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This article describes how nurses can use the Q methodology to include head and neck cancer patients in research. These patients are often excluded from participating in research based on temporary or permanent voiceless, disfigurement, or impaired communication. Q methodology is defined as the method for the study of subjectivity and related procedures seem to facilitate the participation of head and neck cancer patients. As so, this inclusive dimension should be taken into consideration in research project design also as an ethical aspect of the study, in particular when involving these patients or others in similar conditions.

This review aimed to analyze the use of differential validation of nursing diagnosis.Integrative literature review with search on international databases. The diagnoses, the type of the diagnosis differential validation, the sample, the method, main results, and the limitations were extracted. Ten studies were included.Differential diagnostic validation publication dates from 1994, and Brazil was the predominant country.This method seems helpful in improving diagnosis accuracy, particularly those related to subjective, behavioral, or complex human responses.Using this model may facilitate understanding the specificity of nursing diagnosis, which is critical for teaching clinical reasoning and for new opportunities to research.O objetivo desta revisão foi analisar a utilização da validação diferencial de diagnósticos de enfermagem. MÉTODOS: Revisão integrativa da literatura com pesquisa em bases de dados internacionais. Foram extraídos dados referentes ao tipo de diagnóstico, validação diferencial, amostra, metodologia, principais resultados e limitações. Foram incluídos 10 estudos.Foram identificadas publicações desde 1994, sendo o Brasil o país predominante. CONCLUSÕES: Este modelo parece ser útil para melhorar a precisão do diagnóstico, particularmente aqueles relacionados a respostas humanas subjetivas, comportamentais ou complexas. IMPLICAÇÕES PARA A PRÁTICA: O uso deste modelo pode facilitar a compreensão da especificidade do diagnóstico de enfermagem, que é fundamental para o ensino do raciocínio clínico, para novas oportunidades de pesquisa.

(1) Background: An aging population, pollution and an increase in life habits that are harmful to respiratory health, and more recently the COVID-19 pandemic, have led to an increase in chronic respiratory diseases. Thus, this pilot study aims to describe an intervention program on the training of respiratory patients to maintain airway permeability and preventing complications. (2) Methods: An observational, analytical, and prospective study was proposed. After the initial evaluation of each user during hospitalization, the program started with two sessions, at discharge for the second phase, and fifteen days after discharge for the third phase. Throughout the program’s implementation, the modified Medical Research Council scale and the Barthel Index were applied. (3) Results: The population studied aged between 39 and 76 years, diagnosed with pneumonia or chronic obstructive pulmonary disease, showed a significant improvement in the degrees of dyspnea and levels of functionality, as well as an adequate level of learning. (4) Conclusions: This program positively impacted the patients’ independence by reducing dyspnea and increasing functionality of the patients included in this study. The set of exercises and techniques can be replicated at home and may be fundamental in the management of respective recovery, as well as in the COVID-19 pandemic.

Resumo Os sistemas de informação em enfermagem, onde se integram os indicadores de qualidade, têm como foco a uniformização dos registos em saúde e a consequente visibilidade dos cuidados prestados. Apesar da reconhecida importância dos contributos dos sistemas de informação, a sua implementação tem-se pautado por vários desafios pelo que nos propomos assim a refletir sobre estes. Com o objetivo de identificar a evidência disponível na literatura sobre estes mesmos desafios, foi desenvolvida uma revisão narrativa da literatura com análise de artigos e relatórios pertinentes acerca desta questão. Está patente na literatura a importância dos sistemas de informação para a obtenção de indicadores de qualidade sensíveis aos cuidados de enfermagem, existindo efetivamente um impacto positivo na qualidade dos cuidados, permitindo a mensurabilidade da qualidade nas intervenções, bem como facilitando a comparabilidade intra e interinstitucional, em tempo real ou em análise retrospetiva. Os desafios encontrados e que urge resolver na prática clínica, relacionam-se com a dificuldade de os profissionais percecionarem o impacto dos registos informáticos, a visibilidade dos indicadores em enfermagem e o tempo que é alocado em contexto de prestação de cuidados para realizar estes registos. Abstract Nursing information systems, where quality indicators are integrated, focus on the standardization of health records and the consequent visibility of the provided care. Despite the acknowledged importance of the contributions of information systems, their implementation has been characterized by several challenges, so we propose to reflect on them. To identify the evidence available in the literature on these same challenges, a narrative review of the literature was developed, with the analysis of relevant articles and reports on this issue. It is clear in the literature the importance of information systems for obtaining quality indicators that are sensitive to nursing care, with a positive impact on the quality of care, allowing for measurable quality in interventions, as well as facilitating inter and intra-institutional comparability, in real-time or in a retrospective analysis. The challenges encountered and which urgently needs to be resolved in clinical practice are related to the difficulty for professionals to perceive the impact of computer records, the visibility of nursing indicators and the time that is allocated in the context of providing care to carry out these records.

