Publications (17)19.29 Total impact
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Article: Implementing evidence in an onco-haematology nursing unit: a process of change using participatory action research.
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ABSTRACT: To implement evidence in a nursing unit and to gain a better understanding of the experience of change within a participatory action research. Study design of a participatory action research type was use from the constructivist paradigm. The analytical-methodological decisions were inspired by Checkland Flexible Systems for evidence implementation in the nursing unit. The study was carried out between March and November 2007 in the isolation unit section for onco-haematological patients in a tertiary level general university hospital in Spain. Accidental sampling was carried out with the participation of six nurses. Data were collected using five group meetings and individual reflections in participants' dairies. The participant observation technique was also carried out by researchers. Data analysis was carried out by content analysis. The rigorous criteria were used: credibility, confirmability, dependence, transferability and reflexivity. A lack of use of evidence in clinical practice is the main problem. The factors involved were identified (training, values, beliefs, resources and professional autonomy). Their daily practice (complexity in taking decisions, variability, lack of professional autonomy and safety) was compared with an ideal situation (using evidence it will be possible to normalise practice and to work more effectively in teams by increasing safety and professional recognition). It was decided to create five working areas about several clinical topics (mucositis, pain, anxiety, satisfaction, nutritional assessment, nauseas and vomiting, pressure ulcers and catheter-related problems) and seven changes in clinical practice were agreed upon together with 11 implementation strategies. Some reflections were made about the features of the study: the changes produced; the strategies used and how to improve them; the nursing 'subculture'; attitudes towards innovation; and the commitment as participants in the study and as healthcare professionals. The findings throw light on the process of change in the healthcare sector. The results are useful to modify nursing practice based on evidence.International Journal of Evidence-Based Healthcare 03/2013; 11(1):46-55. -
Article: Evaluation of the effectiveness of hospital discharge planning and follow-up in the primary care of patients with chronic obstructive pulmonary disease.
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ABSTRACT: Aims and objectives: To evaluate the effectiveness of protocolised intervention for hospital discharge and follow-up in the primary care of patients with chronic obstructive pulmonary disease (COPD). Background: Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality internationally. Design: A quasi-experimental design was adopted, with a control group and it was pseudorandomised by services. Methods: Patients with COPD admitted to two tertiary-level public hospitals in Spain were recruited (2007-2008). The outcome variables included: readmission rate, patient satisfaction (LOPSS12), quality of life (St. George's Respiratory Questionnaire) and level of knowledge about COPD. 48 hours after admission, both groups were evaluated by specialist coordinating nurses. At the hospital, a coordinating nurse visited each patient in the experimental group every 24 hours to identify the main caregiver, provide information about the disease, explain treatment, identify care problems and needs and facilitate communication between professionals. 24 hours after discharge, the coordinating nurses informed the primary care nurses about patient discharge. The two nurses made the first home visit together. There were follow-up phone calls at 2, 6, 12 and 24 weeks after discharge. A total of 143 patients were recruited (Intervention group=56; Control group=87). Results: The results showed a significant improvement in the evolution of quality of life, at 12 and 24 weeks after discharge; the level of knowledge about COPD revealed significant differences between the groups. There were no differences according to satisfaction or readmission rate. Multivariate analysis (non-conditional logistic regression) showed the intervention to be ineffective in reducing the readmission rate. Conclusions: The planning of discharge for patients with COPD is effective in terms of improving the patients' quality of life and level of knowledge about the disease. Relevance to clinical practice: The characteristics of patients with COPD make it necessary to include them in hospital discharge planning programmes.Journal of Clinical Nursing 07/2012; · 1.12 Impact Factor -
Article: Randomized clinical trial of laparoscopic hernia repair comparing titanium-coated lightweight mesh and medium-weight composite mesh.
