Resultats de l'activitat de lectura crítica d'articles de recerca en la matèria "Introducció a la Metodologia de la Investigació" en el grau d'Infermeria

Podeu consultar la Vuitena trobada de professorat de Ciències de la Salut completa a: http://hdl.handle.net/2445/66524Objectius: Descriure els resultats del treball de lectura crítica d’articles originals: la temàtica escollida pels alumnes, els resultats quantitatius i el grau de concordança entre l’avaluació de l’exposició oral del docent i l’avaluació entre iguals en la matèria d’Introducció a la Metodologia de la Investigació. Metodologia: Àmbit. Escola d’Infermeria, Universitat de Barcelona. Disseny. Estudi descriptiu transversal. Subjectes. 350 alumnes del segon any del Grau d’Infermeria, en el segon semestre. Activitat acreditativa d’aprenentatges. Els professors van distribuir els diferents dissenys metodològics als grups d’alumnes i aquests escolliren un article del que van fer la revisió crítica, la presentació del treball escrit i oral. La qualificació final constava de les notes del treball escrit, de l’avaluació intragrup, i de les notes de l’exposició oral tan del docent com de l’avaluació entre iguals. Anàlisis. Descriptiu i grau de concordança entre les avaluacions de les exposicions orals dels docent i dels alumnes mitjançant el coeficient de correlació intraclasse (software SPSS V20)..

Influencia de la accesibilidad y distancia en el consumo de productos sanitarios en una Unidad de Hemodialisis

Objetivo: determinar si la distancia que deben recorrer las enfermeras para acceder a tres productos sanitarios (gasas, apósitos y sueros fisiológicos) influye en la cantidad consumida en el Gabinete de Hemodiálisis de la Fundació Puigvert (2013-2014). Método: estudio cuasiexperimental en el total de las enfermeras del Gabinete de Hemodiálisis (n= 30). Variable principal: consumo de unidades de tres productos sanitarios (gasas, apósitos y sueros fisiológicos). Variable de intervención: distancia a donde se encontraban los productos sanitarios (5, 7 y 9 m), que fue modificada cada dos meses. En el análisis bivariante se utilizó el coeficiente de correlación de Spearman, el test de Wilcoxon y la prueba U Mann Whitney. Resultados: existía una correlación lineal inversa, de manera que a mayor edad o años de profesión, menor consumo de los productos sanitarios estudiados. Al comparar el consumo a los 7 y 9 m versus los 5 m, se vio que era inferior para todos los productos (p< 0,05). El consumo de gasas y apósitos fue mayor (p< 0,05) en el turno de tarde en todas las distancias exploradas. Conclusiones: a mayor distancia de los productos sanitarios suero fisiológico, gasas y apósitos, menor es el consumo de los mismos por parte de las enfermeras. Existe una asociación estadísticamente significativa entre el consumo, la edad y la experiencia, de manera que las enfermeras más jóvenes y con menos experiencia consumen más

Diagnosis of alpha1-antitrypsin deficiency not just in severe COPD

Alpha1-antitrypsin deficiency (AATD) is a well known genetic risk factor for pulmonary disease and is the most frequent hereditary disease diagnosed in adults. Despite being one of the most common hereditary diseases, AATD remains under-diagnosed because of its variable clinical presentation and the poor knowledge of this disease by physicians. With the aim of identifying clinical differences that could influence early diagnosis, we compared two groups of six AATD Pi*ZZ patients with different lung function severity and clinical expression at diagnosis. On comparing the two groups, we observed a younger mean age at diagnosis and more exacerbations in the severe group, but the percentage of smokers did not statistically differ between the two groups. Our results suggest that AATD continues being a disease suspected on younger patients with a worse lung function. In addition these findings confirm the clinical variability of the disease and that there are still unknown factors that contribute to its development. Therefore, early diagnosis may modify the prognosis of this disease

Treatment of impacted or retained second molars with the miniscrew-supported pole technique: a prospective follow-up study

Ectopic eruption; Molar angulation; Surgical procedureErupción ectópica; Angulación molar; Procedimiento quirúrgicoErupció ectòpica; Angulació molar; Procediment quirúrgicBackground Eruption disturbances of permanent molars are uncommon; however, it is important to treat them as soon as they are diagnosed. The main objective was to analyze the effectiveness of the “miniscrew-supported pole technique,” a surgically assisted orthodontic procedure to force the eruption of impacted/retained second molars (M2s) when there are indicators of complex molar inclusion. An observational prospective study was carried out during a 2-year period. Sociodemographic, clinical and low-dose scanner variables were taken at baseline (T0). Follow-up variables (T1) were the time between surgery and tooth eruption, radiographic measurements, debonding of buttons, failure rate of miniscrews and success rate of eruption. Results A total of 21 patients (mean age of 13.9 years) with 24 retained/impacted M2s were recruited; 13 molars were maxillary (54.2%) and 11 (45.8%) were mandibular. Six (25%) were impacted molars and 18 (75%) primarily retained. At T0, molar angulation was mesial in six molars (25%), distal in five molars (20.8%) and 13 molars were vertically positioned (54.2%). Infraocclusion degree was moderate in four (16.7%) molars and severe in 20 (83.3%). Only three (12.5%) third molars were removed due to lack of space. All M2s managed to erupt, achieving a success rate of 100%; however, two molars of the same patient did not achieve occlusion. The period of eruption after surgery was 126.8 (117.3) days. Anatomical radicular alteration was the only variable independently related to a longer time of treatment (p = 0.027). Conclusions The pole technique, using one mesial miniscrew and simple orthodontic mechanics, applies forces that succeed in erupting complicated retained/impacted M2s in a short period of time and with a low failure rate

