Catheter-related bloodstream infection: burden of disease in a tertiary hospital

Background: Surveillance programmes have become the most effective tool for controlling catheter-related bloodstream infections (CRBSI). However, few studies have investigated programmes covering all hospital settings. Aim: To describe the results of a control and prevention programme for CRBSI based on compliance with recommendations for insertion and maintenance, using annual burden of disease in a tertiary level hospital. Methods: A CRBSI control and prevention programme involving all hospital settings was implemented. The programme consisted of CRBSI surveillance, direct observation of insertion and maintenance of catheters to determine performance, and education for healthcare workers. Findings: In total, 2043 short-term catheters were inserted in 1546 patients for 18,570 catheter-days, and 279 long-term catheters were inserted in 243 patients for 40,440 catheter-days. The annual incidence density was 5.98 (first semester 6.40, second semester 5.64) CRBSI per 1000 catheter-days for short-term catheters, and 0.57 (first semester 0.66, second semester 0.43) CRBSI per 1000 catheter-days for long-term catheters. One hundred and forty insertion procedures were observed, with an average insertion time of 13 (standard deviation 7) min. Compliance with recommendations was as follows: hand hygiene, 86.8%; use of alcoholic chlorhexidine solution for skin disinfection, 35.5%; use of mask, 93.4%; use of gloves, 98.7%; use of gown, 75.0%; use of sterile cloth, 93.8%; use of cap, 92.2%; bandage application, 62.7%; and use of aseptic technique, 89.5%. Forty-five maintenance procedures were observed, and compliance rates were as follows: hand hygiene, 42.1%; use of gloves, 78.1%; and port disinfection with alcoholic chlorhexidine solution, 32.5%. Conclusion: The CRBSI control and prevention programme implemented at the study hospital has decreased the rate of CRBSI, provided important information about the total burden of disease, and revealed possible ways to improve interventions in the future.

Supplemental nursing staff´s experiences at a Spanish hospital: Qualitative phenomenology research

The objective of this study was to describe the Supplemental Nursing Staff´s experiences at different hospital units. A qualitative phenomenological approach was conducted; a purposeful and theoretical sampling was implemented with supplemental nursing staff at Santa Barbara Hospital of Soria (Spain), to gain a more in-depth understanding of the Supplemental Nursing Staff ´s experience. Data were collected by in-depth interviews and through a field notebook. Data were analyzed using the Giorgi proposal. Twenty-one nurses with a mean age of 46 years were included. Three main topics emerged from the data analysis: building the first contact, carving out a niche and establishing interprofessional/interpersonal relationships. We conclude that the experience of hosting the supplemental nursing staff in changing clinical environments is conditioned by various factors. It is necessary for nurses and hospital managers to establish clear objectives with regard to the supplemental nursing staff´s role in the units.

The Spanish version of the Prenatal Breast-feeding Self-efficacy Scale: Reliability and validity assessment

Background: Only a minority of infants are exclusively breastfed for the recommended 6 months postpartum. Breast-feeding self-efficacy is a mother's confidence in her ability to breastfeed and is predictive of breastfeeding behaviors. The Prenatal Breast-feeding Self-efficacy Scale (PBSES) was developed among English-speaking mothers to measure breastfeeding self-efficacy before delivery. Objectives: To translate the PBSES into Spanish and assess its psychometric properties. Design: Reliability and validity assessment. Setting: A public hospital in Yecla, Spain. Participants: A convenience sample of 234 pregnant women in their third trimester of pregnancy. Methods: The PBSES was translated into Spanish using forward and back translation. A battery of self-administered questionnaires was completed by participants, including a questionnaire on sociodemographic variables, breastfeeding experience and intention, as well as the Spanish version of the PBSES. Also, data on exclusive breastfeeding at discharge were collected from hospital database. Dimensional structure, internal consistency and construct validity of the Spanish version of PBSES were assessed. Results: Confirmatory factor analysis suggested the presence of one construct, self-efficacy, with four dimensions or latent variables. Cronbach's alpha coefficient for internal consistency was 0.91. Response patterns based on decision to breastfeed during pregnancy provided evidence of construct validity. In addition, the scores of the Spanish version of the PBSES significantly predicted exclusive breastfeeding at discharge. Conclusions: The Spanish version of PBSES shows evidences of reliability, and contrasting group and predictive validity. Confirmatory factor analysis indicated marginal fit and further studies are needed to provide new evidence on the structure of the scale. The Spanish version of the PBSES can be considered a reliable measure and shows validity evidences.

