Maintain Efficacy and Spare Toxicity: Traditional and New Radiation-Based Conditioning Regimens in Hematopoietic Stem Cell Transplantation.

Novelty in total body irradiation (TBI) as part of pre-transplant conditioning regimens lacked until recently, despite the developments in the field of allogeneic stem cell transplants. Long-term toxicities have been one of the major concerns associated with TBI in this setting, although the impact of TBI is not so easy to discriminate from that of chemotherapy, especially in the adult population. More recently, lower-intensity TBI and different approaches to irradiation (namely, total marrow irradiation, TMI, and total marrow and lymphoid irradiation, TMLI) were implemented to keep the benefits of irradiation and limit potential harm. TMI/TMLI is an alternative to TBI that delivers more selective irradiation, with healthy tissues being better spared and the control of the radiation dose delivery. In this review, we discussed the potential radiation-associated long-term toxicities and their management, summarized the evidence regarding the current indications of traditional TBI, and focused on the technological advances in radiotherapy that have resulted in the development of TMLI. Finally, considering the most recent published trials, we postulate how the role of radiotherapy in the setting of allografting might change in the future.

Validation of a Reduced Set of High-Performance Triggers for Identifying Patient Safety Incidents with Harm in Primary Care: TriggerPrim Project.

OBJECTIVE: The aim of the study was to construct and validate a reduced set of high-performance triggers for identifying adverse events (AEs) via electronic medical records (EMRs) review in primary care (PC). METHODS: This was a cross-sectional descriptive study for validating a diagnostic test. The study included all 262 PC centers of Madrid region (Spain). Patients were older than 18 years who attended their PC center over the last quarter of 2018. The randomized sample was n = 1797. Main measurements were as follows: ( a ) presence of each of 19 specific computer-identified triggers in the EMR and ( b ) occurrence of an AE. To collect data, EMR review was conducted by 3 doctor-nurse teams. Triggers with statistically significant odds ratios for identifying AEs were selected for the final set after adjusting for age and sex using logistic regression. RESULTS: The sensitivity (SS) and specificity (SP) for the selected triggers were: ≥3 appointments in a week at the PC center (SS = 32.3% [95% confidence interval {CI}, 22.8%-41.8%]; SP = 92.8% [95% CI, 91.6%-94.0%]); hospital admission (SS = 19.4% [95% CI, 11.4%-27.4%]; SP = 97.2% [95% CI, 96.4%-98.0%]); hospital emergency department visit (SS = 31.2% [95% CI, 21.8%-40.6%]; SP = 90.8% [95% CI, 89.4%-92.2%]); major opioids prescription (SS = 2.2% [95% CI, 0.0%-5.2%]; SP = 99.8% [95% CI, 99.6%-100%]); and chronic benzodiazepine treatment in patients 75 years or older (SS = 14.0% [95% CI, 6.9%-21.1%]; SP = 95.5% [95% CI, 94.5%-96.5%]).The following values were obtained in the validation of this trigger set (the occurrence of at least one of these triggers in the EMR): SS = 60.2% (95% CI, 50.2%-70.1%), SP = 80.8% (95% CI, 78.8%-82.6%), positive predictive value = 14.6% (95% CI, 11.0%-18.1%), negative predictive value = 97.4% (95% CI, 96.5%-98.2%), positive likelihood ratio = 3.13 (95% CI, 2.3-4.2), and negative likelihood ratio = 0.49 (95% CI, 0.3-0.7). CONCLUSIONS: The set containing the 5 selected triggers almost triples the efficiency of EMR review in detecting AEs. This suggests that this set is easily implementable and of great utility in risk-management practice.

Is primary care a patient-safe setting? Prevalence, severity, nature, and causes of adverse events: numerous and mostly avoidable.

