Víctor Ortíz-Mallasén

Background: Hospital-at-home (HaH) programs provide an effective and safe alternative to conventional hospitalization, particularly for patients with multimorbidity or complex chronic conditions. In this setting, nursing assessment plays a key role, given the intermittent nature of care and the limited presence of other professionals. However, nursing documentation in HaH remains challenging because of organizational heterogeneity, fragmented records, and the coexistence of multiple assessment tools that create redundancy and compromise information quality. The overall objective of this study is to develop and validate a meta-instrument (VALENF-HAD) that integrates the assessment of functional capacity, pressure injury risk, fall risk, frailty, nutritional status, and sleep quality in patients admitted to hospital-at-home units on the basis of the analysis of other validated measurement instruments used in nursing assessment. Methods: A multicentre, cross-sectional study will be conducted in four public hospitals in Castellón Province, Spain. Participants will include adults (≥18 years) admitted to HaH units. Sociodemographic and care-related variables, along with risk-related variables, will be collected using the following instruments: functional capacity (Barthel Index and Lawton & Brody Scale), risk of pressure injuries (Braden Scale), risk of falls (STRATIFY Scale), frailty (FRAIL questionnaire), nutritional status (Nutritional Screening Initiative tool), and sleep quality (Athens Insomnia Scale). The development process of the meta-instrument consists of four phases: (I) analysis of instruments, constructs, and items; (II) meta-instrument design; (III) initial validation; and (IV) determination of clinimetric properties. Discussion: This study is expected to produce a parsimonious and specific meta-instrument for hospital-at-home settings that is capable of integrating functional, nutritional, sleep, fall risk, frailty, and pressure injury assessments. Its implementation will enhance the quality and standardization of nursing documentation, reduce administrative workload, facilitate early risk detection, and free up time for direct patient care. Ultimately, this study will contribute to advancing evidence-based nursing practices in home hospitalization.

Background: Patient safety is a global priority, as adverse events represent the 14th leading cause of morbidity and mortality worldwide. Among the most common complications in hospitalized adults are functional decline, pressure injuries, and falls, all of which increase hospital stays, healthcare costs, and mortality. Although these risks are typically assessed independently, their interaction has been scarcely explored, and the identification of integrated patient risk profiles could better guide nursing care. Objective: To establish profiles of adult inpatients based simultaneously on their level of functional capacity, risk of pressure injuries, and risk of falls. Design: Cross‐sectional observational study. Participants: A total of 2.666 patients were admitted to adult inpatient units in a Spanish hospital. Methods: Data from the Barthel, Braden, and Downton scales collected within 24 h of admission were analyzed. A hierarchical cluster analysis followed by the k‐means method was used to classify patients. Relationship between profiles and clinical variables were explored through multiple correspondence analysis, and predictors for each profile were identified using multinomial logistic regression. Results: Three patient profiles were identified: profile 1 (low risk), minor dependency, low risk of pressure injuries and falls (68.5%); profile 2 (moderate risk), moderate dependency and intermediate risk (15.4%); and profile 3 (high risk), severe dependency with high risk of pressure injuries and falls (16.1%). Older age, female sex, and higher comorbidity were significantly associated with higher‐risk profiles ( p < 0.001). Conclusions: Hospitalized adults can be reliably classified into risk profiles based on functional capacity and the risk of pressure injuries and falls. Implications: The identification of combined risk profiles may potentially guide nursing strategies to enhance patient safety, support individualized care planning, and contribute to optimizing resource distribution in hospital settings. Impact: Loss of functional capacity, pressure injuries, and falls are key nursing‐sensitive indicators of care quality. Profile‐based stratification offers a new framework for personalized, data‐driven, and safety‐oriented nursing care. Clinical Relevance: The identification of integrated risk profiles based on functional capacity, pressure injury risk, and fall risk may support more comprehensive nursing assessment in hospitalized adults. These profiles may help inform care prioritization, facilitate early identification of vulnerable patients, and contribute to more efficient allocation of nursing resources. Incorporating multidimensional risk stratification into clinical practice may enhance coordinated and patient‐centered care planning.

Background/Objectives: Cognitive impairment affects multiple brain functions, and its early detection is essential to prevent progression to dementia; artificial intelligence has shown considerable potential in this field. This scoping review aims to map the impact of artificial intelligence–based tools for the early detection of cognitive impairment by identifying the main technologies used, examining their effectiveness, and exploring their ethical implications. Methods: A scoping review was conducted between April and May 2025 following the PRISMA-ScR methodological framework; the review protocol was previously registered on the Open Science Framework. PubMed, Scopus, and Cochrane databases were searched using natural language and controlled vocabulary terms via Medical Subject Headings. The search was limited to articles published between 2020 and 2025, in English or Spanish, with free full-text access. Methodological quality was assessed using CASPe, JBI, and MMAT. Results: A total of 14 studies were included after the selection and critical appraisal process. The findings show that artificial intelligence–based tools such as deep-learning models applied to neuroimaging, speech and gait analysis, electronic health record analysis, and mobile health applications demonstrate promising accuracy in detecting early cognitive changes. These technologies enable the identification of subtle patterns that may be difficult to detect using conventional clinical assessments. Conclusions: AI-based tools can provide substantial support for clinical decision-making by effectively identifying subtle changes that are imperceptible to human intelligence. However, their use also raises ethical issues related to patient privacy and data security.