Clinical Validation of Adjusted Corneal Power in Patients with Previous Myopic Lasik Surgery

Purpose. To validate clinically a new method for estimating the corneal power (P,) using a variable keratometric index (nkadj) in eyes with previous laser refractive surgery. Setting. University of Alicante and Medimar International Hospital (Oftalmar), Alicante, (Spain). Design. Retrospective case series. Methods. This retrospective study comprised 62 eyes of 62 patients that had undergone myopic LASIK surgery. An algorithm for the calculation of 11kadj was used for the estimation of the adjusted keratometric corneal power (Pkadj). This value was compared with the classical keratometric corneal power (Pk), the True Net Power (TNP), and the Gaussian corneal power (PcGauss). Likewise, Pkadj was compared with other previously described methods. Results. Differences between PcGauss and P, values obtained with all methods evaluated were statistically significant (p < 0.01). Differences between Pkadj and PcGauss were in the limit of clinical significance (p < 0.01, loA [ - 0.33,0.60] D). Differences between Pkadj and TNP were not statistically and clinically significant (p = 0.319, loA [- 0.50,0.44] D). Differences between Pkadj and previously described methods were statistically significant (p < 0.01), except with PcHaigisL (p = 0.09, loA [ - 0.37,0.29] D). Conclusion. The use of the adjusted keratometric index (nkadj) is a valid method to estimate the central corneal power in corneas with previous myopic laser refractive surgery, providing results comparable to PcHaigisL.

Ethical aspects of children’s perceptions of information-giving in care

The aim of this study was to identify key aspects in the exchange of information and to determine how nurses communicate news to hospitalised children. For this study, we applied the critical incident technique with 30 children aged between 8 and 14 years. Data were collected in paediatric units in a hospital in Alicante (Spain) using participant observation and semi-structured interviews. The analysis yielded three main categories: the children’s reaction to the information, nursing staff behaviour as a key aspect in the exchange of information and communication of news as well as children’s experience. This article emphasises the need to promote children’s consent and participation in nursing interventions. An analysis of these aspects will verify whether children’s rights are being respected and taken into account in order to promote children’s well-being and adaptation to hospitalisation.

Relationship between piezometric level and ground deformations measured by means of DInSAR in the Vega Media of the Segura River (Spain)

Differential SAR Interferometry (DInSAR) is a remote sensing method with the well demonstrated ability to monitor geological hazards like earthquakes, landslides and subsidence. Among all these hazards, subsidence involves the settlement of the ground surface affecting wide areas. Frequently, subsidence is induced by overexploitation of aquifers and constitutes a common problem that affects developed societies. The excessive pumping of underground water decreases the piezometric level in the subsoil and, as a consequence, increases the effective stresses with depth causing a consolidation of the soil column. This consolidation originates a settlement of ground surface that must be withstood by civil structures built on these areas. In this paper we make use of an advanced DInSAR approach - the Coherent Pixels Technique (CPT) [1] - to monitor subsidence induced by aquifer overexploitation in the Vega Media of the Segura River (SE Spain) from 1993 to the present. 28 ERS-1/2 scenes covering a time interval of about 10 years were used to study this phenomenon. The deformation map retrieved with CPT technique shows settlements of up to 80 mm at some points of the studied zone. These values agree with data obtained by means of borehole extensometers, but not with the distribution of damaged buildings, well points and basements, because the occurrence of damages also depends on the structural quality of the buildings and their foundations. The most interesting relationship observed is the one existing between piezometric changes, settlement evolution and local geology. Three main patterns of ground surface and piezometric level behaviour have been distinguished for the study zone during this period: 1) areas where deformation occurs while ground conditions remain altered (recent deformable sediments), 2) areas with no deformation (old and non-deformable materials), and 3) areas where ground deformation mimics piezometric level changes (expansive soils). The temporal relationship between deformation patterns and soil characteristics has been analysed in this work, showing a delay between them. Moreover, this technique has allowed the measurement of ground subsidence for a period (1993-1995) where no instrument information was available.

Forensic analysis of buildings affected by mining subsidence based on Differential Interferometry (Part III)

This work presents a forensic analysis of buildings affected by mining subsidence, which is based on deformation data obtained by Differential Interferometry (DInSAR). The proposed test site is La Union village (Murcia, SE Spain) where subsidence was triggered in an industrial area due to the collapse of abandoned underground mining labours occurred in 1998. In the first part of this work the study area was introduced, describing the spatial and temporal evolution of ground subsidence, through the elaboration of a cracks map on the buildings located within the affected area. In the second part, the evolution of the most significant cracks found in the most damaged buildings was monitored using biaxial extensometric units and inclinometers. This article describes the work performed in the third part, where DInSAR processing of satellite radar data, available between 1998 and 2008, has permitted to determine the spatial and temporal evolution of the deformation of all the buildings of the study area in a period when no continuous in situ instrumental data is available. Additionally, the comparison of these results with the forensic data gathered in the 2005–2008 period, reveal that there is a coincidence between damaged buildings, buildings where extensometers register significant movements of cracks, and buildings deformation estimated from radar data. As a result, it has been demonstrated that the integration of DInSAR data into forensic analysis methodologies contributes to improve significantly the assessment of the damages of buildings affected by mining subsidence.