Knowing the frequency and characteristics of adverse events (AEs) is key to implementing actions that can prevent their occurrence. However, reporting systems are insufficient for this purpose and epidemiological studies are also required. Currently, the reviewing of clinical records is the gold standard method for knowing the frequency and characteristics of AEs. Research on AEs in a primary care setting has been limited and primarily focuses on specific types of events (medication errors, etc.) or patients. Large studies that search for any kind of AE in all patients are scarce. This study aimed to estimate the prevalence of AEs in the primary care setting and their characteristics. SETTING: all 262 primary health-care centres in the Madrid region (Spain) during the last quarter of 2018. DESIGN: cross-sectional descriptive study. Eligible population: subjects over 18 years of age who attended medical consultation over the last year (N = 2 743 719); a randomized sample stratified by age. MAIN OUTCOMES: age, sex, occurrence of an AE, number of consultations in the study period, avoidability, severity, place of occurrence, type of event, and contributory factors. The clinical records were reviewed by three teams, each composed of one doctor and one nurse trained and with expertise in patient safety. The SPSS software package (version 26) was used for the statistical analyses. The evaluators reviewed 1797 clinical records. The prevalence of AEs over the study period was 5.0% [95% confidence interval (CI): 4.0%‒6.0%], with higher values in women (5.7%; 95% CI: 4.6%‒6.8%;P = 0.10) and patients over 75 years of age (10.3%; 95% CI: 8.9%‒11.7%; P < 0.001). The overall occurrence per hundred consultations was estimated to be 1.58% (95% CI: 1.28%‒1.94%). Of the detected AEs, 71.3% (95% CI: 62.1%‒80.5%) were avoidable. Additionally, 60.6% (95% CI: 50.7%‒70.5%) were categorized as mild, 31.9% (95% CI: 22.4%‒41.4%) as moderate, and 7.4% (95% CI: 2.1%‒12.7%) as severe. Primary care was the occurrence setting in 76.6% (95% CI: 68.0%‒85.2%) of cases. The overall incidence of AEs related to medication was 53.2% (95% CI: 50.9%‒55.5%). The most frequent types of AEs were prescription errors (28.7%; 95% CI: 19.5%‒37.9%), followed by drug administration errors by patients (17.0%; 95% CI: 9.4%‒24.6%), and clinical assessment errors (11.7%; 95% CI: 5.2%‒18.2%). The most common contributory factors were those related to the patient (80.6%; 95% CI: 71.1%‒90.1%) and tasks (59.7%; 95% CI: 48.0%‒71.4%). A high prevalence of AEs (1 in 66 consultations) was observed, which was slightly higher than that reported in similar studies. About 3 out of 4 such events were considered to be avoidable and 1 out of 13 was severe. Prescription errors, drug administration errors by patients, and clinical assessment errors were the most frequent types of AEs. Graphical Abstract.

Enabling Aqueous Processing of Ni-Rich Layered Oxide Cathode Materials by Addition of Lithium Sulfate.

Aqueous processing of Ni-rich layered oxide cathode materials is a promising approach to simultaneously decrease electrode manufacturing costs, while bringing environmental benefits by substituting the state-of-the-art (often toxic and costly) organic processing solvents. However, an aqueous environment remains challenging due to the high reactivity of Ni-rich layered oxides towards moisture, leading to lithium leaching and Al current collector corrosion because of the resulting high pH value of the aqueous electrode paste. Herein, a facile method was developed to enable aqueous processing of LiNi0.8 Co0.1 Mn0.1 O2 (NCM811) by the addition of lithium sulfate (Li2 SO4 ) during electrode paste dispersion. The aqueously processed electrodes retained 80 % of their initial capacity after 400 cycles in NCM811||graphite full cells, while electrodes processed without the addition of Li2 SO4 reached 80 % of their capacity after only 200 cycles. Furthermore, with regard to electrochemical performance, aqueously processed electrodes using carbon-coated Al current collector outperformed reference electrodes based on state-of-the-art production processes involving N-methyl-2-pyrrolidone as processing solvent and fluorinated binders. The positive impact on cycle life by the addition of Li2 SO4 stemmed from a formed sulfate coating as well as different surface species, protecting the NCM811 surface against degradation. Results reported herein open a new avenue for the processing of Ni-rich NCM electrodes using more sustainable aqueous routes.