Background/Objectives: Pressure injuries and falls are frequent hospital adverse events. Identifying high-risk periods may help guide preventive strategies. In this exploratory study, we aimed to estimate the time from hospital admission to the occurrence of pressure injuries and/or falls and analyze its relationship with the nursing assessment at admission. Methods: A longitudinal observational study was conducted with a systematic sample of 314 adult patients admitted between January and May 2024. Nursing assessment at admission was performed using the VALENF Instrument, which integrates functional capacity, pressure injury risk, and fall risk. Survival analysis was performed to describe the temporal distribution of adverse events and compare their occurrence across nursing assessment variables using the log-rank test. Poisson Generalized Linear Models were applied to explore associated factors. Results: Nineteen adverse events were recorded (15 pressure injuries and 4 falls). Twelve of the 19 total events (63%) occurred within the first five days of admission. Patients with lower functional capacity (log-rank p < 0.001) and high-pressure injury risk (log-rank p < 0.001) according to the VALENF Instrument, showed an earlier occurrence of new pressure injuries in the Kaplan–Meier analysis. Similarly, fall risk scores (log-rank p = 0.037) obtained with the same instrument were associated with falls. Patients classified as high risk for pressure injuries showed an approximately nine-fold higher incidence rate of developing new injuries (Wald χ², p < 0.001), while urgent admission further increased this risk more than six-fold (Wald χ², p = 0.015). Conclusions: In this exploratory study with a limited number of events, most adverse events occurred early during hospitalization. The findings suggest that early nursing assessment using the VALENF Instrument may help stratify patients for closer monitoring early in admission, pending confirmation in larger studies.

Background/Objectives: Chronic musculoskeletal pain is highly prevalent in primary care and is associated with impaired quality of life and increased healthcare utilization. Multimodal physiotherapy approaches combining pain neuroscience education and therapeutic exercise are recommended; however, evidence regarding their feasibility and medium-term effects in Spanish primary care remains limited. This pilot study aimed to evaluate the usefulness of a group-based multimodal physiotherapy program on health-related quality of life and other clinical outcomes. Methods: A multicenter, quasi-experimental pilot study with a pre–post design and 6-month follow-up was conducted in two primary care physiotherapy units in Spain. Adults with non-specific chronic musculoskeletal pain lasting ≥6 months participated in a 12-week group-based intervention combining pain neuroscience education and therapeutic exercise. Outcomes included health-related quality of life (SF-36), pain intensity (VAS), pain catastrophizing (PCS), kinesiophobia (TSK-11), central sensitization (CSI), analgesic consumption, healthcare utilization, and patient satisfaction. Intragroup changes, effect sizes, and minimal clinically important difference were analyzed. Results: Thirty-seven participants completed the program, with adherence > 80% and no adverse events. Significant improvements were observed at 6 months in all outcomes, with moderate to large effect sizes (SF-36, VAS, PCS). Between 54% and 78% of participants achieved minimal clinically important differences in key domains. Improvements were maintained at follow-up without clinically relevant deterioration. Conclusions: This pilot study suggests that a group-based multimodal physiotherapy program is feasible and potentially effective for managing chronic musculoskeletal pain in primary care. Larger controlled trials are warranted.

Background/Objectives: Obstetric violence (OV) is a violation of women’s human rights during reproductive processes. Despite being the subject of debate among healthcare professionals, increasingly recognized, and legislated against in some countries, OV continues to be reproduced and normalized during training. The objective of this study was to determine the perception of OV among health sciences students and gynaecology and obstetrics residents. Methods: A cross-sectional observational study was conducted with 304 health sciences students and gynaecology and obstetrics residents in Spain. An online questionnaire was distributed that gathered information on sociodemographic variables and clinical experience and included the validated PercOV-S instrument. Descriptive and bivariate analyses were performed to explore associations between variables. Results: The overall perception of OV was moderately high (mean 3.93/5), with higher scores for visible or protocolized forms (4.27/5) than for invisible or subtle forms (2.87/5). Being a woman, being a midwifery resident, or having had personal experiences with pregnancy or childbirth increased sensitivity to OV. Clinical exposure in obstetrics and gynaecology services increased both awareness and the likelihood of witnessing OV. Twenty-eight percent of students reported having observed OV, and twenty percent reported emotional distress, even considering dropping out. Conclusions: Despite the recognition of OV, repeated exposure during training can promote its normalization. The results of this study highlight the need for safe, reflective training environments that mainstream feminist perspectives, sexual rights, and the detection of subtle forms of OV.