Objectives: This article provides practical guidance on developing a comprehensible abstract, including those required for funding applications, conferences, and publication. In addition, we discuss and demonstrate the practicalities of editing and revising an abstract for conference or peer review and identify emerging formats that may be more relevant to nurses and researchers. Data Sources: This article has been informed by literature and the coauthors' respective experiences of preparing and reviewing abstracts for publication and conference presentation. Conclusion: Abstracts are a valuable tool to communicate the most important elements of the methods and results of a research project for a conference, manuscript, or even a research funding application. However, abstracts may often be an overlooked part of the dissemination process. An abstract determines whether or not a piece of research is relevant for presentation at a conference or valuable enough to be considered for peer review and subsequent publication. A strong and clearly written abstract positively predisposes reviewers of grant applications. Implications for Nursing Practice: Writing an abstract is arguably the most challenging component of academic writing, summarizing the results of a substantive research project in three to five sentences and positioning them concisely within the background and implications for future practice, policy, and research. A well-written abstract is clear, concise, and critical and requires time and revision to ensure success. © 2023 The Author(s)

Purpose Identifying cancer nursing research priorities is central to influencing the direction of cancer care research. The aim of this rapid review was to explore research priorities identified by oncology nurses for cancer care delivery between 2019-2022. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis informed the design of the rapid review. MEDLINE, CINAHL, PUBMED, Web of Science, and Cochrane databases were searched for studies published between December 1st, 2018, and September 30th, 2022. This timeframe was chosen to account for the latest relevant evidence synthesis, as well as changes in cancer care necessitated by the COVID-19 pandemic. The Quality Assessment of Diverse Studies tool was used to appraise quality. Results Four studies met the inclusion criteria. Many of the research priorities identified were influenced by the COVID-19 pandemic. The top cancer nursing research priority identified was the role of technology in improving patient and caregiver symptoms and health outcomes. Other most prevalent research priorities were focused on symptom management, culturally sensitive palliative and psychosocial care, early/integrated palliative care, financial toxicity, modifiable risk factors related to social determinants of health, public and patient involvement in research, and oncology nurses' well-being and scope of practice. Conclusion The findings indicate a need to steer a strategic programme of cancer nursing research towards digitalisation in cancer care to meet the current needs of people living with cancer and their caregivers. However, cancer nurses' burnout, staff shortages and disparities in specialist education will hinder the implementation of certain models of care.

Nursing information systems, where quality indicators are integrated, focus on the standardization of health records and the consequent visibility of the provided care. Despite the acknowledged importance of the contributions of information systems, their implementation has been characterized by several challenges, so we propose to reflect on them. To identify the evidence available in the literature on these same challenges, a narrative review of the literature was developed, with the analysis of relevant articles and reports on this issue. It is clear in the literature the importance of information systems for obtaining quality indicators that are sensitive to nursing care, with a positive impact on the quality of care, allowing for measurable quality in interventions, as well as facilitating inter and intra-institutional comparability, in real-time or in a retrospective analysis. The challenges encountered and which urgently needs to be resolved in clinical practice are related to the difficulty for professionals to perceive the impact of computer records, the visibility of nursing indicators and the time that is allocated in the context of providing care to carry out these records.Os sistemas de informação em enfermagem, onde se integram os indicadores de qualidade, têm como foco a uniformização dos registos em saúde e a consequente visibilidade dos cuidados prestados. Apesar da reconhecida importância dos contributos dos sistemas de informação, a sua implementação tem-se pautado por vários desafios pelo que nos propomos assim a refletir sobre estes. Com o objetivo de identificar a evidência disponível na literatura sobre estes mesmos desafios, foi desenvolvida uma revisão narrativa da literatura com análise de artigos e relatórios pertinentes acerca desta questão. Está patente na literatura a importância dos sistemas de informação para a obtenção de indicadores de qualidade sensíveis aos cuidados de enfermagem, existindo efetivamente um impacto positivo na qualidade dos cuidados, permitindo a mensurabilidade da qualidade nas intervenções, bem como facilitando a comparabilidade intra e interinstitucional, em tempo real ou em análise retrospetiva. Os desafios encontrados e que urge resolver na prática clínica, relacionam-se com a dificuldade de os profissionais percecionarem o impacto dos registos informáticos, a visibilidade dos indicadores em enfermagem e o tempo que é alocado em contexto de prestação de cuidados para realizar estes registos.