Influence of accesibility and distance in the consumption of disposable equipment in a hemodialysis unit

The location of the disposable material in a hemodialysis unit is essential to ensure the effectiveness of the circuits and to provide quality in nursing care. The law of the minimum effort may explain how the accessibility and distance of dressing trolleys can influence the consumption of some health care supplies [1,2]. It is necessary for health managers to look for effective strategies that optimize the use of wound care material without reducing the quality of care [1,3]. The objective was to determine whether the distance that nurses have to walk to access the trolley with the wound care material (gauzes, dressings and 10cc physiological serum), influence on the amount consumed in a hemodialysis unit at the Fundació Puigvert. The research hypothesis is: consumption of those materials will decrease 5% as the distance to access the trolleys increases from 5 to 7 and from 7 to 9 meters

Practice and knowledge about diagnosis and treatment of alpha-1 antitrypsin deficiency in Spain and Portugal

Background: determining physicians' awareness about alpha-1 antitrypsin (AAT) deficiency (AATD) may help to explain the discrepancy between the observed and expected number of patients diagnosed with this disease. This study was designed to assess the opinions on knowledge, practice pattern and attitude regarding AATD among physicians in Spain and Portugal. Methods: as online anonymous survey was performed on pulmonologists (n = 100), internal medicine specialists (IMS) (n = 100) and primary care physicians (PCP) (n = 176). Of the total number of physicians, 221 were from Spain, and 155 were from Portugal. Physicians answered 21 questions related to their personal and professional profile, knowledge regarding AATD and chronic obstructive pulmonary disease (COPD), performance and attitude about AATD, and use of augmentation therapy. Responses were ranked on a 4-point scale indicating the level of agreement. In addition, some of the responses were rated as either "low" or "high" indicating the level of knowledge the respondent felt he/she possessed. Results: only 14 % of physicians reported to "know very well" about AATD (3.3 [SD 0.6] for pulmonologists vs. 2.64 [SD 0.60] for IMS and 2.48 [SD 0.71] for PCP; p < 0.001). Only 45.2 % of physicians correctly answered "<50 mg/dL" as the threshold value of serum AAT to be considered severe AATD (55.0 % of pulmonologists vs. 47.0 % of IMS and 38.6 % of PCP; p = 0.001). Choice of the correct answer did not agree with those physicians self-declaring a high level of AATD knowledge (51.2 %). A total of 43.9 % of physicians correctly identified all diseases or conditions in a list associated or not with AATD. A similar trend was detected when identifying which conditions would be responsive to augmentation therapy (<50 %). Only 15.8 % of specialists performed AATD testing in all patients with COPD (27.0 % pulmonologists, 12.6 % PCP; p = 0.001). Conclusion: the results suggest that a knowledge gap may be contributing to the underdiagnosis of AATD. Physicians in Spain and Portugal showed a marked lack of awareness of their shortcomings in knowledge about AATD, and in general did not follow guidelines and recommendations for AATD testing

Predictors for functional and anatomic outcomes in macular edema secondary to non-infectious uveitis

Predictors; Macular edema; Non-infectious uveitisPredictors; Edema macular; Uveïtis no infecciosaPredictores; Edema macular; Uveítis no infecciosaAIMS: We aimed to investigate predictive factors for visual and anatomic outcomes in patients with macular edema secondary to non-infectious uveitis. MATERIAL AND METHODS: We conducted a multicenter, prospective, observational, 12-month follow-up study. Participants included in the study were adults with non-infectious uveitic macular edema (UME), defined as central subfoveal thickness (CST) of >300 μm as measured by spectral domain optical coherence tomography (SD-OCT) and fluid in the macula. Demographic, clinical and tomographic data was recorded at baseline, 1, 3, 6 and 12 months. Foveal-centered SD-OCT exploration was set as the gold-standard determination of UME using a standard Macular Cube 512x128 A-scan, within a 6 x 6 mm2 area, and the Enhanced High Definition Single-Line Raster. To assess favorable prognosis, the main outcomes analyzed were the best-corrected visual acuity (BCVA) and the CST. Favorable prognosis was defined as sustained improvement of BCVA (2 lines of gain of the Snellen scale) and CST (decrease of 20% of the initial value or <300 μm) within a 12 month period. RESULTS: Fifty-six eyes were analyzed. The number of eyes with sustained improvement in the CST was 48 (86.2%), against 23 (41.1%) eyes with sustained improvement in BCVA. Favorable prognosis, as defined above, was observed in 18 (32.1%) eyes. UME prognosis was negatively correlated with baseline foveal thickening, alteration in the vitreo-macular interface and cystoid macular edema. In contrast, bilaterally, systemic disease and the presence of anterior chamber cells were predictive of favorable prognosis. CONCLUSION: Available treatment modalities in UME may avoid chronic UME and improve anatomic outcome. However, the proportion of functional amelioration observed during 12 months of follow-up is lower. Thicker CST, alteration in the vitreo-macular interface and cystoid macular edema may denote less favorable prognosis. Conversely, bilaterally, systemic disease and anterior chamber cells may be associated with favorable prognosis in UME

