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Objectives: to cross-culturally adapt the scale Resultados en la valoración y evolución de la cicatrización de las heridas - RESVECH 2.0 for Brazilian Portuguese; to estimate the internal consistency and construct and criterion validity of the scale in the evaluation of venous ulcers. Methods: methodological study, based on international guidelines for studies of this type. Wounds were evaluated using the RESVECH 2.0 and Pressure Ulcer Scale of Healing 3.0 (PUSH). Descriptive analysis, confirmatory factor analysis, Cronbach’s alpha and Spearman’s correlation (p

Background: Venous ulcers usually present a torpid evolution with a negative impact on patients' quality of life. In primary care, they account for 2.5% of nursing consultations and their treatment represents high costs for national health systems. These patients usually have a low level of physical activity, with muscle pump dysfunction of the lower limbs, which may improve with increased physical activity. The purpose of this study is to analyse the effectiveness of a structured intervention involving physical activity and exercise (Active Legs) as an adjuvant treatment in improving healing of chronic venous ulcers at 3 months follow-up. Methods:A randomized, multicentre clinical trial. A total of 224 individuals receiving primary nursing care with a diagnosis of venous ulcer, with a diameter of 1 cm or greater and an ankle-brachial index between 0.8 and 1.3, able to comply with the study requirements and consenting to participate, will be sequentially included (112 per group). Both groups will receive the standard treatment in primary care, with cleansing, debridement and healing in a moist environment together with multilayer compression therapy. The intervention group will also receive a structured educational intervention involving lower limb physical exercise and daily ambulation guidelines. The primary response variables will be complete healing –understood as complete and sustained epithelialisation for at least 2 weeks– and time to healing. The secondary variables will be degree of healing, ulcer area, quality of life, pain and variables related to the healing process, prognosis, and recurrences. Sociodemographic variables, adherence to treatment and satisfaction variables will also be recorded. Data will be collected at baseline, at 3 months and at 6 months follow-up. Survival analysis (Kaplan-Meier and Cox) will be performed to measure primary effectiveness. Intention-to-treat analysis. Discussion: If the intervention is effective, a cost-effectiveness analysis could be conducted and implemented as an additional intervention in the usual venous ulcer treatment in primary care. Trial registration: NCT04039789. [https://ClinicalTrials.gov]. 07/11/2019.

Objectives: This study aimed to assess the validity and psychometric properties of the Spanish version of the Second Victim Experience and Support Tool (SVEST-E) questionnaire. Methods: This was a cross-sectional study aimed at midwives and obstetricians in Spain. An online survey was conducted consisting of 2 parts: the first part collected different variables, and the second part collected the SVEST-E. The temporal stability of the instrument was evaluated using the test-retest method. For the construct validity and reliability, an exploratory factor analysis and a confirmatory factor analysis were performed using FACTOR program v.10 with a polychoric correlation matrix. Results: A total of 689 professionals participated in the study (323 obstetrician physicians/366 midwives). The mean (SD) score on the SVEST-E for the total sample was 3.09 (0.50). The parallel analysis of the exploratory factor analysis suggested a 5-factor solution, with a total explained variability of 61.8%. The goodness-of-fit indices of the model were the following: root mean square error of approximation = 0.038 (95% confidence interval [CI], 0.031–0.042) and comparative fit index = 0.989 (95% CI, 0.988–0.992). The factor model obtained was confirmed by confirmatory factor analysis, obtaining the values of root mean square error of approximation = 0.038 (95% CI, 0.026–0.053) and comparative fit index = 0.989 (95% CI, 0.969–1.000). The intraclass correlation coefficient was 0.97 (95% CI, 0.94–0.99). Conclusions: The SVEST-E instrument maintains the same items as the original questionnaire but introduces changes in the organization of its dimensions. The Spanish version maintains adequate construct validity, reliability, and temporal stability, so it is a valid tool to evaluate the second victim experience in Spanish health professionals.

Background: The dosage and safety of nutritional supplements for patients with venous ulcers are still not well established. Aim: To evaluate the effects of a high calorie, high protein, arginine-, zinc-, and vitamins A, C, and E-enriched nutritional supplement on the biochemical profile, dietary intake, anthropometry, muscle strength, and characteristics of lesions of patients with venous ulcers. Methods: A controlled before–after clinical trial with a four-week follow-up involved 27 patients with venous ulcers under outpatient treatment in Brazil. It was administered in two to three doses per day (200 mL each) of a high-calorie and high-protein supplement enriched with arginine, zinc, and vitamins A, C, and E. Patients were assessed for anthropometric parameters, dietary intake, biochemical tests, and healing conditions according to the Pressure Ulcer Scale for Healing (PUSH). Results: It was observed that an increase in energy and protein supply led to an adequate intake of immunonutrients (zinc and vitamins A, C, and E), increased body weight, increased body mass index, and stronger handgrip strength. The injury area and the score on the PUSH notably decreased after the intervention (p < 0.001). Conclusions: The administered supplement, at the tested dosage, improved the nutritional status and characteristics of lesions in patients with venous ulcers. This research was funded by the Goias Research Foundation, State Health Department of Goias, National Council for Scientific and Technological Development, Ministry of Health, Department of Science and Technology (Research Program for the Brazilian Unified Health System—PPSUS 201410267000321), and the National Council for Scientific and Technological Development (487093/2013-5).