Purpose This article explores the current structure of NANDA-I nursing diagnoses (ND) labels. Methods Critical analysis of the ND labels, as categorized in the NANDA-I terminology. Findings Most of the 244 ND labels are composed of terms from the focus and judgment axes. Conclusions The specificity of the human responses toward health and life transitions may not be totally represented in the two most common axes, as categorized within taxonomy II. Implications for nursing practice Improvements in NANDA-I diagnosis labels would contribute to an advanced terminology and to increased specificity and accuracy of the diagnostic process that is needed in clinical practice. Completeness of the ND labels would reflect clinical reasoning preciseness and help students and nurses in delivering more personalized, safe, and effective patient-centered care. Objetivo Este artigo explora os titulos dos diagnosticos de enfermagem da NANDA-I. METODOS: Analise critica dos titulos dos diagnosticos de enfermagem da NANDA-I. Resultados A maioria dos 244 diagnosticos de enfermagem classificados sao compostos essencialmente por termos referentes ao foco e ao julgamento. CONCLUSOES: A especificidade das respostas as transicoes de saude e vida pode nao estar totalmente representada nos dois eixos mais comuns, como apresentado na taxonomia II. IMPLICACOES PARA A PRATICA: Melhorias nos diagnosticos da NANDA-I em relacao ao seu aspeto multiaxial contribuiriam no desenvolvimento da sua terminologia e poderiam melhorar a especificidade e acuracia do processo diagnostico que e necessario a pratica clinica. Complementar os titulos dos diagnosticos de enfermagem poderia refletir a acuracia do raciocinio clinico e ajudar os estudantes e enfermeiros em prestarem cuidados centrados no paciente mais personalizados, seguros e eficazes.

OBJECTIVE This article describes the adequacy of the Q methodology as a new option for the validation of nursing diagnoses related to subjective foci. METHODS Discussion paper about the characteristics of the Q methodology. FINDINGS This method has been used in nursing research particularly related to subjective concepts and includes both a quantitative and qualitative dimension. CONCLUSIONS The Q methodology seems to be an adequate and innovative method for the clinical validation of nursing diagnoses. IMPLICATIONS FOR PRACTICE The validation of nursing diagnoses related to subjective foci using the Q methodology could improve the level of evidence and provide nurses with clinical indicators for clinical reasoning and for the planning of effective interventions. OBJETIVO Descrever a adequacao da metodologia Q como uma nova opcao para a validacao clinica de diagnosticos de enfermagem relacionados com focos subjetivos. METODOS Artigo de discussao sobre as caracteristicas da metodologia Q. RESULTADOS Este metodo tem sido utilizado na pesquisa em enfermagem relacionada com conceitos subjetivos e inclui em simultâneo uma vertente qualitativa e quantitativa. CONCLUSOES A metodologia Q parece ser uma opcao metodologica adequada para a validacao clinica de diagnosticos de enfermagem. IMPLICACOES PARA A PRATICA A utilizacao da metodologia Q na validacao clinica de diagnosticos de enfermagem relacionados com focos subjetivos pode melhorar o nivel e evidencia e facilitar o raciocinio clinico dos enfermeiros, ao providenciar indicadores clinicos tambem necessarios ao desenvolvimento de intervencoes efetivas.

Tese de Doutoramento em Ciências Agronómicas e Florestais

AIM Of the few instruments available to measure the important, positive aspects of caring, the Caregiver Reaction Assessment is regarded as the most suitable, but there is no validated Spanish version. The aim of this study was to translate the Caregiver Reaction Assessment into Spanish and assess its psychometric properties. METHODS The Caregiver Reaction Assessment was translated into Spanish and then back translated. Validation included construct validity, criterion validity and reliability: 287 interviews were conducted with informal caregivers of patients with dementia between November 2010 and April 2012. RESULTS Principal component analysis confirmed the original instrument's five subscales. Criterion validity showed a moderate negative correlation between the impact on health and the EQ-5D (r = -.43), that is, a greater impact on health correlated with lower health-related quality of life. The Caregiver Reaction Assessment showed good internal consistency, with a Cronbach alpha of .804, and good temporal stability for the distinct subscales, with intraclass correlation coefficients varying from .683 to .729 (p < .001). CONCLUSION The Caregiver Reaction Assessment is a reliable, valid instrument for the measurement of the reactions of informal caregivers of patients with dementia, with good psychometric properties.

Relatório Final de Estágio apresentado à Escola Superior de Dança, com vista à obtenção do grau de Mestre em Ensino de Dança Submitted by Ana Correia (acorreia@esd.ipl.pt) on 2019-01-07T14:47:33Z No. of bitstreams: 1 RF_MED_2018_SusSil.pdf: 2823335 bytes, checksum: a241320b5281636bfcd33364a880d508 (MD5) Made available in DSpace on 2019-01-07T14:47:33Z (GMT). No. of bitstreams: 1 RF_MED_2018_SusSil.pdf: 2823335 bytes, checksum: a241320b5281636bfcd33364a880d508 (MD5) Previous issue date: 2018-11-27 N/A

