BackgroundVentilator-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.AimTo 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.MethodA 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.FindingsNurses 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).ConclusionThe programme improved both knowledge of and compliance with VAP preventive measures, although improved knowledge did not always result in improved compliance.

BackgroundDementia 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.MethodsDesign: 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.ResultsOverall, 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.ConclusionsA 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.Electronic supplementary materialThe online version of this article (10.1186/s12877-018-1015-9) contains supplementary material, which is available to authorized users.

No abstract

Sobrecarga, ansiedad y depresión en cuidadores de pacientes incluidos en el programa de atención domiciliaria Overload, anxiety and depression in caregivers of patients included in the home care program RESUMEN 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. PALABRAS CLAVESobrecarga, ansiedad, depresión, cuidadores. SUMMARYThe 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.

No abstract