Aims The assumption that improved self-care in the setting of heart failure (HF) care necessarily translates into improvements in long-term mortality and/or hospitalization is not well established. We aimed to study the association between self-care and long-term mortality and other major adverse HF events (MAHFE). Methods and results We conducted an observational, prospective, cohort study of 1123 consecutive patients with chronic HF. The primary endpoint was all-cause mortality. We used the European Heart Failure Self-care Behaviour Scale 9-item version (EHFSCBS-9) to measure global self-care (overall score) and three specific dimensions of self-care including autonomy-based adherence, consulting behaviour and provider-based adherence. After a mean follow-up of 3.3 years, all-cause death occurred in 487 patients (43%). In adjusted analysis, higher EHFScBS-9 scores (better self-care) at baseline were associated with lower risk of all-cause death [hazard ratio (HR) 0.993, 95% confidence interval (CI) (0.988–0.997), P-value = 0.002], cardiovascular (CV) death [HR 0.989, 95% CI (0.981–0.996), P-value = 0.003], HF hospitalization [HR 0.993, 95% CI (0.988–0.998), P-value = 0.005], and the combination of MAHFE [HR 0.995, 95% CI (0.991–0.999), P-value = 0.018]. Similarly, impaired global self-care [HR 1.589, 95% CI (1.201–2.127), P-value = 0.001], impaired autonomy-based adherence [HR 1.464, 95% CI (1.114–1.923), P-value = 0.006], and impaired consulting behaviour dimensions [HR 1.510, 95% CI (1.140–1.923), P-value = 0.006] were all associated with higher risk of all-cause mortality. Conclusion In this study, we have shown that worse self-care is an independent predictor of long-term mortality (both, all-cause and CV), HF hospitalization, and the combinations of these endpoints in patients with chronic HF. Important dimensions of self-care such as autonomy-based adherence and consulting behaviour also determine the risk of all these outcomes in the long term.

RESUMEN Introducción: La reciente pandemia de COVID-19 ha representado la utilización por parte de los profesionales de la salud de diferentes equipos de protección individual (EPI), lo que ha dado lugar a la aparición de lesiones cutáneas asociadas a los mismos (LC-EPI). Conocer la epidemiología, las características y los factores relacionados con el uso de los diferentes tipos de EPI y la prevención y el tratamiento de las LC-EPI puede ser muy útil para comprender el alcance del problema y definir estrategias para su prevención y tratamiento en posibles pandemias futuras. Métodos: Estudio transversal realizado por el Grupo Nacional para el Estudio y Asesoramiento en Úlceras por Presión y Heridas Crónicas (GNEAUPP) en el ámbito geográfico del Estado español, mediante una encuesta autoadministrada utilizando un cuestionario de Google Forms. El universo de estudio fueron profesionales de la salud, de cualquier disciplina y nivel asistencial o tipo de institución que habían estado en contacto con pacientes o sospechosos de COVID-19 y habían utilizado EPI durante la primera ola de la pandemia de COVID-19 en España. Resultados: Se obtuvieron 2078 cuestionarios, el 75,5% de enfermeras, el 10,79% de técnicos en cuidados auxiliares de enfermería (TCAE) y el 6,6% de médicos. De los respondedores, el 84,7% eran mujeres y el 15,3% hombres con una edad media de 43,7 años. En el 18,2% de los casos, la institución del profesional contaba con un protocolo para la prevención de las LC-EPI, en el 10,2% el profesional no sabía si existía y en el 71,3% restante la institución no contaba con dicho protocolo. El 29,9% de los profesionales utilizaba siempre algún producto de prevención de LC-EPI y el 25,3% en ocasiones. El 52,4% de los encuestados informó haber presentado al menos una LC-EPI, de los cuales el 39% había presentado una, el 35,8% dos, el 14,3% tres, el 2,2% cuatro y el 8,6% más de cuatro. En relación con el tipo de lesiones, el 74,3% fueron definidas como lesiones por presión (LPP), el 11% como lesiones por fricción (LF), el 8,5% como lesiones combinadas o multicausales (LCMC) y el 6,1% como lesiones cutáneas asociadas a la humedad (LESCAH). La duración media de las lesiones incidentes fue de 11,6 días (9,7 días para las LPP, 10,2 días para las LF, 19,9 días para las LCMC y 19,4 días para las LESCAH). En el artículo se presenta información más detallada por tipo de dispositivo causante, tipología y gravedad de las lesiones por dispositivo, así como las medidas preventivas utilizadas.