Risk factors associated with admission of people with dementia to long-term care institutions need to be identified to support health-care professionals in dementia care at home. An explorative study, combining quantitative and qualitative data collection methods, was performed in people with dementia in Spain. The sample, consisting of people with dementia receiving formal care from health-care professionals but at risk of institutionalisation, and their informal care-givers; and people with dementia recently admitted to a long-term care institution, and their informal care-givers, was interviewed between November 2010 and April 2012. Perceived reasons for admission were determined through an open-ended question put to both groups. Presumed risk factors were collected with validated questionnaires and analysed using bivariate analysis. A total of 287 people with dementia and informal care-givers were studied. Reasons given by the institutionalised group were mostly related to the level of dependency of the person with dementia. People recently admitted to a long-term care institution had more cognitive impairment, a greater degree of dependency and poorer quality of life than those still living at home. Home-care services in Spain need to develop or improve interventions based on the risk factors identified in this study: informal care-giver profile, high cognitive impairment, high level of dependency and the poor quality of life of the person with dementia.

Background Prevalence of dementia in developed countries is high. Optimising the quality of life (QoL) of both patient and caregiver is the most important treatment goal. The main objective is to measure the QoL of people with dementia living at home or in long-term care institutions (LTCI) and identify related factors. Methods Cross-sectional study. Data of people with dementia who lived at home or who had been recently admitted to an LTCI in Spain was included. QoL was assessed by people with dementia themselves and their proxies using the ‘Quality of Life-Alzheimer's Disease scale' (QoL-AD). Clinical, cognitive and neuropsychiatric data were collected. Results In total, 287 PwD were included; 113 from LTCIs (39.4%) and 174 from home care (HC) (60.6%). Mean age was 83.2 (7.1) years; 201 (70%) patients were women and mean of the MMSE score was 15.1 (5.6). A total of 160 (55.7%) PwD had completed data for both QoL self-reported and proxy-reported (35.4% from LTCI and 69% from HC; P b : –0.534, P =0.001) and neuropsychiatric symptoms ( b : –0.223, P =0.004) were independently associated with self-reported QoL. The Charlson index ( b : –0.637, P =0.032), Katz ( b : 0.481, P =0.019) and Cornell index score ( b : –0.367, P =0.001) were independently associated with proxy-reported QoL. Conclusions Low depressive and neuropsychiatric symptoms were independently associated with better self-reported QoL. On the other hand, low comorbidity, better functional status and low depressive symptoms were independently associated with QoL reported by the informer caregivers.

Background Due to the high prevalence of dementia, health care needs are increasing beyond existing formal resources. In Spain, it is the family that takes care of this disease. Aims To analyze the direct (health and non-health) and indirect economic costs related to care of people with dementia living with their informal caregiver in the home care/community environment, from the perspective of illness severity, associated comorbidity and social impact. Design Multicentric, descriptive study. Setting Three primary care public health centers associated with Hospital Clinic, Barcelona (Spain). Participants Patients over 65 years old with a diagnosis of dementia, and included in a home care program. Inclusion criteria People with a diagnosis of dementia made by a specialist neurologist; aged 65 years or older; a score ≤24 on the Mini-Mental State Examination, and identification of an informal caregiver. Exclusion criteria Patients unable to identify an informal caregiver, and those with primary psychiatric pathology or Korsakoff's syndrome. Measurements Use of Resources in Dementia to assess costs; Mini-Mental State Examination to evaluate cognitive capacity; Katz-Index to measure functional capacity; Neuropsychiatric Index for neuropsychiatric symptoms, and the Charlson-Index for comorbidity. Data collection took place between November, 2010 and April, 2012. Results The average estimated monthly care costs for people with dementia in the home setting are 1956.2€ (SD 1463.9). Informal care was the major contributor to this with a mean estimated cost of 1214.86 (SD 902.68)€/month. Greater illness severity, dependency in activities of daily living, comorbidity and behavioral disturbance are associated with higher costs. Behavioral disturbance appeared as the only factor independently associated with cost in dementia care. The group of people with dementia with severe behavioral disturbance requires the most care resources with an average cost of 2545.2 (SD 1753.2)€/month. Conclusions There is a direct association between dementia severity and increased costs. In addition, informal caregivers looking after people with dementia in Spain represent an important social cost. The independent factor associated with an increase in the total costs of patient care was neuropsychiatric symptoms.

