Evaluation of psychometric properties of instruments measuring nursing-sensitive outcomes: a systematic review.

AIM: To evaluate the psychometric properties of instruments measuring Nursing-sensitive Outcomes in acute care hospitals. INTRODUCTION: Nursing-sensitive outcomes have been shown to play an active role in the quality of care and cost-effectiveness of health systems. Tools for assessing nursing-sensitive outcomes are necessary to evaluate the nurses' contributions to the health of patients. METHODS: Psychometric systematic review. The SCOPUS, PubMed, CINAHL, PsychoINFO, EMBASE, Science Direct and Web of Science databases were used. Searches were performed between March and May 2018. A search with screened titles and abstracts, assessment of methodological quality using the COSMIN checklist and risk of bias assessment using QUADAS-2 were carried out. RESULTS: Twenty-nine studies validated 26 different instruments. The methodological quality, measured with the COSMIN checklist, showed that the studies which assessed fewer psychometric properties had poorer quality. The majority of studies had high quality, and optimally assessed the risk of bias evaluated with QUADAS-2. DISCUSSION: Concerning the focus of the scales, some of them focused on the patients while others focused on the nursing staff. The scales found assessed aspects such as nursing-care quality, complexity and personalization. CONCLUSION: The majority of studies had a high methodological strength and a thorough validation process. The Nurse Caring Behaviours Scale, the MISSCARE Survey, the Patient Advocacy Engagement Scale and the INICIARE scale were the tools which best combined structure, methodological quality and risk of bias. IMPLICATIONS FOR NURSING AND HEALTH POLICY: The instruments with the best psychometric properties should be implemented in acute care settings to improve the quality of care, assess the effectiveness of nursing interventions, reduce health expenditure and reduce the occurrence of adverse events.

Health literacy interventions for immigrant populations: a systematic review.

BACKGROUND: Health literacy is considered a social health determinant that influences improvement in health, patient empowerment and reduction in inequalities. There is a lack of health literacy interventions for vulnerable social groups (i.e. immigrants), and nurses have shown little familiarity with the concept. AIM: This study aimed to identify and analyse whether interventions directed at immigrant populations improve the functional (basic reading, writing and arithmetic skills), interactive (social and cognitive skills) and critical (advanced cognitive and social skills in critically analyzing information and making informed decisions) dimensions of health literacy, taking into account the role played by nursing in these interventions. METHODS: A systematic review of four databases including PubMed, PsycINFO, the Cochrane Library and ERIC was conducted to identify relevant articles published between 2000 and 2015. Thirty-four articles met the inclusion criteria, and nine articles used a validated instrument. RESULTS: Few specific health literacy interventions for immigrant populations were found. The main findings of the studies showed positive changes in functional health literacy. However, the interventions were less effective in improving interactive and critical health literacy. LIMITATIONS: Several of the findings of this review were based on studies that had their own limitations. The assessment of the articles was not blinded, and the review was restricted to articles written in Spanish and English. CONCLUSIONS: The interventions studied were reported as being effective in improving health literacy in immigrants, particularly the functional aspects. Regarding the role played by nursing, this review observed little involvement. IMPLICATIONS FOR NURSING AND HEALTH POLICY: It is important for educational strategies to include health literacy dimensions. The concept of health literacy should be included as a Nursing Outcomes Classification and in its subsequent validation taxonomy. To promote community health, health literacy must be a prioritized objective of health management and policies.

[Post-traumatic stress disorder in premature newborns]. / Trastorno por estrés postraumático en nacidos prematuros.