Aim: To get consensus on the knowledge and skills that nursing students need to acquire regarding venous leg ulcer care, the strategies that can be applied during education and to design a first draft of a questionnaire to assess knowledge to be validated. Background: Venous leg ulcers’ care is included on undergraduate nursing education programmes but without specifying the content and training implementation strategies. Different tools have been validated to assess knowledge, but have been found inadequate. Design: An e-Delphi study. Methods: The participants were Chronic Wound Care expert nurses. Two questions were constructed and agreed on by the research team to define the problem. To answer the third question, a search was conducted for publications on venous leg ulcers, to help design the questionnaire. A 2-round e-Delphi study was conducted from January to March 2022. A panel of 17 experts participated in both rounds. The data were analysed using statistical and qualitative analysis. Results: Content must fulfil knowledge-skill areas: epidemiology, venous pathophysiology and aetiology, classification scales, knowing how to determine a differential diagnosis, treatment, measures for prevention and care of the venous return circuit, quality-of-life scales. As implementation strategies, proposals were made in four areas: subject profile where training is to be acquired, theoretical teaching, practical teaching in the classroom and clinical practice. The average consensus of the questionnaire proposal was high (>86 %) both in relevance and clarity in both rounds. We thereby obtained a questionnaire with 72 items. Conclusions: Seven categories and eight subcategories were created regarding knowledge/skills that nursing students should acquire. Four categories were recognised as strategies that can be implemented during education. A high level of consensus was reached on the items in the initial versions of the questionnaire. Open Access funding provided by University of Basque Country.

Objetivo: Conocer el grado de satisfacción de las mujeres tras el parto en el Hospital Universitario Materno-Infantil de Gran Canaria (HUMIC) y establecer posibles relaciones entre el grado de satisfacción y las variables estudiadas. Método: Estudio observacional descriptivo de corte transversal con componente analítico. La población a estudio fueron las mujeres cuyo parto tuvo lugar en el mes de noviembre del 2018 en el HUMIC reclutadas mediante muestreo no probabilístico de tipo consecutivo. Se utilizó el cuestionario Childbirth Experience Questionnaire en su versión española (CEQ-E) (cuestionario con 4 dominios: capacidad propia, apoyo profesional, seguridad percibida y participación/modelo de análisis 2). En una primera fase se realizó un análisis descriptivo y en una segunda, un análisis inferencial para explorar la asociación entre diferentes variables. Resultados: La muestra total fue de 257 mujeres (n = 257). La puntuación total con el CEQ-E fue de 3,24 (DE 0,37 puntos). No se encontraron diferencias estadísticamente significativas en la puntuación final del CEQ-E entre las mujeres con parto espontáneo frente a inducciones-estimulaciones (p = 0,563) ni entre mujeres primíparas frente a multíparas (p = 0,060). Las mujeres cuyo parto había sido menor o igual a 12 h (p = 0,024), sin traumatismo perineal (p = 0,021) y aquellas a las que no se les ha realizado episiotomía (p = 0,002) obtuvieron mejor puntuación final en el CEQ-E. El parto instrumental (fórceps) frente al parto eutócico se asocia a puntuaciones menores respecto a la puntuación final en el CEQ-E (p ≤ 0,001). Conclusiones: La satisfacción global de la gestante tras el parto en el HUMIC es alta. El parto instrumental parece asociarse a menor satisfacción percibida. Aspectos como el miedo y el cansancio en el parto pueden influir negativamente en la satisfacción. Estos aspectos son susceptibles de mejora mediante el establecimiento de estrategias que ayuden a mayor bienestar y minimicen el miedo de las gestantes en su parto. Objective: To determine the degree of satisfaction of women after childbirth at the Hospital Universitario Materno-Infantil of Gran Canaria (HUMIC) and to establish possible relationships between the degree of satisfaction and the variables studied. Method: A cross-sectional, descriptive, observational study with an analytical component. The study population comprised women who gave birth at the HUMIC in November 2018, recruited through consecutive non-probabilistic sampling. The Spanish version of the Childbirth Experience Questionnaire (CEQ-E) was used (questionnaire with 4 domains: own capacity’, professional support, perceived safety and participation/analytical model 2). In a first phase a descriptive analysis was made, and in a second phase an inferential analysis to explore the association between different variables. Results: The total sample comprised 257 women (n = 257). The total score using the CEQ was 3.24 (SD .37 points). No statistically significant differences were found in the final CEQ score between the women who had a spontaneous delivery versus induction-stimulation (P=.563) or between primiparous versus multiparous women (P=.060). The women whose labour lasted 12 hours or less (P=.024), without perineal trauma (P=.021) and those who had not undergone episiotomy (P=.002) achieved a better final CEQ score. Instrumental delivery (forceps) versus normal delivery is associated with lower scores with respect to the final CEQ-E score (P=≤.001). Conclusions: Women's overall satisfaction after delivery in HUMIC was high. Instrumental delivery seems to be associated with lower perceived satisfaction. Aspects such as fear and fatigue in labour could affect satisfaction negatively. These aspects can be improved by establishing strategies to increase comfort and minimise pregnant women's fear of labour.