Prescription patterns of non-vitamin K antagonist oral anticoagulants (NOACs) are unknown among primary care physicians, where most patients with nonvalvular atrial fibrillation (NVAF) are diagnosed and followed up. The goal of this study was to evaluate overdosing and underdosing of NOACs in patients with NVAF followed up in primary care and determine their clinical predictors.This multicenter cross-sectional study included all patients with NVAF followed up in 13 primary care units in the center region of Portugal. Patients receiving antithrombotic regimens other than NOACs and patients with missing data were excluded.The study included 858 patients with NVAF on an NOAC regimen. Overall, 30.3% were prescribed an off-label dosage (25.4% with infratherapeutic dosing [ITD] and 4.9% with supratherapeutic dosing). Chronic kidney disease (odds ratio, 14.0; 95% CI, 5.4-36.5; P 0.001) and female sex (odds ratio, 2.6; 95% CI, 1.2-5.7; P 0.001) were independent predictors of supratherapeutic dosing. We also found a significant effect of chronic kidney disease on ITD (odds ratio, 0.22; 95% CI, 0.258-0.678; P 0.001).In primary care, NOACs are frequently prescribed with unadjusted dosages, generally infratherapeutic. Attention should be paid to women and patients with chronic kidney disease.

We analyzed indirect costs related to loss of labor productivity (LLP) in informal caregivers (ICs) of people with dementia (PwD) and the associated caregiver burden and patients' clinical variables.Multicenter cohort study of PwD and their ICs (n = 287) focused on two groups: (1) home care and (2) institutional long-term care. The costs of LLP were assessed using the Resource Utilization Dementia instrument and a human capital approach.The cost for LLP was 378OV0556;/month or 4.536OV0556;/year. Greater disease severity increased the likelihood of reducing working hours and missing a working day. There was a significant association between partial absenteeism and burden in employed informal caregiver in both the home and institutional setting.Cognitive impairment contributes to the cost of LLP in IC especially in home-care. LLP has a negative impact on IC burden.

Objectives: To explore associations between carer burden and characteristics of (1) the informal carer, (2) the person with dementia, and (3) the care support network in 8 European countries.Design: Cross-sectional study.Setting: People with dementia judged at risk of admission to long-term care (LTC) facilities in 8 European countries (Estonia, Finland, France, Germany, Netherlands, Spain, Sweden, United Kingdom).Participants: A total of 1223 people with dementia supported by community services at home or receiving day care or respite care and their informal carers.Measurements: Variables regarding the informal carer included familial relationship and living situation. Variables relating to the person with dementia included cognitive functioning (S-MMSE), neuropsychiatric symptoms (NPI-Q), depressive symptoms (Cornell depression scale), comorbidity (Charlson Comorbidity Index), and physical functioning (Katz Activity of Daily Living [ADL] Index). The care support network was measured using hours of caregiving (ADLs, instrumental ADLs [IADLs], supervision), additional informal care support, and service receipt (home care, day care). Experience of carer burden was recorded using the Zarit Burden Interview. Logistic regression analysis was used to determine factors associated with high carer burden.Results: Carer burden was highest in Estonia (mean 39.7/88) and lowest in the Netherlands (mean 26.5/88). High burden was significantly associated with characteristics of the informal carer (family relationship, specifically wives or daughters), of the person with dementia (physical dependency in ADLs; neuropsychiatric symptoms, in particular night time behaviors and irritability), the care support network (hours of caregiving supervision; receipt of other informal care support) and country of residence.Conclusion: A range of factors are associated with burden in informal carers of people with dementia judged to be on the margins of LTC. Support for informal carers needs to take account of gender differences. The dual challenges of distressed behaviors and difficulties in ADLs by the person with dementia may be addressed by specific nonpharmacological interventions focusing on both elements. The potential protective effect of additional informal support to carers highlights the importance of peer support or better targeted home support services. The implementation of appropriate and tailored interventions to reduce burden by supporting informal carers may enable people with dementia to remain at home for longer. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Background: The aim of this study is to identify the barriers and facilitators in dementia care with respect to information provision, communication, and collaboration from the perspectives of the person with dementia, family caregivers, and health care professionals over the course of the illness. Methods: A qualitative study using Focus-Group methodology was carried out in people with dementia, family caregivers, and health care providers. Results: The categories that emerged from the analysis were insufficient information provided, specific dementia care needs, and acceptance of long-term care institutionalization from the people with dementia and caregivers’ groups and insufficient communication between health care providers, differential information according to disease stage, and home care coordination from the health care providers’ groups. Conclusion: The family is a key element in successful care coordination during dementia care provision. New effective strategies including self-management and emergent roles, such as case managers, could bring great benefits to people with dementia, caregivers, and health care providers.

Background: Dementia is a progressive neurological disorder that causes a high degree of dependency. This dependency has been defined as an increased need for assistance due to deterioration in cog ...