INTRODUCTION: Preterm newborns are physiologically immature and vulnerable. Following birth, they must face a battery of adverse stimuli, radically different from the warmth of the mother's womb. The aims of this study were to evaluate the prevalence of emotional alterations in the neonate and to examine the influence of physical contact with the mother during the infant's stay in the Neonatal-Intensive-Care-Unit (NICU). PATIENTS AND METHODS: Prospective follow-up study of a group of 15 neonates admitted to a NICU, together with a control-group of 15 full-term neonates, not admitted to a NICU. RESULTS: The number of responses considered to be pathological observed among neonates, in the mothers' arms was 0.6-per-hour and in the incubator/cot, 20.6, (p < 0.001). There were statistically significant differences as regards the presence of pathological reactions to external stimuli, which tended to produce a repeated sensation of living out the traumatic event (RR = 3.3). CONCLUSIONS: Beyond a doubt, many factors should be taken into consideration in order to prevent the development of PTSD, and research such as the present leads us to believe that studies should be made of possible modifications to the environmental surroundings of the NICU.

Trastorno por estrés postraumático en nacidos prematuros / Post-traumatic stress disorder in premature newborns

Introducción: El recién nacido prematuro es fisiológicamente inmaduro y vulnerable. Tras el alumbramiento, se enfrenta a un contingente de estímulos adversos, radicalmente opuestos a la calidez del útero materno. En este estudio se pretende evaluar la prevalencia de las alteraciones emocionales del recién nacido y la influencia del contacto físico con la madre durante el ingreso en una unidad de cuidados intensivos neonatales (UCIN). Pacientes y métodos: Estudio de seguimiento prospectivo de una cohorte de recién nacidos ingresados en una UCIN, con grupo de comparación de recién nacidos a término, no ingresados. Resultados: Comparando el número de respuestas consideradas patológicas dentro de la incubadora/cuna y fuera de la misma en brazos de la madre, se hallaron los siguientes promedios: en brazos de la madre, 0,6/h, y en la incubadora/ cuna, 20,6/h (p < 0,001). Se encontraron diferencias estadísticamente significativas respecto a la presencia de reacciones patológicas a estímulos externos que favorecían la reexperimentación del acontecimiento traumático (riesgo relativo: 3,3). Conclusiones: Sin duda, son muchos los factores que deben considerarse en la prevención del desarrollo de trastorno por estrés postraumático, y son investigaciones de esta índole las que nos impulsan a pensar en la necesidad de realizar estudios sobre modificaciones ambientales en la UCIN

Introduction: Preterm neborns are physiologically immature and vulnerable. Following birth, they must face a battery of adverse stimuli, radically different from the warmth of the mother's womb. The aims of this study were to evaluate the prevalence of emotional alterations in the neonate and to examine the influence of physical contact with the mother during the infant's stay in the Neonatal-Intensive-Care-Unit (NICU). Patients and methods: Prospective follow-up study of a group of 15 neonates admitted to a NICU, together with a control-group of 15 full-term neonates, not admitted to a NICU. Results: The number of responses considered to be pathological observed among neonates, in the mothers' arms was 0.6-per-hour and in the incubator/cot, 20.6, (p < 0.001). There were statistically significant differences as regards the presence of pathological reactions to external stimuli, which tended to produce a repeated sensation of living out the traumatic event (RR 3.3). Conclusions: Beyond a doubt, many factors should be taken into consideration in order to prevent the development of PTSD, and research such as the present leads us to believe that studies should be made of possible modifications to the environmental surroundings of the NICU

Eritroblastopenia secundaria a infección por parvovirus B19 / Erythroblastopenia secondary to parvovirus B19 infection

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[Persistent hyperglycemia and hyperinsulinemia in a newborn infant]. / Recién nacido con hiperglucemia persistente e hiperinsulinemia.

Management of neonatal hyperglycemia is complex, especially in immature newborns. Etiology is diverse, the most frequent cause being iatrogeny. Neonatal diabetes mellitus is a rare cause of hyperglycemia during the first days of life. Insulin treatment is sometimes required to control the condition. When insulin requirements exceed 2I U/kg/day insulin resistance syndrome should be suspected. We present the case of a newborn infant with Donohue syndrome, or leprechaunism, which is a rare, genetically determined dysmorphic syndrome leading to significant insulin resistance.