Objective: To determine the degree of satisfaction of women after childbirth at the Hospital Universitario Materno-Infantil of Gran Canaria (HUMIC) and to establish possible relationships between the degree of satisfaction and the variables studied. Method: A cross-sectional, descriptive, observational study with an analytical component. The study population comprised women who gave birth at the HUMIC in November 2018, recruited through consecutive non-probabilistic sampling. The Spanish version of the Childbirth Experience Questionnaire (CEQ-E) was used (questionnaire with 4 domains: own capacity’, professional support, perceived safety and participation/analytical model 2). In a first phase a descriptive analysis was made, and in a second phase an inferential analysis to explore the association between different variables. Results: The total sample comprised 257 women (n = 257). The total score using the CEQ was 3.24 (SD .37 points). No statistically significant differences were found in the final CEQ score between the women who had a spontaneous delivery versus induction-stimulation (p = .563) or between primiparous versus multiparous women (p = .060). The women whose labour lasted 12 h or less (p = .024), without perineal trauma (p = .021) and those who had not undergone episiotomy (p = .002) achieved a better final CEQ score. Instrumental delivery (forceps) versus normal delivery is associated with lower scores with respect to the final CEQ-E score (p ≤ .001). Conclusions: Women’s overall satisfaction after delivery in HUMIC was high. Instrumental delivery seems to be associated with lower perceived satisfaction. Aspects such as fear and fatigue in labour could affect satisfaction negatively. These aspects can be improved by establishing strategies to increase comfort and minimise pregnant women's fear of labour. Objetivo: Conocer el grado de satisfacción de las mujeres tras el parto en el Hospital Universitario Materno-Infantil de Gran Canaria (HUMIC) y establecer posibles relaciones entre el grado de satisfacción y las variables estudiadas. Método: Estudio observacional descriptivo de corte transversal con componente analítico. La población a estudio fueron las mujeres cuyo parto tuvo lugar en el mes de noviembre del 2018 en el HUMIC reclutadas mediante muestreo no probabilístico de tipo consecutivo. Se utilizó el cuestionario Childbirth Experience Questionnaire en su versión española (CEQ-E) (cuestionario con 4 dominios: capacidad propia, apoyo profesional, seguridad percibida y participación/modelo de análisis 2). En una primera fase se realizó un análisis descriptivo y en una segunda, un análisis inferencial para explorar la asociación entre diferentes variables. Resultados: La muestra total fue de 257 mujeres (n = 257). La puntuación total con el CEQ-E fue de 3,24 (DE 0,37 puntos). No se encontraron diferencias estadísticamente significativas en la puntuación final del CEQ-E entre las mujeres con parto espontáneo frente a inducciones-estimulaciones (p = 0,563) ni entre mujeres primíparas frente a multíparas (p = 0,060). Las mujeres cuyo parto había sido menor o igual a 12 h (p = 0,024), sin traumatismo perineal (p = 0,021) y aquellas a las que no se les ha realizado episiotomía (p = 0,002) obtuvieron mejor puntuación final en el CEQ-E. El parto instrumental (fórceps) frente al parto eutócico se asocia a puntuaciones menores respecto a la puntuación final en el CEQ-E (p ≤ 0,001). Conclusiones: La satisfacción global de la gestante tras el parto en el HUMIC es alta. El parto instrumental parece asociarse a menor satisfacción percibida. Aspectos como el miedo y el cansancio en el parto pueden influir negativamente en la satisfacción. Estos aspectos son susceptibles de mejora mediante el establecimiento de estrategias que ayuden a mayor bienestar y minimicen el miedo de las gestantes en su parto.

Objective: To determine the number of specialised wound care units/clinics (SWCUs) in Spain, at present, and to describe their most important characteristics. Method: This was an observational study with a descriptive-analytical, cross-sectional, multicentre approach, where the studied population consisted of SWCUs in Spain. A specific data-collection questionnaire was designed using a modified Delphi method, consisting of four rounds, with the collaboration of 10 wound experts. The final questionnaire included 49 items distributed across four dimensions/areas with a content validity index (CVI-Total for pertinence=0.96 and CVI-Total for relevance=0.94. Results: A total of 42 SWCUs were included in the study. Most SWCUs were based in hospitals (n=15, 35.7%) or healthcare centres, covering a specific healthcare area (n=17, 40.5%). SWCU coordinators were primarily nurses (n=33, 78.6%). Staff members' professions in SWCUs included registered nurses (n=38 units, 92.7%), nursing assistants (n=8 units, 19.5%), podiatrists (n=8 units, 19.5%), vascular surgeons (n=7 units, 17%), osteopaths (n=2 units, 4.8%) and medical doctors from different specialties (n=3 units, 7.2%). For wound aetiology, the most prevalent wounds managed were diabetic foot ulcers (n=38 units, 90.5%), followed by venous leg ulcers (n=36 units, 85.7%) and arterial ischaemic ulcers (n=36 units, 85.7%). A statistically significant association was found between the number of staff members in a SWCU and the existence of resistance/opposition barriers when developing a SWCU (Chi-square test, p=0.049; Cramér's V=0.34; 34%), as well as between resistance/opposition barriers when developing a SWCU and a nurse as coordinator of a SWCU (MacNemar test, p=0.007, Cramér's V=0.35; 35%). Conclusion: The typical SWCU implemented in Spain is located in a hospital or integrated in a healthcare structure that offers coverage to a whole health area and providing services for people with hard-to-heal wounds (wound management and prevention) and health professionals (advice, consultancy and training/education). Despite the growing number of SWCUs in Spain, the future of this new organisational model is uncertain, as there can be barriers to creating them and some deficiencies, such as low staff numbers, which need to be addressed.