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ABSTRACT: BACKGROUND: The use of lightweight meshes in incisional hernia repair could have beneficial effects on quality of life. This study aimed to compare a new titanium-coated lightweight mesh with a standard composite mesh after laparoscopic incisional hernia repair. METHODS: A randomized controlled single-center clinical trial was designed using the basic principle of one unit, one surgeon, one technique (midline incisional hernia with a laparoscopic approach), and two meshes: a lightweight titanium-coated mesh (group 1) and a medium-weight collagen-polyester composite mesh (group 2) used in 102 patients. The primary end points were pain and recurrence. The secondary end points were morbidity and patient outcomes (analgesic consumption, return to everyday activities). RESULTS: The postoperative complication rates were similar for the two meshes. Pain was significantly less common in group 1 than in group 2 at 1 month (P = 0.029) but was similar for the two groups at 6 months and 1 year. There was a significant difference between the two groups in the average use of analgesics: 6.1 days in group 1 versus 1.6 days in group 2 (P < 0.001). The lightweight group returned to everyday activities after 6.9 days versus 9.7 days for the composite group (P < 0.001). The rate of recurrence did not differ between the two groups at the 2-year follow-up evaluation. CONCLUSIONS: The light titanium-covered polypropylene mesh was associated with less postoperative pain in the short term, lower analgesic consumption, and a quicker return to everyday activities than the Parietex composite medium-weight mesh. The recurrence rates at 2 years showed no difference between the two groups.Surgical Endoscopy 07/2012; · 4.01 Impact Factor -
Article: [Difficulties in implementing a surgical check list in operating theatres].
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ABSTRACT: To assess the level of implementation and the factors associated with the compliance to the surgical check list (SCL) proposed by the WHO, in surgery departments in public hospitals in the Murcia Region of Spain. A retrospective cross-sectional study was conducted using a random, non-proportional, and stratified sample in each hospital. The sample size was established as 10 cases per centre, with a total of 90 surgical operations. The data analysis included the percentage of compliance of the variables of interest (presence of an SCL and the compliance to it, complete, by sections and by items) at regional level, according to hospital, hospital groups, depending on the size; the type of anaesthesia (local, regional or general); the work shift (morning or afternoon); as well as the age and sex of the surgery patients. The check list was found in the medical records in 75 cases (83.33%; confidence interval [CI]: 78.7% - 87.5%), and complied with in full in 25 cases (27.8%; 95% CI: 18.5% - 37.0%). The percentage of items complied with was 70.1% (95% CI: 67.9%-72.2%). The percentage compliance varied by hospital, from 35.8% to 98.9%. The logistic regression analysis showed significance in the variables such as, the size of the hospital (the list was more likely to be complied with in small and medium hospitals) and operations with local anaesthetic as a negative predictive factor of compliance. The SCL is used, but is not always complied with, and not homogeneously in all its sections. There is also significant variation between the public hospitals in the Murcia Region of Spain.Cirugía Española 03/2012; 90(3):180-5. · 0.87 Impact Factor -
Article: Effectiveness of participatory-action-research to put in practice evidence at a nursing onco-hematology unit.
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ABSTRACT: The aim was to evaluate the effectiveness of evidence implementation through participatory-action research (PAR). A prospective quasi-experimental design with two non-equivalent and non-concurrent groups (2006 and 2008) was adopted. The research was conducted at the bone marrow transplant unit of a tertiary-level Spanish hospital. To put the evidence in practice, PAR was adopted as an "intervention studied". The dependent variables were: professional performance and patient outcomes (psycho-emotional area and adverse effects). In total, 125 patients were recruited (1(st) period=56; 2(nd) period=69). The results in the second period show significant improvements in professional performance in terms of the quality of the registers of signs and symptoms. In the psycho-emotional area, the psycho-social adjustment improved significantly; without caregiver burden or satisfaction showing any clear tendencies. Among the adverse effects, catheter-related thrombosis and catheter-related infection improved significantly; there were no significant differences in the level of pain or mucositis. Through the PAR, evidence could be put in practice and the outcomes under analysis could be improved.Revista Latino-Americana de Enfermagem 02/2012; 20(1):59-67. · 0.63 Impact Factor -
Article: [A descriptive study of the socio-demographic and clinical profile of the patient with chronic obstructive pulmonary disease].
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ABSTRACT: To find out the socio-demographic and clinical profile of the patient with Chronic Obstructive Pulmonary Disease (COPD): characteristics, state of health, situation of disease and social resources. A descriptive, longitudinal and prospective study, in the Morales Meseguer and Reina Sofía Hospitals in Murcia (Spain), was performed between June 2007 and April 2008. The inclusion criteria was hospital admission due to COPD and patients with cognitive deterioration, a hospital stay > 30 days or < 2 days, or were institutionalised, were excluded. Socio-demographic, state of health and social variables were collected using the patient's clinical history and an interview during hospital stay and at discharge. The descriptive statistical analysis was carried out using SPSS v.15. A total of 143 patients were studied, of which 90.2% were males who had a mean age of 72.76 ± 8.04 years, 95.1% were in an inactive work situation and had a mean score on the social problem scale of 8.08 ± 2.1. Most were in a fragile state (71.3%), approximately half (44.8%) suffered heart disease as the main co-morbidity factor, and the impact of the disease on quality of life was 55.1 ± 19.01. The level of knowledge on the therapeutic regime was 3.13 ± 0.7. A total of 72% were independent for carrying out Basic Activities of Daily Living (BADL) after hospital discharge. Most of the population that suffers from COPD were elderly males, who were retired without social problems, with a high percentage of co-morbidity, an intermediate alteration in their quality of life, having a moderate level of knowledge about the therapeutic regime and were independent for BADL, but fragile.Enfermería Clínica 02/2011; 21(1):12-8. -
Article: [Use and abuse of the term 'haemorrhoid': importance of anal examination].