Genetic diagnosis of α1-antitrypsin deficiency using DNA from buccal swab and serum samples

Background: α1-Antitrypsin deficiency (AATD) is associated with a high risk of developing lung and liver disease. Despite being one of the most common hereditary disorders worldwide, AATD remains under-diagnosed and prolonged delays in diagnosis are usual. The aim of this study was to validate the use of buccal swab samples and serum circulating DNA for the complete laboratory study of AATD. Methods: Sixteen buccal swab samples from previously characterized AATD patients were analyzed using an allele-specific genotyping assay and sequencing method. In addition, 19 patients were characterized by quantification, phenotyping and genotyping using only serum samples. Results: the 16 buccal swab samples were correctly characterized by genotyping. Definitive results were obtained in the 19 serum samples analyzed by quantification, phenotyping and genotyping, thereby performing the complete AATD diagnostic algorithm. Conclusions: Buccal swab samples may be useful to expand AATD screening programs and family studies. Genotyping using DNA from serum samples permits the application of the complete diagnostic algorithm without delay. These two methods will be useful for obtaining more in depth knowledge of the real prevalence of patients with AATD

Application of a diagnostic algorithm for the rare deficient variant Mmalton of alpha-1-antitrypsin deficiency: a new approach

Background and objectives: alpha-1-antitrypsin deficiency (AATD) is associated with a high risk for the development of early-onset emphysema and liver disease. A large majority of subjects with severe AATD carry the ZZ genotype, which can be easily detected. Another rare pathologic variant, the Mmalton allele, causes a deficiency similar to that of the Z variant, but it is not easily recognizable and its detection seems to be underestimated. Therefore, we have included a rapid allele-specific genotyping assay for the detection of the Mmalton variant in the diagnostic algorithm of AATD used in our laboratory. The objective of this study was to test the usefulness of this new algorithm for Mmalton detection. Materials and methods: we performed a retrospective revision of all AATD determinations carried out in our laboratory over 2 years using the new diagnostic algorithm. Samples with a phenotype showing one or two M alleles and AAT levels discordant with that phenotype were analyzed using the Mmalton allele-specific genotyping assay. Results: we detected 49 samples with discordant AAT levels; 44 had the MM and five the MS phenotype. In nine of these samples, a single rare Mmalton variant was detected. During the study period, two family screenings were performed and four additional Mmalton variants were identified. Conclusion: the incorporation of the Mmalton allele-specific genotyping assay in the diagnostic algorithm of AATD resulted in a faster and cheaper method to detect this allele and avoided a significant delay in diagnosis when a sequencing assay was required. This methodology can be adapted to other rare variants. Standardized algorithms are required to obtain conclusive data of the real incidence of rare AAT alleles in each region

Prevalence of altered passive eruption in orthodontically treated and untreated patients

Background: some authors have reported that after orthodontic treatment (OT), a 'gummy smile' might develop. Nevertheless, there are no studies in the literature that investigate whether OT increases the presence of altered passive eruption (APE). The primary aim of this cross-sectional study is to evaluate the prevalence of APE after OT (OT group) and compare it with patients who never received OT (control group). A secondary aim is to identify which variables are related to APE. Methods: the study population consisted of 190 patients (95 patients each in the control and OT groups), providing 1,140 anterior teeth for the clinical examination. The following clinical parameters were assessed: presence or absence of APE, clinical crown length, and gingival biotype, which was divided into three categories: thin-scalloped, thick-flat, and thick-scalloped. Results: twenty-eight patients (29.5%) were diagnosed with APE in the control group and 40 (42.1%) in the OT group, although this difference was not statistically significant (P = 0.07). Furthermore, 34 (75.6%) patients with thick-flat biotype were diagnosed with APE, whereas 30 (31.3%) and four (8.2%) with thick-scalloped and thin-scalloped biotypes, respectively, had APE. These differences were statistically significant (P <0.001). Conclusions: it was concluded that: 1) the prevalence of APE is higher after OT but not to a statistically significant degree and 2) APE is more common in individuals with a thick-flat gingival biotype