The fear of childbirth is a topical concern, yet the issue has barely been studied in Spain, and only one fear of childbirth measurement instrument has been validated in the country. The aim of this study was to translate, adapt and validate the Fear of Childbirth Questionnaire (CFQ) for use in Spain, as well as to describe and evaluate the psychometric properties of the Spanish version of this instrument. In a first phase, a methodological study was carried out (translation–backtranslation and cross-cultural adaptation), and pilot study was carried out in the target population. In addition, content validation of the instrument was obtained (CFQ-e) from 10 experts. In the second phase, a cross-sectional study was carried out at several centres in Gran Canaria Island to obtain a validation sample. The evaluation of the psychometric properties of the CFQ-e, including construct validity through exploratory factor analysis and confirmatory factor analysis, the calculation of reliability via factor consistency using the ORION coefficients as well as alpha and omega coefficients were carried out. The CFQ-e showed evidence of content validity, adequate construct validity and reliability. The CFQ-e is composed of 37 items distributed in four subscales or dimensions: “fear of medical interventions”; “fear of harm and dying”; “fear of pain” and “fears relating to sexual aspects and embarrassment”. The CFQ-e constitutes a valid and reliable tool to measure the fear of childbirth in the Spanish pregnant population.

Aim: According to our scoping review questions, three aims were formulated to synthesize the evidence published on: (1) the content (2) the best or most appropriate teaching-learning methods for training nurses and undergraduate nursing students in venous leg ulcer care, and (3) to identify the level of knowledge in nurses and undergraduate nursing students about venous leg ulcer care. Background: A venous leg ulcer can be defined as a skin lesion on the leg or foot that occurs in an area affected by ambulatory venous hypertension. Hence, nurse visits are the main driver of Venous Leg Ulcer-related healthcare costs. Optimal levels of knowledge obtained with appropriate methodologies tend to improve care. Nonetheless, the time devoted to chronic wound education in undergraduate nursing curricula has been considered insufficient and inadequate. Methods: For this scoping review, a search was performed in January 2021. To identify sources of evidence, a systematic search was conducted in MEDLINE, Embase, CINAHL, Web of Science, Scopus, Cuiden, ERIC and ScienceDirect. All types of evidence associated with knowledge, teaching and/or learning methods regarding venous leg ulcers in nursing were included. Results: Finally, 19 documents were included. In these articles, the content mostly widely included in teaching-learning methods was compression therapy (14/19), anatomy, physiology, aetiology and/or pathophysiology (10/19) and topical treatment and care (8/19); various other topics were mentioned but less frequently. Teaching/learning methods and interventions were heterogeneous in modality, content, and duration but the majority showed better results after implementation. When looking at knowledge level, studies mainly focused on nursing staff. In general, it seems that there is a lack of knowledge and skills. Conclusions: Regarding our three pivotal questions: (1) There is no uniform type of content over the studies analysed and the most referred was compression therapy. (2) The educational interventions studied have demonstrated effectiveness, but there is insufficient data to determine which is the most effective. (3) This scoping review has highlighted the lack of knowledge among nurses and nursing students about venous leg ulcer care. Additionally, we felt that there is no ideal assessment tool to quantify knowledge, skills, attitude, confidence, and commitment in this context. Tweetable abstract: A scoping review that synthesise the evidence on the level of knowledge and teaching-learning methods in nursing regarding of people with venous leg ulcers shows lack of knowledge and variability in programs.