Atención Primaria 08/2010; 42(8):445. · 0.63 Impact Factor -
Article: Effectiveness of the implementation of an evidence-based nursing model using participatory action research in oncohematology: research protocol.
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ABSTRACT: To generate changes in nursing practice introducing an evidence-based clinical practice (EBCP) model through a participatory process. To evaluate the effectiveness of the changes in terms of nurse-sensitive outcome (NSO). For international nursing science, it is necessary to explore the reasons for supporting EBCP and evaluate the real repercussions and effectiveness. A mixed methods study with a sequential transformative design will be conducted in the bone marrow transplant unit of a tertiary-level Spanish hospital, in two time periods >12 months (date of approval of the protocol: 2006). To evaluate the effectiveness of the intervention, we will use a prospective quasi-experimental design with two non-equivalent and non-concurrent groups. NSO and patient health data will be collected: (a) impact of psycho-social adjustment; (b) patient satisfaction; (c) symptom control; (d) adverse effects. All patients admitted during the period of time will be included, and all staff working on the unit during a participatory action research (PAR). The PAR design will be adopted from a constructivist paradigm perspective, following Checkland's "Soft Systems" theoretical model. Qualitative techniques will be used: 2-hour group meetings with nursing professionals, to be recorded and transcribed. Field diaries (participants and researchers) will be drawn up and data analysis will be carried out by content analysis. PAR is a rigorous research method for introducing changes into practice to improve NSO.Journal of Advanced Nursing 08/2010; 66(8):1845-51. · 1.48 Impact Factor -
Article: Effectiveness of planning hospital discharge and follow-up in primary care for patients with chronic obstructive pulmonary disease: research protocol.
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ABSTRACT: To evaluate the effectiveness of a protocolized intervention for hospital discharge and follow-up planning for primary care patients with chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality internationally. These patients suffer from high rates of exacerbation and hospital readmission due to active problems at the time of hospital discharge. A quasi-experimental design will be adopted, with a control group and pseudo-randomized by services (protocol approved in 2006). Patients with pulmonary disease admitted to two tertiary-level public hospitals in Spain and their local healthcare centres will be recruited. The outcome variables will be readmission rate and patient satisfaction with nursing care provided. 48 hours after admission, both groups will be evaluated by specialist coordinating nurses, using validated scales. At the hospital, a coordinating nurse will visit each patient in the experimental group every 24 hours to identify the main caregiver, provide information about the disease, and explain treatment. In addition, the visits will be used to identify care problems and needs, and to facilitate communication between professionals. 24 hours after discharge, the coordinating nurses will inform the primary care nurses about patient discharge and nursing care planning. The two nurses will make the first home visit together. There will be follow-up phone calls at 2, 6, 12 and 24 weeks after discharge. The characteristics of patients with this pulmonary disease make it necessary to include them in hospital discharge planning programmes using coordinating nurses.Journal of Advanced Nursing 06/2010; 66(6):1365-70. · 1.48 Impact Factor -
Article: Associated factors and cost of inappropriate hospital admissions and stays in a second-level hospital.
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ABSTRACT: The objective of this study was to analyze the variables related to inappropriate admissions and hospital stays and their financial repercussions. This was a descriptive retrospective study in which the Appropriateness Evaluation Protocol (AEP) was applied to a representative sample of 725 hospital admissions and 1350 hospital stays. The cost of inappropriate stays was calculated by cost accounting. The study found that 7.4% of admissions and 24.6% of stays were inappropriate. Inappropriate admissions were significantly related to medical specialties and younger patient age. Inappropriate stays were related to these factors, plus patients being outside their corresponding areas, nonurgent admissions, and low occupancy rate. The cost of the inappropriate admissions and stays was 147 044 euros. Extrapolated to the hospital as a whole this would represent 2125638 euros per year. Steps must be taken to reduce inappropriate admissions and stays to lower health care costs and to reserve hospital resources for patients who genuinely need them.American Journal of Medical Quality 07/2009; 24(4):321-32. · 1.64 Impact Factor -
Article: [Computerised tomography in the diagnosis of intestinal and mesenteric injuries in closed abdominal trauma].