Background/Objectives: Pressure injuries and falls are frequent hospital adverse events. Identifying high-risk periods during hospitalization is essential for guiding effective prevention. In this study, we aimed to estimate the time from hospital admission to the occurrence of pressure injuries and/or falls and analyze its relationship with the nursing assessment at admission. Methods: A longitudinal observational study was conducted with a systematic sample of 314 adult patients admitted between January and May 2024. Survival analysis was performed to describe the temporal distribution of adverse events and compare their occurrence across nursing assessment variables using the log-rank test. Poisson Generalized Linear Models were applied to explore associated factors. Results: Fifteen pressure injuries and four falls were recorded. Overall, 63% of these adverse events occurred within the first five days of hospitalization. Patients with lower functional capacity (log-rank p2, p < 0.001), while urgent admission further increased this risk more than six-fold (Wald χ², p = 0.015). Conclusions: This exploratory study highlights the value of early nursing assessment using the VALENF Instrument in identifying high-risk patients and planning timely, individualized preventive care during hospitalization.

The rate of six-month-old infants exclusively breastfed in Spain remains below the recommended rate. This study aimed to explore in detail the evolution of feeding during the first six months of life of a group of newborns, as well as to identify the reasons reported by the mothers for feeding change. A secondary analysis of two prospective longitudinal observational studies was conducted. In both studies, women participants, during the clinical puerperium, opted for exclusive breastfeeding for their newborns. The participants were followed up during the infants’ first six months. A sample size of 314 participants was obtained, of which 77.1% (n = 232) were of Spanish origin, and 51% (n = 160) were primiparous. The prevalence of exclusive breastfeeding at six months was 55.4% (n = 174). During the first four months of life, the main reason for early abandonment of breastfeeding was the perception of insufficient milk production. After the fourth month, the predominant reason was starting work. Statistically significant differences were observed between the reasons for giving up and the total weeks of exclusive breastfeeding (p < 0.001) and total weeks of breastfeeding (p = 0.002). Early weaning from breastfeeding is a multifactorial phenomenon. However, depending on the moment cessation occurs, some reasons predominate over others and, in many cases, can be prevented. These results indicate the need to continue investing efforts to promote and protect breastfeeding in Spain.

Nonspecific lower back pain is one of the main health issues experienced by nonprofessional caregivers of dependent individuals. The repetitive movements and efforts made by caregivers to assist dependent individuals are associated with the onset of this lower back pain. The main objective of this study was to assess the effectiveness of an educational intervention for the management of nonspecific lower back pain in nonprofessional caregivers of dependent individuals (TRANSFE program). The secondary objectives were to (i) evaluate the effectiveness of the TRANSFE program on other variables (caregiver burden, perceived social support, and health-related quality of life), (ii) obtain the sociodemographic profile of the sample, and (iii) determine the baseline of the study variables. A quasi-experimental study with post-intervention measurements at 3 months was conducted. Thirty-six nonprofessional caregivers of dependent individuals participated in this study. The presence of lower back pain (back pain index), low back pain (visual analogue scale), disability due to low back pain (Oswestry disability index), perceived social support (Duke-UNK scale), caregiver burden (Zarit burden scale), and health-related quality of life (EuroQol-5D) were assessed. The intervention significantly improved all the studied variables related to lower back pain (p < 0.001). The intervention was effective on other variables related to nonprofessional caregiving such as caregiver burden, perceived social support, and health-related quality of life, albeit with moderate results. An educational intervention for lower back pain experienced by caregivers of dependent individuals was effective in reducing lower back pain and addressing caregiver burden, perceived social support, and health-related quality of life. This study was registered retrospectively on the Open Science Framework platform on 20 June 2024, with the registration number 10.17605/OSF.IO/K7WTE.

Background: Active aging is considered one of the most effective methods for a healthy aging process. There are numerous clinical practice guidelines that address this model and propose multiple strategies for its achievement through the improvement of motor and cognitive function. Virtual reality is emerging as a potential tool, with various modalities focused on promoting good health maintenance in older adults. The objectives of this review were to map the potential benefits of virtual reality for active aging and delve into adaptability and adherence in older individuals. Methods: A scoping review was conducted on studies published between 2013 and 2023 in English, Spanish, or Catalan, examining virtual reality interventions in older adults. The search was performed using the Medline, CINAHL, Scopus, and Web of Science databases. The methodological quality was assessed using CASPe and FLC 3.0 critical appraisal guidelines. The graphical data were reported narratively, grouping results based on the study characteristics and the impact of virtual reality. Results: The review process resulted in the inclusion of 22 articles out of the initial 459 following the application of the selection criteria. Most articles were randomized controlled trials (45.4%; n = 10), systematic reviews (40.9%; n = 9), observational studies (9%; n = 2), and pilot studies (4.5%; n = 1). The information was organized based on the virtual reality modality (immersive, non-immersive, and 360) and application area (motor, cognitive, and mental health). Conclusions: Virtual reality (both immersive and non-immersive) is a valuable tool for promoting physical exercise in older adults, helping to prevent recurrent accidental falls. It also yields positive results for cognitive stimulation in healthy older individuals, improving memory, depression, and mental health in those with cognitive impairment. Virtual reality is generally well-received by older adults, achieving high adherence rates.