Recién nacido con hiperglucemia persistente e hiperinsulinemia / Persistent hyperglycemia and hyperinsulinemia in a newborn infant

La hiperglucemia neonatal es un cuadro de complejo tratamiento sobre todo en recién nacidos inmaduros. La etiología es muy variada, aunque la causa más frecuente suele ser la yatrogénica. La diabetes mellitus neonatal es una causa rara de hiperglucemia en los primeros días de vida, que en ocasiones necesita tratamiento insulínico para su control. Cuando los requerimientos de insulina sobrepasan las 2 U/kg/día hay que sospechar un síndrome de resistencia a la insulina. Se presenta el caso de un recién nacido con un síndrome de Donohue o leprechaunismo que es un raro síndrome dismórfico de causa genética y que determina una importante resistencia a la insulina (AU)

[Use of intrapleural urokinase in children]. / Utilización de urocinasa intrapleural en niños.

OBJECTIVE: To present the use of intrapleural urokinase as an alternative to surgical management of complicated pleural effusions in children. To add new cases to the literature and set bases for the development of a standardized protocol. METHOD: Presentation of three cases in children under three years of age treated with intrapleural urokinase. RESULTS: Resolution of the effusions with lack of adverse effects. CONCLUSION: Treatment of pleural effusions when loculations develop. This invasive approach might be avoided in some cases by instillation of a fibrinolytic agent such as urokinase into the pleural space, this being an efficient and safe procedure.

Paciente de 10 años con cuadro confusional y desorientación temporospacial / Confusional state and spatiotemporal disorientation in a 10-year-old girl

Las intoxicaciones son una causa frecuente de consulta en los servicios de urgencias pediátricos. El inicio brusco de sintomatología de tipo neurológico constituye una posible forma de manifestación de esta patología, lo que conlleva un estrés adicional por las posibilidades diagnósticas que se barajan en dichos casos (infecciones del sistema nervioso central, lesiones ocupantes de espacio, etcétera). Presentamos un caso de intoxicación por anticolinérgicos con sintomatología neurológica llamativa (AU)

Utilización de urocinasa intrapleural en niños / Use of intrapleural urokinase in children

Objetivo: Presentar la utilización de urocinasa (UC) intrapleural como tratamiento alternativo a la decorticación quirúrgica en los derrames pleurales complicados durante la infancia. Aportar nuevos casos a la escasa casuística pediátrica existente y sentar bases para el futuro desarrollo de un protocolo estandarizado para su utilización. Método Presentación de tres casos de niños menores de tres años en los que se ha utilizado dicha técnica. Resultados Evolución favorable en los tres casos, con ausencia de efectos secundarios. Conclusión El tratamiento del derrame pleural en ocasiones requiere la inserción de un tubo torácico e incluso en algunos casos la realización de una toracotomía y decorticación cuando se desarrollan empiemas tabicados. Este procedimiento invasivo puede ser evitado en algunos casos mediante la instilación de fibrinolíticos como la urocinasa en la cavidad pleural, siendo éste un procedimiento eficaz y seguro (AU)

[High rate of early hospitalization in healthy newborns]. / Alta hospitalaria temprana en recién nacidos a término sanos.