Opportunities and Challenges of Li2 C4 O4 as Pre-Lithiation Additive for the Positive Electrode in NMC622||Silicon/Graphite Lithium Ion Cells.

Silicon (Si)-based negative electrodes have attracted much attention to increase the energy density of lithium ion batteries (LIBs) but suffer from severe volume changes, leading to continuous re-formation of the solid electrolyte interphase and consumption of active lithium. The pre-lithiation approach with the help of positive electrode additives has emerged as a highly appealing strategy to decrease the loss of active lithium in Si-based LIB full-cells and enable their practical implementation. Here, the use of lithium squarate (Li2 C4 O4 ) as low-cost and air-stable pre-lithiation additive for a LiNi0.6 Mn0.2 Co0.2 O2 (NMC622)-based positive electrode is investigated. The effect of additive oxidation on the electrode morphology and cell electrochemical properties is systematically evaluated. An increase in cycle life of NMC622||Si/graphite full-cells is reported, which grows linearly with the initial amount of Li2 C4 O4 , due to the extra Li+ ions provided by the additive in the first charge. Post mortem investigations of the cathode electrolyte interphase also reveal significant compositional changes and an increased occurrence of carbonates and oxidized carbon species. This study not only demonstrates the advantages of this pre-lithiation approach but also features potential limitations for its practical application arising from the emerging porosity and gas development during decomposition of the pre-lithiation additive.

Practical Implementation of Magnetite-Based Conversion-Type Negative Electrodes via Electrochemical Prelithiation.

We report the performance of a conversion-type magnetite-decorated partially reduced graphene oxide (Fe3O4@PrGO) negative electrode material in full-cell configuration with LiNi0.8Co0.15Al0.05O2 (NCA) positive electrodes. To enable practical implementation of the conversion-type negative electrodes in full cells, the beneficial impact of electrochemical prelithiation on mitigating active lithium losses and improving cycle life is shown here for the first time in the literature. The initial Coulombic efficiency (ICE) of the full cells is improved from 70.8 to 91.2% by prelithiation of the negative electrode to 35% of its specific delithiation capacity. The prelithiation is shown to improve the surface passivation of the Fe3O4@PrGO electrodes, leading to less electrolyte reduction on their surface which is prominent from the significantly lowered accumulated Coulombic inefficiency values, lower polarization growth, and doubled capacity retention by the 100th cycle. The reduced surface reactions of the negative electrode by prelithiation also aids in reducing the extent of aging of the NCA positive electrode. Overall, the prelithiation leads to a longer cycle life, where a retained capacity of 60.4% was achieved for the prelithiated cells by the end of long-term cycling, which is 3 times higher than the capacity retention of the non-prelithiated cells. Results reported herein indicate for the first time that the electrochemical prelithiation of the Fe3O4@PrGO electrode is a promising approach for making conversion negative electrode materials more applicable in lithium-ion batteries.

Investigation of Lithium Polyacrylate Binders for Aqueous Processing of Ni-Rich Lithium Layered Oxide Cathodes for Lithium-Ion Batteries.

Ni-rich layered oxide cathodes are promising candidates to satisfy the increasing energy demand of lithium-ion batteries for automotive applications. Aqueous processing of such materials, although desirable to reduce costs and improve sustainability, remains challenging due to the Li+ /H+ exchange upon contact with water, resulting in a pH increase and corrosion of the aluminum current collector. Herein, an example was given for tuning the properties of aqueous LiNi0.83 Co0.12 Mn0.05 O2 electrode pastes using a lithium polyacrylate-based binder to find the "sweet spot" for processing parameters and electrochemical performance. Polyacrylic acid was partially neutralized to balance high initial capacity, good cycling stability, and the prevention of aluminum corrosion. Optimized LiOH/polyacrylic acid ratios in water were identified, showing comparable cycling performance to electrodes processed with polyvinylidene difluoride requiring toxic N-methyl-2-pyrrolidone as solvent. This work gives an exemplary study for tuning aqueous electrode pastes properties aiming towards a more environmentally friendly processing of Ni-rich cathodes.