Aim To describe the associations between positive and negative reactions of informal caregivers of people with dementia and health outcomes across eight European Countries. BackgroundCaring for someone with dementia may have implications for the caregiver's own health and for the care recipient. These consequences could be associated with caregivers' reactions to the process of care. DesignAssociation study based on cross-sectional data. MethodsParticipants were people with dementia and their informal caregivers living at home or in long-term care institutions. Data were collected between November 2010-April 2012 using the Caregiver Reaction Assessment (with dimensions of self-esteem, lack of family support, financial problems, disrupted schedule and health problems) and associations were sought with informal caregiver burden, quality of life and psychological well-being and with dementia sufferers' neuropsychiatric symptoms, comorbidity and dependency in activities of daily living using correlation coefficients. ResultsData from 2014 participants were used. Variability across countries was noted, as well as differences between care at home and in long-term care institutions. In general, self-esteem and lack of family support correlated with caregiver burden and psychological well-being. Associations were also found between disrupted schedule and caregiver burden, psychological well-being and quality of life. Health problems were clearly associated with caregiver burden, psychological well-being and quality of life. ConclusionStudy results support links between the reactions of informal caregivers of people with dementia and health outcomes. These may have implications in terms of how services are addressed.

AimTo investigate persons with dementia and their informal caregivers' views of inter-sectoral information, communication and collaboration throughout the trajectory of dementia care, in eight European countries.BackgroundLiving with dementia and being next of kin to a person with dementia means having to live through stages that have different characteristics, needs, challenges and requirements.DesignQualitative research. Focus groups were conducted in England, Estonia, Finland, France, Germany, The Netherlands, Spain and Sweden.MethodsPersons with dementia and their informal caregivers (N=137) participated in focus group interviews during 2011. Content analysis generated a tentative model of information, communication and collaboration for people with dementia and their caregivers, which was then tested.ResultsThe core finding was that information, communication and collaboration were to be focused on the persons with dementia and the informal caregivers. Entering into the trajectory of the disease and its consequences was addressed as an important point of departure. The relation to professional care required establishing a trusting relationship, tailor-made intervention and a single person or organization to contact. Professional knowledge and commitment, variation in service and care adapted to needs were important.ConclusionAs focus of care is on the person with dementia and their informal caregivers, a dyadic approach seems most suitable for dementia care. A trusting relationship and a specific person or organization to contact seem to be indicators of best practice, as does adaptation to the needs of the person with dementia and their informal caregiver.

espanolObjetivo: describir las caracteristicas de los pacientes con demencias y la calidad del cuidado (CDC) recibida tanto en aquellos sujetos que vivian en casa como en los que estaban institucionalizados, y evaluar las diferencias entre ambos entornos. Metodo: se realizo un estudio transversal analitico en el cual se incluyeron pacientes con demencia que vivian en casa o estaban institucionalizados. Se recogieron datos sociodemograficos, clinicos y relacionados con la demencia. La CDC se analizo mediante el cuestionario CLINT y se identificaron otras variables indicativas de la misma. Las variables recopiladas se compararon en funcion de los dos entornos de convivencia. Resultados: se incluyeron 287 pacientes con demencia. El 39,4% institucionalizados y el 60,6% vivia en el domicilio. Los sujetos presentaban una media de edad (desviacion tipica) de 83,2 (7,1) anos. El principal tipo de demencia fue el alzheimer, que representaba el 71%. Los pacientes institucionalizados presentaban peor estado cognitivo (12,2 frente a 16,1; p= 0,001) y funcional (1,1 frente a 3,1; p= 0,001) que los pacientes con demencia que vivian en el domicilio familiar. La CDC fue similar en ambos grupos, pero los sujetos institucionalizados presentaban mayor porcentaje de ulceras y caidas, mas medidas de contencion y mayor soporte del sistema sanitario, en general. Conclusiones: el cuidado de la demencia es complejo y la calidad del cuidado de estos pacientes sigue siendo baja tanto en el ambito de las medidas fisicas generales como las basadas en el soporte del sistema sanitario, tanto a enfermos como cuidadores informales. EnglishObjective: to describe the characteristics of patients with dementia and the quality of care (QoC) received by patients living at home and by those institutionalized, and to evaluate the differences between both settings. Methods: an analytical cross-sectional study was conducted, including patients with dementia living at home or institutionalized. Sociodemographical and clinical data were collected, as well as data associated with dementia. QoC was analyzed through the CLINT questionnaire, and other variables of reference were identified. There was a comparison of the variables collected, based on the two living settings. Results: the study included 287 patients with dementia: 39.4% were institutionalized and 60.6% lived at home. The subjects were 83.2-year-old (7.1) as mean age (standard deviation). The main type of dementia was Alzheimer, representing 71% of cases. Institutionalized patients presented worse cognitive (12.2 vs. 16.1; p= 0.001) and functional status (1.1 vs. 3.1; p= 0.001) than patients with dementia living in the family home. QoC was similar in both groups, but institutionalized subjects presented in general a higher proportion of ulcers and falls, more containment measures, and higher support by the healthcare system. Conclusions: care for dementia is complex, and the quality of care for these patients is still low, both in the setting of general physical measures and regarding the support by the healthcare system for nurses and casual caregivers.

