on health status measured by the SGRQ, or the number of visits to the center and hospital admissions. A statistically significant impact was found on the number of visits to the emergency department (p = 0.03). Conclusions. The "Care of the Elderly" program in frail elderly individuals with COPD was not effective. The present study is of use in identifying aspects that are ineffective so that nurses designing future programs and studies can include new aspects such as treatment adherence, smoking cessation, and patient satisfaction
Subject(s)
Male , Female , Aged , Humans , Pulmonary Disease, Chronic Obstructive/nursing , Sickness Impact Profile , Outcome and Process Assessment, Health Care/methods , Pulmonary Disease, Chronic Obstructive/epidemiology , Frail Elderly/statistics & numerical data , Geriatric Nursing/statistics & numerical dataABSTRACT
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Subject(s)
Male , Female , Aged , Aged, 80 and over , Humans , Depression/complications , Cognition Disorders/etiology , Memory Disorders/epidemiology , Cognition Disorders/epidemiology , Depressive Disorder/epidemiology , Prospective StudiesABSTRACT
La enfermería de práctica avanzada (EPA) se caracteriza por ofrecer un nivel avanzado de práctica enfermera, que maximiza la utilización de competencias especializadas y de conocimiento enfermero a fin de responder a las necesidades de los clientes en el dominio de la salud. Esta práctica avanzada es ya un hecho en países como Estados Unidos y Canadá. La revisión de la historia de la EPA en estos países nos permite evidenciar que esta práctica, que surge para responder a las demandas sociales de la población, se consolida gracias al desarrollo de diferentes estructuras organizacionales, educacionales y de investigación (AU)