This 8-week, multicenter, randomized, active-controlled, observer-blinded clinical trial was designed to demonstrate the accelerating effect on wound healing of the novel Olea europaea leaf extract hydrogel (EHO-85) by comparing it to a widely used amorphous hydrogel. Results showed that EHO-85 significantly accelerated wound healing, regardless of ulcer etiology (pressure, venous leg or diabetic foot) and prognosis, doubling the median wound area reduction compared with a reference amorphous hydrogel (79.4% vs. 39.7%; difference: −39.7%, 95% CI: −71.1 to −21.3%; p < 0.001). The intention-to-treat analysis was conducted on 195 patients from 23 Spanish health centers/nursing homes. This novel treatment balances the ulcer microenvironment by modulating reactive oxygen species and pH. These actions complement the moistening and barrier functions inherent to amorphous hydrogels, whilst also conferring EHO-85 its documented granulation formation and pain relief properties. Furthermore, efficacy was achieved safely and in a cost-efficient manner due to its multi-dose format, which reduced the amount of product needed by 85.8% over 8 weeks compared to single-use hydrogel. The present randomized controlled trial is a relevant milestone in evidence-based practice for being the first to demonstrate (i) the effectiveness of an amorphous hydrogel in accelerating wound healing and (ii) the superiority of a specific hydrogel over another. This research was funded by QUESPER R&D (Córdoba, Spain) and partially by the programme for the Reinforcement of Research Activity in the Clinical Management Units of the Andalusian Health Service (Department of Health. Regional Government of Andalusia, Spain).

The presence of venous leg ulcers (VLU) is associated with emotional disorders in individuals who have conditions, such as depression, anxiety, and sleeping problems, which result in a reduced perceived quality of life by these individuals. The study aim was to describe the perceived quality of life and associated factors for individuals with VLU. We conducted a cross-sectional study in 22 primary care health centers with a sample of 93 individuals with VLU. The variables collected were the following: perceived quality of life measured with Spanish version of the Charing Cross Venous Ulcer Questionnaire (CCVUQ-e), ulcer severity measured with the RESVECH 2.0 Score, demographic variables, and those related to the healing process. The results showed a mean CCVUQ-e score of 47.4 ± 11.8 points (Mean ± SD), with the most affected dimension being the emotional status, followed by cosmesis, social interaction, and domestic activities. The mean RESVECH 2.0 score was 11.1 ± 3.7 points. An association was found between ulcer-related pain and poorer quality of life (P < .05, t test) and between erythema in perilesional skin and poorer quality life (P < .05, t test). The signs of infection and inflammation in the VLUs were as follows: increasing exudate, friable tissue, and biofilm-compatible tissue, which were associated with a poorer quality of life (P < .05, t test). The multivariate model was statistically significant and explained a variability of 26% in the CCVUQ-e score. This study confirms that wound severity, pain, and signs of infection in VLU decrease the perceived quality of life of individuals with these wounds. This study was funded by PN of I+D+I 2013-2016 and the ISCIII—General Deputy Directorate of Research Evaluation and Promotion and FEDER funds (PI13/01975). The Ministry of Economics and Competitiveness.

The prevalence of chronic wounds is increasing due to the population aging and associated pathologies, such as diabetes. These ulcers have an important socio-economic impact. Thus, it is necessary to design new products for their treatment with an adequate cost/effectiveness ratio. Among these products are amorphous hydrogels. Their composition can be manipulated to provide a favorable environment for ulcer healing. The aim of this study was to evaluate a novel multifunctional amorphous hydrogel (EHO-85), containing Olea europaea leaf extract, designed to enhance the wound healing process. For this purpose, its moistening ability, antioxidant capacity, effect on pH in the wound bed of experimental rats, and the effect on wound healing in a murine model of impaired wound healing were assessed. EHO-85 proved to be a remarkable moisturizer and its application in a rat skin wound model showed a significant antioxidant effect, decreasing lipid peroxidation in the wound bed. EHO-85 also decreased the pH of the ulcer bed from day 1. In addition, in mice (BKS. Cg-m +/+ Leprdb) EHO-85 treatment showed superior wound healing rates compared to hydrocolloid dressing. In conclusion, EHO-85 can speed up the closure of hard-to-heal wounds due to its multifunctional properties that are able to modulate the wound microenvironment, mainly through its remarkable effect on reactive oxygen species, pH, and moistening regulation. This research was funded by QUESPER R&D, and partially by INNCORPORA-TU-2011-1886 subprogramme (Ministry of Economy and Competitiveness, Spain) and the program for the Reinforcement of Research Activity in the Clinical Management Units of the Andalusian Health Service (Department of Health. Regional Government of Andalusia, Spain).

The excess of free radicals in the wound environment contributes to its stagnation during the inflammatory phase, favoring hard-to-heal wounds. Oxidative stress negatively affects cells and the extracellular matrix, hindering the healing process. In this study, we evaluated the antioxidant and wound-healing properties of a novel multifunctional amorphous hydrogel-containing

This 8-week, multicenter, randomized, active-controlled, observer-blinded clinical trial was designed to demonstrate the accelerating effect on wound healing of the novel

The prevalence of chronic wounds is increasing due to the population aging and associated pathologies, such as diabetes. These ulcers have an important socio-economic impact. Thus, it is necessary to design new products for their treatment with an adequate cost/effectiveness ratio. Among these products are amorphous hydrogels. Their composition can be manipulated to provide a favorable environment for ulcer healing. The aim of this study was to evaluate a novel multifunctional amorphous hydrogel (EHO-85), containing