Synergistic Effects of Surface Coating and Bulk Doping in Ni-Rich Lithium Nickel Cobalt Manganese Oxide Cathode Materials for High-Energy Lithium-Ion Batteries.

Invited for this month's cover is a combined work of the Helmholtz Institute Münster together with the MEET Battery Research Center and the Universities of Münster and Mainz. The cover shows multiple treatment choices for the modification of cathode active materials for lithium-ion batteries. Similar to a car wash program, the treatment will typically result in an improvement of the status quo. However, the best treatment procedure will only become clear if all modification pathways are explored. The Research Article itself is available at 10.1002/cssc.202102220.

Synergistic Effects of Surface Coating and Bulk Doping in Ni-Rich Lithium Nickel Cobalt Manganese Oxide Cathode Materials for High-Energy Lithium Ion Batteries.

Ni-rich layered oxide cathodes are promising candidates to satisfy the increasing energy demand of lithium-ion batteries for automotive applications. Thermal and cycling stability issues originating from increasing Ni contents are addressed by mitigation strategies such as elemental bulk substitution ("doping") and surface coating. Although both approaches separately benefit the cycling stability, there are only few reports investigating the combination of two of such approaches. Herein, the combination of Zr as common dopant in commercial materials with effective Li2 WO4 and WO3 coatings was investigated with special focus on the impact of different material processing conditions on structural parameters and electrochemical performance in nickel-cobalt-manganese (NCM) || graphite cells. Results indicated that the Zr4+ dopant diffusing to the surface during annealing improved the electrochemical performance compared to samples without additional coatings. This work emphasizes the importance to not only investigate the effect of individual dopants or coatings but also the influences between both.

Establishing Technical Values for Nursing Diagnoses in Primary Healthcare.

PURPOSE: To establish technical values for nursing diagnoses in primary healthcare with which to weight the delivery of care based on criteria of complexity and relevance. METHODS: A three-phase cross-sectional descriptive study: (1) establishing and weighting of the assessment criteria of technical values, (2) scoring of the assessment criteria per diagnosis, and (3) assigning technical values. FINDINGS: Diagnoses were ordered on the scoring scale obtained and a technical value of 1 to 4 was assigned according to their quartile. CONCLUSIONS: Having a technical value for each nursing diagnosis helps to measure the diversity and complexity of care. IMPLICATIONS FOR NURSING PRACTICE: Technical values may contribute to improving nursing management indicators, as they incorporate a quantitative view into the assessment process.

OBJETIVO: Definir un valor técnico para los diagnósticos enfermeros en Atención Primaria que permita ponderar la prestación de cuidados en base a criterios de complejidad y relevancia. MÉTODOS: Estudio descriptivo transversal realizado en 3 fases: 1) definición y ponderación de los criterios de valoración del valor técnico, 2) puntuación de los criterios de valoración por diagnóstico, 3) asignación del valor técnico. RESULTADOS: Se ordenaron los diagnósticos en la escala de puntuación obtenida y se asignó un valor técnico del 1 al 4 en función del cuartil. CONCLUSIONES: Disponer de un valor técnico de cada diagnóstico enfermero permite dimensionar la diversidad y la complejidad de los cuidados. IMPLICACIONES: El valor técnico puede contribuir a mejorar los indicadores de gestión de servicios enfermeros al añadir una visión cuantitativa al proceso evaluativo. PALABRAS CLAVE: diagnóstico de enfermería; terminología normalizada de enfermería; Atención Primaria de salud; indicadores de calidad de la atención de salud; indicadores de gestión.