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ABSTRACT: The frequency of bowel and mesenteric injuries is increasing. They are difficult to diagnose and delays in their diagnosis leads to a significantly increased morbidity and mortality. The aim of this study is to evaluate the usefulness of the computed tomography (CT) in the detection of blunt bowel and mesenteric injuries. Between January 2000 and October 2007, 79 patients with blunt abdominal trauma (60 men and 19 women) were included in our study. They underwent laparotomy after performing the abdominal CT. The CT findings were compared with the findings at laparotomy in order to determine the accuracy of the CT in the detection of bowel and mesenteric injuries. For the detection of bowel and mesenteric injuries we obtained for the CT: Sensitivity=84.2%, Specificity=75.6%, Positive Predictive Value =76.2%, Negative Predictive Value =83.8%, Positive Probability Value=3.45 and Negative Probability Value =0.21. Accuracy: 79.7%. The abdominal CT is suitable for detecting bowel and mesenteric injuries following blunt abdominal trauma.Cirugía Española 07/2009; 86(1):13-6. · 0.87 Impact Factor -
Article: Finding evidences on oncohematological patients (2nd part): Catheter-related infection and pressure ulcers
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ABSTRACT: There is an enormous knowledge base in the field of health which has no application. Its growth is not limited by its discovery but by the lack of its implementation. The necessity of implementing conclusions is evident in evaluating the real repercussion on quality daily cares; as “strategies” and “outcomes”. In talking about oncohematological nursing, some health outcomes would be: the reduction of adverse events such as nosocomial infections and pressure ulcers. Consequently, our objective has been: to find and summarize the evidences about Venous Catheterization and Pressure Ulcers; in order to encourage the spread of knowledge and promote changes in practice.Method: Databases as CINAHL, MEDLINE, Cochrane Library, EMBASE, Pascal Biomed, LILACS, CUIDEN, CUIDEN qualitative y CUIDATGE were revised in Spanish, French and English. No time restrictions were applied.Findings: The main findings and recommendations were synthesised on a poster, next to suggestions for practical changes to implement, evidence levels used, and the clinic problem significance. The suggested changes arose from nursing staff based on evidences found that includes behaviours and attitudes changes, which should facilitate more rapid innovations diffusion.NURE Investigacion. 01/2009; -
Article: Evaluation and monitoring of the clinical pathway for thyroidectomy.
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ABSTRACT: The aim of this study is to present the evaluation and monitoring of a clinical pathway for thyroidectomy 1 year after its implementation and after 4 years' follow up. We compare the results of an evaluation and monitoring indicators series before and after the establishment of the clinical pathway for thyroidectomy in the Surgery Department of Morales Meseguer Hospital, a general university hospital in Murcia, Spain. Implementation of the clinical pathway led to a reduction in length of hospital stay for all the surgery patients (4.8 +/- 2.1 and 3.6 +/- 1.9 days before and after pathway implementation, respectively; P < 0.001). Implementation of the clinical pathway led to a reduction in cost in all the operated patients (3357 +/- 966 and 2695 +/- 970 US$ before and after implementing the clinical pathway, respectively; P < 0.001). Evolution of the mean hospital cost according to year of study shows a reduction from 2000 (3400 +/- 1056 US$) to 2004 (2404 +/- 666 US$) with a slight increase during 2005 (2721 +/- 1335 US$) (P < 0.001). Implementation of the clinical pathway for thyroidectomy has successfully reduced clinical variation and therefore the length of hospital stay and mean cost of the process. In subsequent years, no such major improvements have been made with regard to hospital stay, although they are still clearly better than those before pathway implementation.The American surgeon 01/2008; 74(1):29-36. · 1.28 Impact Factor -
Article: [Importance of effective oral communication when presenting scientific results].
Cirugía Española 08/2007; 82(1):56-7. · 0.87 Impact Factor -
Article: [Predictive factors related to success of non invasive ventilation and mortality in the treatment of acute cardiogenic pulmonary edema].