El objetivo del presente estudio fue comparar la respuesta de perros infectados naturalmente con el Tumor Venéreo Transmisible (TVTc) al tratamiento con vincristina comercial de patente y genérica. Se trabajó con 12 perros infectados naturalmente y con diagnóstico por citología y PCR. Los perros fueron asignados aleatoriamente a un tratamiento semanal con 0.025 mg/kg de vincristina de patente comercial o de tipo genérico, hasta que dos citologías consecutivas resultaran negativas. Se hicieron pruebas de citología y hemograma antes de cada aplicación para determinar reacciones adversas al tratamiento. En ambos grupos se aplicó un máximo de cinco dosis para dar por concluido el tratamiento. El mínimo de aplicaciones en el grupo Patente fue de cuatro, mientras que en el grupo Genérico fue de tres aplicaciones, aunque sin diferencia significativa en el número de dosis aplicadas ni en el tiempo de remisión. Los perros de ambos grupos presentaron algún tipo de reacción adversa ligera sin mostrar diferencia estadística entre grupos. En ningún caso hubo que descontinuar el tratamiento por este tipo de reacciones. Se concluye que las presentaciones de patente y genérica son igualmente eficaces para el tratamiento de TVTc.

This article describes the adequacy of the Q methodology as a new option for the validation of nursing diagnoses related to subjective foci.Discussion paper about the characteristics of the Q methodology.This method has been used in nursing research particularly related to subjective concepts and includes both a quantitative and qualitative dimension.The Q methodology seems to be an adequate and innovative method for the clinical validation of nursing diagnoses.The validation of nursing diagnoses related to subjective foci using the Q methodology could improve the level of evidence and provide nurses with clinical indicators for clinical reasoning and for the planning of effective interventions.Descrever a adequação da metodologia Q como uma nova opção para a validação clínica de diagnósticos de enfermagem relacionados com focos subjetivos. MÉTODOS: Artigo de discussão sobre as características da metodologia Q.Este método tem sido utilizado na pesquisa em enfermagem relacionada com conceitos subjetivos e inclui em simultâneo uma vertente qualitativa e quantitativa. CONCLUSÕES: A metodologia Q parece ser uma opção metodológica adequada para a validação clínica de diagnósticos de enfermagem. IMPLICAÇÕES PARA A PRÁTICA: A utilização da metodologia Q na validação clínica de diagnósticos de enfermagem relacionados com focos subjetivos pode melhorar o nível e evidência e facilitar o raciocínio clínico dos enfermeiros, ao providenciar indicadores clínicos também necessários ao desenvolvimento de intervenções efetivas.

To describe the implementation of the Balance of Care model in decision-making regarding the best care for patients with dementia in Spain.The Balance of Care model was used, which consists of (1) describing the profile of the typical cases of people with dementia and their caregivers, (2) identifying the most suitable care setting for each of the cases (home-care or long-term care institution), (3) designing specific care plans for each case, and (4) evaluating the cost of the proposed care plans.A total of 1,641 people with dementia and their caregivers from eight European countries were used in the case design. The evaluation of cases was conducted by 20 experts in different medical fields of dementia. In Spain, the results indicated that initially the most suitable placement to take care of people with dementia was the home, however in cases with higher dependency in activities of daily living, the long-term care setting was the best option. For the best care plan, the following resources were chosen: professional help to perform basic activities; day center; multidisciplinary home care team; financial support; community nurse; and social worker.The Balance of Care method allows us to assess the most appropriate place of care for people with dementia systematically, objectively and with a multidisciplinary team. Other cost-effective interventions should be integrated in patients with dementia care in order to improve home care.

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El objetivo del presente estudio fue comparar la respuesta de perros infectados naturalmente con el Tumor Venéreo Transmisible (TVTc) al tratamiento con vincristina comercial de patente y genérica. Se trabajó con 12 perros infectados naturalmente y con diagnóstico por citología y PCR. Los perros fueron asignados aleatoriamente a un tratamiento semanal con 0.025 mg/kg de vincristina de patente comercial o de tipo genérico hasta que dos citologías consecutivas resultaran negativas. Se hicieron pruebas de citología y hemograma previo a cada aplicación para determinar reacciones adversas al tratamiento. En ambos grupos se aplicó un máximo de cinco dosis para dar por concluido el tratamiento. El mínimo de aplicaciones en el grupo Patente fue de cuatro, mientras que en el grupo Genérico fue de tres aplicaciones, aunque sin diferencia significativa en el número de dosis aplicadas ni en el tiempo de remisión. Los perros de ambos grupos presentaron algún tipo de reacción adversa ligera sin mostrar diferencia estadística entre grupos. En ningún caso hubo que descontinuar el tratamiento por este tipo de reacciones. Se concluye que las presentaciones de patente y genérica son igualmente eficaces para el tratamiento de TVTc., The aim of this study was to compare the response of naturally infected dogs with transmissible venereal tumor (TVT) to treatment with two sources of vincristine: patented and generic. Twelve naturally infected dogs diagnosed with TVT by cytology and PCR were randomly assigned to a weekly treatment with vincristine at a dose of 0.025 mg/kg until two consecutive cytological evaluations resulted negative. Cytology tests and haemograms were performed prior to vincristine applications to evaluate adverse reaction to treatment. In both groups, a maximum of five applications were applied to obtain a successful treatment. The minimum number of applications in the Patent group was four while in the Generic group was three, although without significant difference between groups in number of applications or time for healing. Dogs in both groups showed some kind of adverse reactions to the treatment but without statistical difference between groups. There was no need to discontinue the treatment in any case. It is concluded that the patent and generic presentations of vincristine are equally effective for treating TVT in dogs.

