Continuidad asistencial: rol de la enfermera de enlace

ObjetivoEvaluar el programa de enfermera de enlace a los 2 años de funcionamiento.DiseñoEstudio descriptivo.EmplazamientoAtención primaria de los municipios de Sant Boi de Llobregat y Sant Vicenç dels Horts (Barcelona) y el Hospital Comarcal de Sant Boi.PacientesPacientes dados de alta del hospital (entre octubre de 2000 y octubre 2002) y que necesitaban cuidados de continuidad en el equipo de atención primaria o domicilio.IntervencionesVisitas conjuntas entre la enfermera de enlace y la supervisora de la unidad hospitalaria para elaborar el plan de cuidados previo al alta hospitalaria. Se comunica al equipo de atención primaria del traspaso del enfermo y su plan de cuidados. Las visitas posteriores al domicilio las realiza la enfermera de enlace, el equipo de atención primaria, o conjuntamente.ResultadosSe ha estudiado a 854 pacientes (57,6% mujeres); media de edad en mujeres 69,82±14,7 años y en varones de 61,7±19,6 años (p<0,0001).La enfermera de enlace ha realizado 2.241 visitas hospitalarias, 81 domiciliarias y 434 llamadas telefónicas. También se han hecho 636 coordinaciones.El diagnóstico de enfermería más frecuente ha sido trastorno de la movilidad física (61% de los pacientes).ConclusionesSe ha creado un mecanismo que mejora la continuidad desde el alta hospitalaria hasta el contacto con el equipo de atención primaria. La enfermera de enlace coordina y gestiona los casos antes de que el paciente sea traspasado al ámbito de la atención primaria.ObjectiveTo evaluate the link nurse programme after 2 years of operation.DesignDescriptive study.SettingPrimary vare in the towns of Sant Boi de Llobregat and Sant Vicenç dels Horts (Barcelona) and the County Hospital of Sant Boi, Spain.PatientsPatients discharged from the hospital (October 2000-October 2002) and who needed ongoing care in the primary care centre or at home.InterventionsJoint visits of the link nurse and the hospital unit's supervisor to work out the care plan before discharge. The PC team was informed of the transfer of the patient and his/her care plan. Subsequent home visits were by the link nurse, the primary care team or both together.Results854 patients (57.6% women) were studied.Women's mean age was 69.82 (SD, 4.7) and men's was 61.7 (SD, 9.6) (P<.0001). The link nurse made 2241 hospital visits, 81 home visits, and 434 phone calls. There were 636 co-ordinations.The most common nursing diagnosis made was physical mobility disorder (61% of patients).ConclusionsA mechanism was created to improve continuity from hospital discharge to contact with the PC team. The link nurse coordinates and manages patients before they are handed over to PC

PdZn catalysts for CO2 hydrogenation to methanol using chemical vapour impregnation (CVI)

The formation of PdZn bimetallic alloys on ZnO, TiO2 and Al2O3 supports was investigated, together with the effect of alloy formation on the CO2 hydrogenation reaction. The chemical vapour impregnation (CVI) method produced PdZn nanoparticles with diameters of 3–6 nm. X-ray photoelectron spectroscopy and X-ray diffraction revealed the changes in the structure of the PdZn alloy that help stabilise formate intermediates during methanol synthesis. PdZn supported on TiO2 exhibits high methanol productivity of 1730 mmol kgcat−1 h−1 that is associated with the high dispersion of the supported PdZn alloy

Effect of Base on the Facile Hydrothermal Preparation of Highly Active IrO_x Oxygen Evolution Catalysts