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ABSTRACT: Recent studies support the use of non invasive ventilation (NIV) in patients with acute cardiogenic pulmonary edema (ACPE). We aimed to evaluate the factors related to the success of the technique in patients admitted to an intensive care unit (ICU) with ACPE. An observational prospective study was performed in ICU.199 consecutive patients were enrolled with ACPE at admission who received treatment with NIV and standardized pharmacological treatment. The success of the NIV was achieved when endotracheal intubation was avoided and patients were alive without dyspnea within and 24 hours after discharge from the ICU. Clinical, physiological and gasometric parameters were analyzed at admission and one hour after starting NIV. Patient's age was 74 years. 43% were male. The SAPS II was 45. 74.4% of the patients were successfully treated with NIV. 12.6% required endotracheal intubation. In a multivariate analysis, the success of the technique (values expressed as odds ratio [95% confidence interval]) was related to: SAPS II (0.95 [0.91-0.99]); the place of admission (6.78 [1.85-24.79]); value of PCO2 at admission (1.05 [1.01-1.09]); PO2/FiO2 index (1.03 [1.01-1.06]) and respiratory frequency (0.91 [0.84-0.99]) within the first hour; SOFA (acute failure organics score) (0.62 [0.49-0.78]); concomittant acute myocardial infarction (AMI) (0.05 [0.01-0.22]) and number of complications (0.17 [0.47-0.65]). The hospital mortality rate was 32.7%. The non intubation order (0.12 [0.04-0.32]) and the success of the technique (100.03 [28.71-348.47]) were related to the hospital mortality. The success of NIV in the treatment of ACPE is related to a lower SAPS II, admission at the emergency department, elevated PCO2 at admission, improvement of the PO2/FiO2 index and the respiratory rate within the first hour. The non intubation order and the success of the technique were related to the hospital mortality.Medicina Clínica 03/2005; 124(4):126-31. · 1.38 Impact Factor -
Article: [Atorvastatin lowers C-reactive protein in dislipemic patients with type 2 diabetes mellitus].
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ABSTRACT: Type 2 diabetes mellitus is associated with an augmented risk for cardiovascular disease. The levels of C-reactive protein (CRP), the prototypic marker of inflammation, are associated with an increased risk for cardiovascular events. The statins have direct anti-inflammatory effects. Thus, we tested the effects of atorvastatin on levels of CRP on patients with type 2 diabetes. We evaluated CRP in baseline and 6 months after onset of 20 mg daily atorvastatin therapy of 30 patients with type 2 diabetes with hyperlipidemia. Clinical and biochemical data were obtained. CRP-levels were significantly decreased after treatment with atorvastatin compared with baseline (median change: -4,99 mg/l; p < 0.001). We observed an correlation between CRP baseline with body mass index (r = 0.429; p = 0.018), serum fibrinogen (r = 0.607; p = 0.001) and microalbuminuria (r = 0.470; p = 0.01). Conversely, there was no significant correlation between CRP baseline with LDL cholesterol. The CRP reduction was significantly correlated with fasting glucose (r = -0.457; p = 0.019) and glycosylated hemoglobin at 6 months (r = -0.421; p = 0.03). These results confirm findings from previous studies that atorvastatin reduce CRP levels in a largely LDL cholesterol independent manner.Medicina Clínica 10/2004; 123(14):535-7. · 1.38 Impact Factor -
Article: Evaluation of a clinical pathway to improve colorectal cancer outcomes.
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ABSTRACT: The aims of this preintervention and postintervention study were to monitor and evaluate the clinical pathway (CP) for colorectal cancer (CRC) over a 5-year period and to compare 2 groups of patients (before and after the intervention) with regard to different variables of effectiveness. Group I comprised 68 patients who underwent planned surgery between January 2002 and January 2003. Group II comprised a sample of 202 patients who underwent surgery between January 2004 and December 2008. No significant differences were found in the majority of the parameters measured: postoperative stay, compliance with antibiotic prophylaxis, compliance with the staging study, mortality, rate of infection, and reoperations. The mean length of stay (±standard deviation) for patients without complications was reduced significantly (9.2 ± 3.6 in group I versus 7.7 ± 1.7 in group II, P = .031). The CP for CRC did not achieve most of the objectives for which it was designed.American Journal of Medical Quality 26(5):396-404. · 1.64 Impact Factor
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2004
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Universidad de Murcia
Murcia, Murcia, Spain
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