Incontinence-associated dermatitis (IAD) has been studied over the last decades, but gaps in the knowledge related to its identification, etiological agents, and risk factors remain. We carried out a scoping review about IAD that included systematic reviews, experimental, and observational studies about IAD and its potential risk factors. We retrieved 24 articles that described 100 potential risk factors and which were synthesized by the authors and proposed to a panel of experts. Panelists used a structured process of consensus development to create a conceptual framework of factors associated with IAD. This framework proposes that liquid fecal material, when combined with exposure to urine and stool, and bacterial contaminated urine are etiological factors for development of IAD. The framework also proposes 2 pathophysiological mechanisms and 8 main risk factors for IAD development. The proposed model could improve the quality of care for patients with or at risk of IAD, assisting healthcare professionals to identify at-risk patients, diagnose the type of lesion, and establish adequate and effective prevention and treatment measures.

Resumo Objetivo: Verificar a consistência interna e estabilidade do Charing Cross Venous Ulcer Questionnaire - Brasil (CCVUQ-Brasil). Métodos: Trata-se de uma pesquisa metodológica realizada em duas regiões do Brasil (Goiânia e Niterói), no período de junho de 2016 a junho de 2018. A amostra para a consistência interna foi composta por 112 pessoas e para a estabilidade foram avaliados 74 participantes, todos com úlcera venosa atendidas na rede pública de saúde. Para análise da consistência interna foi calculado o alfa de Cronbach. Para estabilidade, o questionário foi aplicado duas vezes com intervalo de 30 minutos e para sua análise foi calculado o coeficiente de correlação intraclasse (CCI). Resultados: O CCVUQ-Brasil apresentou alfa de Cronbach para pontuação total do questionário igual 0,92 e para os domínios (interação social, atividades domésticas, estética e estado emocional) foi acima de 0,70. A estabilidade foi excelente (CCI=0,96) para pontuação total do questionário e para a maioria dos domínios. Conclusão: O CCVUQ - Brasil obteve boa consistência interna considerando os dois cenários estudados e excelente estabilidade no cenário Goiânia.

Background: Chronic wounds give rise to major costs and resource consumption in health care systems, due to their protracted healing time. Incidence and prevalence data are scarce or nonexistent in community settings. Objective: The aim of the present epidemiological study was to analyse and determine the prevalence of chronic wounds in the community in the south of the province of Barcelona (Spain). Design: A cross-sectional, multicentre secondary data analysis study was conducted in the community (excluding nursing homes) in Barcelona between 16 April and 13 June 2013. It included 52 primary care centres that serve a total population of 1,217,564 inhabitants. Results: The observed prevalence was 0.11%. Venous ulcers presented the highest prevalence, at 0.04%, followed by pressure injuries, at 0.03%. The &gt, 74 age group presented the highest frequency of chronic wounds, accounting for 69.4% of cases. Conclusion: The results obtained are consistent with those reported in previous similar studies conducted in Spain and elsewhere. As with most studies that adjusted their variables for age and sex, we found that the prevalence of ulcers increased with age and was higher in women, except in the case of diabetic foot ulcers and ischaemic ulcers, which were more frequent in men.

espanolRESUMEN Objetivos: Describir y analizar la incidencia de ulceras por presion (UPP) en una unidad geriatrica de recuperacion funcional de un hospital geriatrico y examinar los posibles factores de riesgo. Metodos: Estudio retrospectivo de dos series cronologicas de incidencia de UPP en la unidad geriatrica, de media estancia o convalecencia. Conformaron las dos series todos los pacientes ingresados consecutivamente en los dos periodos de estudio (n = 241). Se considero UPP incidente o intrahospitalaria aquella que se produjo a partir de las 48 horas desde el ingreso (formula de calculo: Pacientes que han desarrollado una UPP en el hospital × 100/ pacientes ingresados mas de 2 dias). Se realizo un analisis descriptivo de las variables recogidas y comparaciones mediante la prueba de la χ2 o el test exacto de Fisher, segun correspondiera. Resultados: La incidencia acumulada para el primer periodo fue del 23%, IC 95% = 15,8-31,4 y en el segundo, del 23,5%, IC 95% = 15,9-31,2; no se encontraron diferencias estadisticamente significativas. Se obtuvo una tasa de incidencia de 3,4 por 1000 pacientes/dia en el primer periodo y de 4,6 por 1000 pacientes/ dia en el segundo, lo que supone una razon de tasas de 0,857, IC 95% = 0,49-1,5. No hubo diferencias en el RR de desarrollar UPP en funcion del periodo por cada variable, a excepcion del diagnostico de problemas musculoesqueleticos donde los pacientes con este problema en el segundo grupo tuvieron un riesgo relativo (RR) = 3,3, IC 95% = 1,1-10,9. Conclusiones: Este estudio ha permitido determinar la incidencia de UPP y sus factores de riesgo en una unidad de recuperacion funcional de un hospital geriatrico, resultado epidemiologico apenas identificado en la literatura y de gran importancia para poder abordar mejoras en la calidad del cuidado del paciente anciano. EnglishABSTRACT Objectives: To describe and analyze the incidence of pressure ulcers (PU) at the geriatric functional recovery unit of a geriatric hospital, along with the possible risk factors. Methods: a retrospective time series study conducted at a mid-stay or convalescence geriatric unit to examine the incidence of PU. Two study periods were examined between 2012 and 2013. The data comprised all patients consecutively admitted during both study periods, n=241. The occurrence of a PU or hospital-acquired pressure ulcer was considered as a lesion that occurred > 48 hours after admission (the formula used for calculation was: patients who have developed a PU at the hospital × 100 / patients admitted for more than two days). A descriptive analysis was performed of the gathered variables and these were compared using the Chi-Squared test or the Fisher’s exact test, as appropriate. Results: the accumulated incidence for the first study period was 23%, 95% CI=15.8-31.4, whereas during the second period this was 23.5%, 95% CI=15.9-31.2. No statistically significant differences were found. An incidence rate of 3.4 per 1,000 patients / day was obtained during the first period and of 4.6 per 1,000 patients / day during the second period, equaling a rate of 0.857, 95% CI=0.49-1.5. There were no differences in the RR of developing PU according to the period for each variable, with the exception of the diagnosis of muscle-skeletal problems; patients in the second group who had this ailment obtained a RR of 3.3, 95% CI=1.1-10.9. Conclusions: This study has enabled us to determine the incidence of PU and their risk factors at the functional recovery unit of a geriatric hospital. To date, there is scarce epidemiological data on this population. However, further studies on this topic are necessary in order to continue improving the quality of care for older patients.