Porous Graphene-like Carbon from Fast Catalytic Decomposition of Biomass for Energy Storage Applications.

A novel carbon material made of porous graphene-like nanosheets was synthesized from biomass resources by a simple catalytic graphitization process using nickel as a catalyst for applications in electrodes for energy storage devices. A recycled fiberboard precursor was impregnated with saturated nickel nitrate followed by high-temperature pyrolysis. The highly exothermic combustion of in situ formed nitrocellulose produces the expansion of the cellulose fibers and the reorganization of the carbon structure into a three-dimensional (3D) porous assembly of thin carbon nanosheets. After acid washing, nickel particles are fully removed, leaving nanosized holes in the wrinkled graphene-like sheets. These nanoholes confer the resulting carbon material with ≈75% capacitance retention, when applied as a supercapacitor electrode in aqueous media at a specific current of 100 A·g-1 compared to the capacitance reached at 20 mA·g-1, and ≈35% capacity retention, when applied as a negative electrode for lithium-ion battery cells at a specific current of 3720 mA·g-1 compared to the specific capacity at 37.2 mA·g-1. These findings suggest a novel way for synthesizing 3D nanocarbon networks from a cellulosic precursor requiring low temperatures and being amenable to large-scale production while using a sustainable starting precursor such as recycled fiberwood.

Iron-Catalyzed Graphitic Carbon Materials from Biomass Resources as Anodes for Lithium-Ion Batteries.

Graphitized carbon materials from biomass resources were successfully synthesized with an iron catalyst, and their electrochemical performance as anode materials for lithium-ion batteries (LIBs) was investigated. Peak pyrolysis temperatures between 850 and 2000 °C were covered to study the effect of crystallinity and microstructural parameters on the anodic behavior, with a focus on the first-cycle Coulombic efficiency, reversible specific capacity, and rate performance. In terms of capacity, results at the highest temperatures are comparable to those of commercially used synthetic graphite derived from a petroleum coke precursor at higher temperatures, and up to twice as much as that of uncatalyzed biomass-derived carbons. The opportunity to graphitize low-cost biomass resources at moderate temperatures through this one-step environmentally friendly process, and the positive effects on the specific capacity, make it interesting to develop more sustainable graphite-based anodes for LIBs.

Effectiveness of an educational group intervention in primary healthcare for continued exclusive breast-feeding: PROLACT study.

BACKGROUND: The World Health Organization leads a global strategy to promote the initiation and maintenance of breast-feeding. Existing literature shows that education and supportive interventions, both for breast-feeding mothers as well as for healthcare professionals, can increase the proportion of women that use exclusive breast-feeding, however, more evidence is needed on the effectiveness of group interventions. METHODS: This study involves a community-based cluster randomised trial conducted at Primary Healthcare Centres in the Community of Madrid (Spain). The project aims to evaluate the effectiveness of an educational group intervention performed by primary healthcare professionals in increasing the proportion of mother-infant pairs using exclusive breastfeeding at six months compared to routine practice. The number of patients required will be 432 (216 in each arm). All mother-infant pairs using exclusive breastfeeding that seek care or information at healthcare centres will be included, as long as the infant is not older than four weeks, and the mother has used exclusive breastfeeding in the last 24 h and who gives consent to participate. The main response variable is mother-infant pairs using exclusive breast-feeding at six months. Main effectiveness will be analysed by comparing the proportion of mother-infant pairs using exclusive breast-feeding at six months between the intervention group and the control group. All statistical tests will be performed with intention-to-treat. The estimation will be adjusted using an explanatory logistic regression model. A survival analysis will be used to compare the two groups using the log-rank test to assess the effect of the intervention on the duration of breastfeeding. The control of potential confounding variables will be performed through the construction of Cox regression models. DISCUSSION: We must implement strategies with scientific evidence to improve the percentage of exclusive breast-feeding at six months in our environment as established by the WHO. Group education is an instrument used by professionals in Primary Care that favours the acquisition of skills and modification of already-acquired behaviour, all making it a potential method of choice to improve rates of exclusive breast-feeding in this period. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov under code number NCT01869920 (Date of registration: June 3, 2013).