OBJECTIVE: The length of hospital stay of healthy term newborns and their mothers varies in different developed countries. The American Academy of Pediatrics defines early postpartum discharge (EPD) as a discharge occurring within 48 hours of postpartum. EPD has been advocated by patients as part of the humanization of care after delivery and by health services as a more efficient management of resources. Controversies in relation to EPD focus on its impact on initiation and maintenance of breastfeeding, the possible increase of readmissions of newborns with jaundice and the influence on newborn screening for endocrine and metabolic disorders. PATIENTS AND METHODS: Five years ago we started an EPD program for healthy term newborns. We present a descriptive observational study including a series of 2798 consecutive live newborns over a period of 19 months (April 1996 to October 1997). Data about breastfeeding at the time of discharge, coverage of hypothyroidism and phenylketonuria screening and readmissions for newborn jaundice were collected during this period. RESULTS: During the defined period of time, 2798 live newborns were registered. Of these, 2109 (75.38%) were included in the EPD group, the majority of them (75.86%) between 24 and 40 hours postpartum. Breastfeeding was implemented in 95.82% of the newborns, 3.56% of the mothers decided to use artificial formulas and 0.52% were prescribed artificial formulas due to health problems in the mother. In relation to newborn screening of endocrine and metabolic diseases, we found similar coverage of hypothyroid screening compared to the other 7 maternities in our province (public and private) and of phenylketonuria screening compared to the other 5 primary care districts. Regarding newborn jaundice, we detected 47 readmissions, which is 2.23% of the total EPD. These newborns were treated with phototherapy and none required exchange transfusion. The mean value of total serum bilirubin at the time of readmission was 18.7 mg/dl, with a range between 15.1 and 22.6 mg/dl. CONCLUSIONS: In our experience, 75.38% of live newborns were included in a EPD program that has been shown to be safe in relation to controversial subjects, although the limitations of an observational study must be taken into consideration. The safety of this program is inferred by the high proportion of breastfeeding on EPD (95.82%), coverage of endocrine and metabolic screening comparable to other surrounding hospitals and adequate control of hyperbilirubinemia in the newborn period.

[Effectiveness of brain imaging in children with headache]. / Efectividad de los estudios de neuroimagen en niños con cefalea.

OBJECTIVE: Headache is a common complaint in children and brain imaging has become widely used to evaluate this clinical condition. We studied the value of neuroimaging in children with chronic headaches. PATIENTS AND METHODS: A retrospective chart review was conducted of all children referred to the pediatric outpatient clinic for evaluation of headache over a 3-year period. The charts were reviewed for headache characteristics, clinical indications for performing neuroimaging, and imaging results. Special attention was paid to evidence of space-occupying lesions. RESULTS: A total of 160 records were studied, with subjects ranging in age from 4 to 14 years. Most patients were diagnosed as having migraine headaches (60%) or chronic tension headaches (29.5%). Other diagnoses were post-traumatic (6%) and unclassified (4%). Sixty-six patients (41%) had computed tomography imaging performed. In most cases, brain imaging studies were performed because of clinical data (41%) like atypical pattern, sleep-related headache or increase of headache, because of the parents' concerns about brain lesions (38%) and because of an age less than 5 years (14%). Structural changes were found on brain imaging in 4 patients, but none indicated the presence of a treatable space-occupying lesion and all were deemed unrelated to the headache. Our findings of no relevant abnormalities in a series of 66 neuroimaging studies indicate that the maximal rate at which such abnormalities might appear in this population is 4.4%. CONCLUSIONS: These results indicate that neuroimaging studies have very limited value in the clinical evaluation of pediatric patients with chronic headache and should be reserved for those patients with clinical evidence suggestive of underlying structural lesion.

[Prognostic value and accuracy of crisis indicators in severe asthma]. / Valor pronóstico y precisión de los indicadores de crisis asmática severa.

OBJECTIVE: The objective of this study was to evaluate the predictive index of several scores such as the Scarfone score. Wood-Downes modified by Ferrés and transcutaneous oxygen saturation. (Stc,O2) for the detection of severe asthma exacerbations. PATIENTS AND METHODS: A transverse study design was used. Sixty patients under 15 years of age admitted consecutively with acute asthma were included in the study. We evaluated the relation (Pearson "r" correlation), precision (sensibility and specificity) and odds ratio (logistic regression) of the scores and Stc,O2 with the number of salbutamol doses required by the patients during their hospitalization. RESULTS: The number of doses of bronchodilator needed to revert acute asthma relates to the hospital stay (r = 0.74, p < 0.0002), to all the scores taken into account (r > 0.65, 0 < 0.001) an to the Stc,O2 (r = -0.66, p < 0.001). The evaluated scores are prognostic factors for severe acute asthma, while heart rate and respiratory rate did not predict severe acute asthma. CONCLUSIONS: We have to identify, treat and classify as having severe acute asthma those patients who after receiving three doses of inhaled bronchodilator show a Scarfone score over 10 or a Ferrés score over 8, these being situations related to an increased need of bronchodilator therapy and a longer hospital stay.