AimTo explore inter-country variation of factors associated with institutionalization of people with dementia.BackgroundThere is an urgent need for evidence on whether factors associated with admission to institutional dementia care are applicable across healthcare systems, as increasing evidence suggests that these factors could be country-specific.DesignA prospective cohort study.MethodPrimary data were collected in eight European countries, at baseline and after 3months follow-up (November 2010-April 2012). The sample included 2014 dyads of people with dementia and their informal caregivers; 791 patients were recently institutionalized, 1223 patients lived at home and were at risk of institutionalization. Associations between care setting (institution vs. home) and factors shown to influence institutionalization (e.g. cognition, independence in activities of daily life, behaviour) were studied.ResultsConsiderable differences were found between the eight countries in characteristics of people with dementia who had been recently admitted to ILTC. However, caregiver burden appeared the most consistent factor associated with institutionalization in all analyses. Indications for the importance of independence in activities of daily life were found as well, although country differences may be more prominent for this factor.ConclusionEvidence was found for two common factors, crucial in the process of institutionalization across countries: caregiver burden and independency in activities of daily life. However, this study also suggests that admission to institutional dementia care is context-specific, as wide variation exists in factors associated with institutionalization across countries. Tailored best-practice strategies are needed to reflect variations in response to these needs.

AIMS: To explore the perceptions of informal caregivers and healthcare professionals regarding potential reasons for the institutionalization of older persons with dementia in eight European countries. BACKGROUND: Healthcare professionals may have an important role in facilitating informal caregivers' decision-making regarding institutionalization. Little is known about the perceptions of informal caregivers and healthcare professionals prior to institutionalization. DESIGN: Cross-sectional survey in eight European countries (November 2010-January 2012). METHODS: Healthcare professionals reported why they clinically judged persons with dementia at risk for institutionalization. Informal caregivers reported potential reasons from their perspectives. Answers were openly coded and categorized. Variation between informal caregivers and healthcare professionals was investigated (agreement on at least one potential reason per case/proportion of maximum attainable kappa). RESULTS: Judgements of healthcare professionals and informal caregivers on 1160 persons with dementia were included. A total of 22 categories emerged. Approximately 90% of informal caregivers reported potential reasons. In 41% of the cases, informal caregivers and healthcare professionals agreed on at least one reason. Discrepancy was high for potential reasons related to caregiver burden. For the most frequent categories (caregiver burden, caregiver unable to provide care, neuropsychiatric symptoms, overall deterioration, care dependency), 24-41% of the attainable kappa was achieved. Differences between countries emerged indicating more favourable agreement in Finland, Sweden and Estonia and lowest agreement in England and Spain. CONCLUSION:Agreement between healthcare professionals and informal caregivers on potential reasons for institutionalization was low-to-moderate. Healthcare professionals are challenged to develop a detailed understanding of the perspectives and perceived burden of informal caregivers.

Aims. To describe differences in caregiver burden and health-related quality of life of informal caregivers of people with dementia in eight European countries and assess changes after transition from home to institutional long-term care. Background. Country differences in the experience of burden and health-related quality of life are rarely described. Design. Prospective cohort study. Methods. Data on burden and health-related quality of life were collected at baseline (conducted between November 2010–April 2012) and follow-up (after 3 months) using face-to-face interviews. Two groups of informal caregivers included those: (1) of people with dementia recently admitted to institutional long-term care facilities; and those (2) of people with dementia receiving home care. Statistical analyses focused on descriptive comparisons between groups and countries. Results. Informal caregivers of about 2014 were interviewed. Informal caregivers of people with dementia at home experienced more burden compared with informal caregivers of recently institutionalised people with dementia. Almost no differences in health-related quality of life were found between groups. Large differences between countries on outcomes were found. Informal caregivers of people with dementia who made the transition to an institutional long-term care facility experienced a statistically significant decrease in burden and psychological distress at follow-up. Conclusion. Cross-country differences may be related to differences in health and social care systems. Taking this into account, informal caregiver interventions need to be tailored to (country specific) contexts and (individual) needs. Findings highlight the positive impact of admission to institutional long-term care on informal caregiver well-being.