Performance of biomorphic Silicon Carbide as particulate filter in diesel boilers.

Biomorphic Silicon Carbide (bioSiC) is a novel porous ceramic material with excellent mechanical and thermal properties. Previous studies have demonstrated that it may be a good candidate for its use as particle filter media of exhaust gases at medium or high temperature. In order to determine the filtration efficiency of biomorphic Silicon Carbide, and its adequacy as substrate for diesel particulate filters, different bioSiC-samples have been tested in the flue gases of a diesel boiler. For this purpose, an experimental facility to extract a fraction of the boiler exhaust flow and filter it under controlled conditions has been designed and built. Several filter samples with different microstructures, obtained from different precursors, have been tested in this bench. The experimental campaign was focused on the measurement of the number and size of particles before and after placing the samples. Results show that the initial efficiency of filters made from natural precursors is severely determined by the cutting direction and associated microstructure. In biomorphic Silicon Carbide derived from radially cut wood, the initial efficiency of the filter is higher than 95%. Nevertheless, when the cut of the wood is axial, the efficiency depends on the pore size and the permeability, reaching in some cases values in the range 70-90%. In this case, the presence of macropores in some of the samples reduces their efficiency as particle traps. In continuous operation, the accumulation of particles within the porous media leads to the formation of a soot cake, which improves the efficiency except in the case when extra-large pores exist. For all the samples, after a few operation cycles, capture efficiency was higher than 95%. These experimental results show the potential for developing filters for diesel boilers based on biomorphic Silicon Carbide.

Modelo de intervención y retos en el acogimiento familiar: la experiencia de la Fundación Márgenes y Vínculos / No disponible

En este trabajo se realiza una aproximación a la intervención profesional en acogimiento familiar en Andalucía, exponiendo información relevante acerca de las Instituciones Colaboradoras de Integración Familiar (ICIF) habilitadas en nuestra comunidad autónoma y deteniéndonos particularmente en la práctica profesional de la Fundación Márgenes y Vínculos de Sevilla. Dicha práctica profesional está regulada en un marco jurídico al cual se hace referencia. Se define la diversa tipología del recurso de acogimiento familiar y se lleva a cabo un acercamiento a la población con quienes se desarrolla el quehacer profesional en el día a día. En el presente artículo también se presenta un recorrido a través de las diferentes fases del trabajo profesional en acogimiento familiar y las funciones que desempeña el equipo multidisciplinar. Finalmente, se recogen los retos actuales en el acogimiento familiar, tratando mirar hacia el futuro en una medida que cada vez adquiere una mayor relevancia en el sistema de protección de menores

In this paper, we provide insight into professional intervention in foster care in Andalusia. We expose further information about the Family Integration Collaborating Institutions (ICIF in Spanish) enabled in Andalucía and we particularly focus on the professional practice of Fundación Márgenes y Vínculos in Seville. This professional practice is regulated by a legal framework which we also reference in the paper. At the same time, we define the typology of fostering and we approach the foster population on which our daily professional practice is based. In the paper, we present several phases of professional work in foster care and tasks relevant to multidisciplinary team. Finally, the current challenges of fostering are explained in order to look to the future of foster care, a measure that is becoming increasingly relevant in child protection system

Influencia de los factores sociodemográficos, laborales y profesionales de enfermería en la percepción del entorno de la práctica en atención primaria / Influence of socio-demographic, labour and professional factors on nursing perception concerning practice environment in Primary Health Care