Clinical pathway intervention compliance and effectiveness when used in the treatment of patients with severe sepsis and septic shock at an Intensive Care Unit in Spain

The purpose of this quasi-experimental study was to assess levels of compliance with the intervention bundles contained in a clinical pathway used in the treatment of patients with severe sepsis and septic shock, and to analyze the pathway’s impact on survival and duration of hospital stays. We used data on 125 patients in an Intensive Care Unit, divided into a control group (N=84) and an intervention group (N=41). Levels of compliance increased from 13.1% to 29.3% in 5 resuscitation bundle interventions and from 14.3% to 22% in 3 monitoring bundle interventions. In-hospital mortality at 28 days decreased by 11.2% and the duration of hospital stay was reduced by 5 days. Although compliance was low, the intervention enhanced adherence to the instructions given in the clinical pathway and we observed a decline in mortality at 28 days and shorter hospital stays.

The episcopal complex of Eio-El Tolmo de Minateda (Hellín, Albacete, Spain). Architecture and spatial organization. 7th to 8th centuries AD

The episcopal complex of Eio, located in El Tolmo de Minateda, was built between the end of the 6th century and the beginning of the 7th century, possibly as a political decision taken by the ecclesiastical authority in the capital of the Visigothic kingdom (Toletum). With the comprehensive study of the whole complex presented below (construction cycles, furniture, decoration and location of spaces), we can interpret the function of each space in the basilica and the domus episcopi, the liturgical and general movement routes, the existence of some hierarchical environments, and specify the chronological development of the buildings. After the Arab-Berber conquest of Hispania in the early 8th century, the whole complex will experience a series of transformations that will convert the religious and monumental public area into a private, residential and industrial Islamic quarter.

A methodology for evacuation route planning inside buildings using geospatial technology

Evacuation route planning is a fundamental task for building engineering projects. Safety regulations are established so that all occupants are driven on time out of a building to a secure place when faced with an emergency situation. As an example, Spanish building code requires the planning of evacuation routes on large and, usually, public buildings. Engineers often plan these routes on single building projects, repeatedly assigning clusters of rooms to each emergency exit in a trial-and-error process. But problems may arise for a building complex where distribution and use changes make visual analysis cumbersome and sometimes unfeasible. This problem could be solved by using well-known spatial analysis techniques, implemented as a specialized software able to partially emulate engineer reasoning. In this paper we propose and test an easily reproducible methodology that makes use of free and open source software components for solving a case study. We ran a complete test on a building floor at the University of Alicante (Spain). This institution offers a web service (WFS) that allows retrieval of 2D geometries from any building within its campus. We demonstrate how geospatial technologies and computational geometry algorithms can be used for automating the creation and optimization of evacuation routes. In our case study, the engineers’ task is to verify that the load capacity of each emergency exit does not exceed the standards specified by Spain’s current regulations. Using Dijkstra’s algorithm, we obtain the shortest paths from every room to the most appropriate emergency exit. Once these paths are calculated, engineers can run simulations and validate, based on path statistics, different cluster configurations. Techniques and tools applied in this research would be helpful in the design and risk management phases of any complex building project.

Self-rated health and hospital services use in the Spanish National Health System: a longitudinal study

Background: Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. Methods: Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. Results: By the end of a 4-year follow-up period, 1,184 participants (22.4 %) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. Conclusions: Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.

Construction of 17-19th century domes in the province of Alicante (Spain): the case of San Juan Bautista in Cox

From the late seventeenth to early nineteenth centuries, many religious temples have been built in the province of Alicante (south east of Spain) with brick domes as their main characteristic feature. Often, the limited data available about these remarkable constructions make rehabilitation interventions become into real research projects, with a high value for their historic conservation over time. The aim of this paper is to show a detailed refurbishment analysis of a religious temple built in 1778, showing the need of preservation of historic buildings as a part of the architectural heritage by establishing a common pattern of materials, geometry and constructive systems, specifically in their domes. In most cases, there was not an architectural project for the construction, that is why the analysis of any documentary and archival sources available is essential to find different ways to proceed on the use and maintenance of these religious buildings.