Objective: A score to identify local wound infections was developed by a panel of experts from seven European countries. The Therapeutic Index for Local Infections (TILI) score was designed for health professionals who are not specialised in wound care. This study was carried out to test the validity of the TILI score in everyday practice. Method: Content validity was analysed by means of evaluation by a panel of experts, individually and face-to-face, followed by a European multicentred, retrospective, observational study. Participating clinicians sent anonymised copies of completed TILI scores for patients with leg ulcers along with a photograph of the wound for analysis by two blinded reviewers. Concordance (Kappa index) and convergent criterion validity (sensitivity, specificity, accuracy, Youden's J Index and receiver operator characteristic (ROC) or area under the curve (AUC) curve) were calculated to construct validity and reliability. Results: A total of 307 patients with leg ulcers from seven institutions in five European countries were included in this retrospective analysis. It was shown that the diagnosis of local wound infection could be documented well with five of the six clinical criteria included in the TILI score. By summing up these facultative criteria in comparison with any direct criteria that may be present, there would have been an indication for local antiseptic wound therapy in 22% of patients examined. Conclusions: The results show that the TILI score is concordant with the expert assessment of patients and with good diagnostic characteristics. Thus, the easy-to-use TILI score can now be used in the daily routine practice of health professionals to diagnose local wound infections.

Diabetic foot ulcer (DFU) is a chronic complication that negatively affects the quality of life (QoL) of diabetic patients. In Spain, there is no specifically designed and validated instrument to assess the QoL of patients with DFU. Our aim was to adapt the Diabetic Foot Ulcer Scale-Short Form (DFS-SF) questionnaire to a Spanish population and validate it. A prospective, observational design was used. The DFS-SF was administered by personal interview. The validated SF-36 and EQ-5D generic instruments were used as reference tools. The reliability, validity, and sensitivity to changes were assessed using standard statistical methods. A sample of 141 patients with DFU was recruited. The content validity was 3.46 on average (maximum score of 4). The internal consistency of the DFS-SF subscales showed a standardized Cronbach’s α range between 0.720 and 0.948. The DFS-SF domains showed excellent reproducibility measures (intraclass correlation coefficient from 0.77–0.92). The criterion validity was good with significant correlations between each DFS-SF subscale and its corresponding SF-36 and EQ-5D subscales (p < 0.001). However, the questionnaire structure was not validated (comparative fit index = 0.844, root mean square error of approximation = 0.095, and standardized root mean square residual = 0.093). The instrument showed high sensitivity to ulcer changes over time (p < 0.001). The adapted and validated Spanish version of the DFS-SF questionnaire has good psychometric properties and shows good sensitivity to ulcer changes, although the construct validity was not optimal. The adapted questionnaire will be a useful tool specifically to assess the QoL in subjects with diabetic foot ulcers in the clinical and research settings in Spain. CIBERDEM is an initiative from Instituto de Salud Carlos III (Plan Nacional de I + D + I and Fondo Europeo de Desarrollo Regional). M.G.-C. held a predoctoral fellowship from the Ministerio de Educación, Cultura y Deporte, FPU15/03005. This project was developed in the context of the Programme “Doctorat en Medicina de la Universitat Autònoma de Barcelona”, Autonomous University of Barcelona.