Objetivo: Analizar la percepción de los profesionales enfermeros de atención primaria de Madrid sobre el entorno en el que realizan su práctica, también relacionada con los factores sociodemográficos, laborales y profesionales. Diseño: Estudio observacional analítico transversal. Participantes y contexto: 475 enfermeros de Atención Primaria de Madrid (áreas 6 y 9, en 2010). Mediciones principales: Percepción del entorno de la práctica, a través del cuestionario Practice Environment Scale of the Nursing Work Index (PES-NWI); edad; sexo; años de experiencia profesional; categoría; área de salud; contratación y nivel académico. Resultados: Se estudiaron 331 sujetos (tasa de respuesta: 69,7%). La puntuación bruta para el PES-NWI fue: 81,04 [IC 95%: 79,18-82,91]. El factor mejor valorado fue «Apoyo de los gestores» (2,9 [IC 95%: 2,8-3]) y el peor, «Adecuación de la plantilla» (2,3 [IC 95%: 2,2-2,4]). En el modelo de regresión (variable dependiente: puntuación bruta del PES-NWI), ajustado por edad, sexo, situación laboral, permanecieron con una p≤0,05, la categoría profesional (coeficiente B =6,586) y los años de ejercicio profesional en el centro (coeficiente B = 2,139, para tiempo de 0a 2 años; coeficiente B = 7,482, para tiempo de 3-10 años; coeficiente B = 7,867, para tiempo de más de 20 años).Conclusiones: Las enfermeras con cargo de responsabilidad y aquellas que tienen mayor formación tienen una mejor percepción de su entorno de práctica. Conocer los factores del entorno de la práctica es un elemento clave para la organización sanitaria con el fin de optimizar la provisión de cuidados, y mejorar los resultados en salud (AU)

Aim: To analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors. Design: Cross-sectional, analytical, observational study. Participants and context: Questionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010. Main measurements: Perception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level. Results: There was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18–82.91]. The factor with the highest score was “Support from Managers” (2.9 [95%CI: 2.8–3]) and the lowest “Workforce adequacy” (2.3 [95%CI: 2.2–2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B = 6.586), and years worked at the centre (coefficient B = 2.139, for a time of 0–2 years; coefficient B = 7.482, for 3–10 years; coefficient B = 7.867, for over 20 years) remained at p ≤ 0.05. Conclusions: The support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results (AU)

Influence of socio-demographic, labour and professional factors on nursing perception concerning practice environment in Primary Health Care.

AIM: To analyze the perception of nursing professionals of the Madrid Primary Health Care environment in which they practice, as well as its relationship with socio-demographic, work-related and professional factors. DESIGN: Cross-sectional, analytical, observational study. PARTICIPANTS AND CONTEXT: Questionnaire sent to a total of 475 nurses in Primary Health Care in Madrid (former Health Care Areas 6 and 9), in 2010. MAIN MEASUREMENTS: Perception of the practice environment using the Practice Environment Scale of the Nursing Work Index (PES-NWI) questionnaire, as well as; age; sex; years of professional experience; professional category; Health Care Area; employment status and education level. RESULTS: There was a response rate of 69.7% (331). The raw score for the PES-NWI was: 81.04 [95%CI: 79.18-82.91]. The factor with the highest score was "Support from Managers" (2.9 [95%CI: 2.8-3]) and the lowest "Workforce adequacy" (2.3 [95%CI: 2.2-2.4]). In the regression model (dependent variable: raw score in PES-NWI), adjusted by age, sex, employment status, professional category (coefficient B=6.586), and years worked at the centre (coefficient B=2.139, for a time of 0-2 years; coefficient B=7.482, for 3-10 years; coefficient B=7.867, for over 20 years) remained at p≤0.05. CONCLUSIONS: The support provided by nurse managers is the most highly valued factor in this practice environment, while workforce adequacy is perceived as the lowest. Nurses in posts of responsibility and those possessing a higher degree of training perceive their practice environment more favourably. Knowledge of the factors in the practice environment is a key element for health care organizations to optimize provision of care and to improve health care results.