La gestión de los cuidados enfermeros en el hospital San Juan de Dios de Alicante: a propósito de tres fuentes documentales inéditas del siglo XVIII

Se propone como objetivo principal mostrar y analizar tres fuentes documentales inéditas del siglo XVIII, localizadas en el Archivo Municipal Sant Joan d’Alacant que aportan información sobre la gestión de enfermería realizada en el Hospital San Juan de Dios de Alicante. Son tres las fuentes documentales que se transcriben y analizan, una “relación jurada de Fray Joseph Martínez Maza”, fechando el documento entre 1710 y 1718; un “Real privilegio de S.M. para amortizar la cantidad de 120 libras libres de sello y demás”. Dado en 23 de enero de 1794, a favor del convento hospital de N.P. San Juan de Dios de la ciudad de Alicante y un “formulario o modelo para dar cumplimiento a la orden del nuncio de su Santidad referente a las rentas, gravámenes, limosnas y otras entradas, con la curación a pobres, enfermos, con arreglo a los libros de caja”, datando el documento entre 1748 y 1760.

How to measure healthiness in buildings: Experiences in teaching with BIM tools

Introducing teaching about healthy solutions in buildings and BIM has been a challenge for the University of Alicante. Teaching attached to very tighten study plans conditioned the types of methods that could be used in the past. The worldwide situation of crisis that especially reached Spain and the bursting of the housing bubble generated a lack of employment that reached universities where careers related to construction, Architecture and Architectural Technologist, suffered a huge reduction in the number of students enrolled. In the case of the University of Alicante, students’ enrolment for Architectural Technology reached an 80% reduction. The necessity of a reaction against this situation made the teachers be innovative and use the new Bologna adapted study plans to develop new teaching experiences introducing new concepts: people wellbeing in buildings and BIM. Working with healthy solutions in buildings provided new approaches for building design and construction as an alternative to sustainability. For many years sustainability was the concept that applied to housing gave buildings an added value and the possibility of having viability in a very complex scenario. But after lots of experiences, the approved methodologies for obtaining sustainable housing were ambiguous and at the end, investors, designers, constructors and purchasers cannot find real and validated criteria for obtaining an effective sustainable house. It was the moment to work with new ideas and concepts and start facing buildings from the users’ point of view. At the same time the development of new tools, BIM, has opened a wide range of opportunities, innovative and suggestive, that allows simulation and evaluation of many building factors. This paper describes the research in teaching developed by the University of Alicante to adapt the current study plans, introducing work with healthy solutions in buildings and the use of BIM, with the aim of attracting students by improving their future employability. Pilot experiences have been carried out in different subjects based on the work with projects and case studies under an international frame with the cooperation of different European partner universities. The use of BIM tools, introduced in 2014, solved the problems that appeared in some subjects, mainly building construction, and helped with the evaluation of some healthy concepts that presented difficulties until this moment as knowledge acquired by the students was hard to be evaluated. The introduction of BIM tools: Vasari, FormIt, Revit and Light Control among others, allowed the study of precise healthy concepts and provided the students a real understand of how these different parameters can condition a healthy architectural space. The analysis of the results showed a clear acceptance by the students and gave teachers the possibility of opening new research lines. At the same time, working with BIM tools to obtain healthy solutions in building has been a good option to improve students’ employability as building market in Spain is increasing the number of specialists in BIM with a wider knowledge.

Health-related quality of life and determinant factors in celiac disease. A population-based analysis of adult patients in Spain

Background: Celiac disease (CD) has a negative impact on the health-related quality of life (HRQL) of affected patients. Although HRQL and its determinants have been examined in Spanish CD patients specifically recruited in hospital settings, these aspects of CD have not been assessed among the general Spanish population. Methods: An observational, transversal study of a non-randomized, representative sample of adult celiac patients throughout all of Spain's Autonomous Regions. Subjects were recruited through celiac patient associations. A Spanish version of the self-administered Celiac Disease-Quality of Life (CD-QOL) questionnaire was used. Determinant factors of HRQL were assessed with the aid of multivariate analysis to control for confounding factors. Results: We analyzed the responses provided by 1,230 patients, 1,092 (89.2%) of whom were women. The overall mean value for the CD-QOL index was 56.3 ± 18.27 points. The dimension that obtained the most points was dysphoria, with 81.3 ± 19.56 points, followed by limitations with 52.3 ± 23.43 points; health problems, with 51.6 ± 26.08 points, and inadequate treatment, with 36.1 ± 21.18 points. Patient age and sex, along with time to diagnosis, and length of time on a gluten-free diet were all independent determinant factors of certain dimensions of HRQL: women aged 31 to 40 expressed poorer HRQL while time to diagnosis and length of time on a gluten-free diet were determinant factors for better HRQL scores. Conclusions: The HRQL of adult Spanish celiac subjects is moderate, improving with the length of time patients remain on a gluten-free diet.