The efficient electrochemical splitting of water is limited by the anodic oxygen evolution reaction (OER). IrO2 is a potential catalyst with sufficient activity and stability in acidic conditions to be applied in water electrolyzers. The redox properties and structural flexibility of amorphous iridium oxo-hydroxide compared to crystalline rutile-IrO2 are associated with higher catalytic activity for the OER. We prepared IrOx OER catalysts by a simple hydrothermal method varying the alkali metal base (Li2CO3, LiOH, Na2CO3, NaOH, K2CO3, KOH) employed during the synthesis. This work reveals that the surface area, particle morphology, and the concentration of surface hydroxyl groups can be controlled by the base used and greatly influence the catalyst activity and stability for OER. It was found that materials prepared with bases containing lithium cations can lead to amorphous IrOx materials with a significantly lower overpotential (100 mV @ 1.5 mA·cm–2) and increased stability compared to materials prepared with other bases and rutile IrO2. This facile method leads to the synthesis of highly active and stable catalysts which can potentially be applied to larger scale catalyst preparations

BARD1 Pathogenic Variants are Associated with Triple-Negative Breast Cancer in a Spanish Hereditary Breast and Ovarian Cancer Cohort

Only a small fraction of hereditary breast and/or ovarian cancer (HBOC) cases are caused by germline variants in the high-penetrance breast cancer 1 and 2 genes (BRCA1 and BRCA2). BRCA1-associated ring domain 1 (BARD1), nuclear partner of BRCA1, has been suggested as a potential HBOC risk gene, although its prevalence and penetrance are variable according to populations and type of tumor. We aimed to investigate the prevalence of BARD1 truncating variants in a cohort of patients with clinical suspicion of HBOC. A comprehensive BARD1 screening by multigene panel analysis was performed in 4015 unrelated patients according to our regional guidelines for genetic testing in hereditary cancer. In addition, 51,202 Genome Aggregation Database (gnomAD) non-Finnish, non-cancer European individuals were used as a control population. In our patient cohort, we identified 19 patients with heterozygous BARD1 truncating variants (0.47%), whereas the frequency observed in the gnomAD controls was 0.12%. We found a statistically significant association of truncating BARD1 variants with overall risk (odds ratio (OR) = 3.78; CI = 2.10-6.48; p = 1.16 x 10(-5)). This association remained significant in the hereditary breast cancer (HBC) group (OR = 4.18; CI = 2.10-7.70; p = 5.45 x 10(-5)). Furthermore, deleterious BARD1 variants were enriched among triple-negative BC patients (OR = 5.40; CI = 1.77-18.15; p = 0.001) compared to other BC subtypes. Our results support the role of BARD1 as a moderate penetrance BC predisposing gene and highlight a stronger association with triple-negative tumors

Large scale multifactorial likelihood quantitative analysis of BRCA1 and BRCA2 variants: An ENIGMA resource to support clinical variant classification

The multifactorial likelihood analysis method has demonstrated utility for quantitative assessment of variant pathogenicity for multiple cancer syndrome genes. Independent data types currently incorporated in the model for assessing BRCA1 and BRCA2 variants include clinically calibrated prior probability of pathogenicity based on variant location and bioinformatic prediction of variant effect, co-segregation, family cancer history profile, co-occurrence with a pathogenic variant in the same gene, breast tumor pathology, and case-control information. Research and clinical data for multifactorial likelihood analysis were collated for 1,395 BRCA1/2 predominantly intronic and missense variants, enabling classification based on posterior probability of pathogenicity for 734 variants: 447 variants were classified as (likely) benign, and 94 as (likely) pathogenic; and 248 classifications were new or considerably altered relative to ClinVar submissions. Classifications were compared with information not yet included in the likelihood model, and evidence strengths aligned to those recommended for ACMG/AMP classification codes. Altered mRNA splicing or function relative to known nonpathogenic variant controls were moderately to strongly predictive of variant pathogenicity. Variant absence in population datasets provided supporting evidence for variant pathogenicity. These findings have direct relevance for BRCA1 and BRCA2 variant evaluation, and justify the need for gene-specific calibration of evidence types used for variant classification

Large scale multifactorial likelihood quantitative analysis of BRCA1 and BRCA2 variants: An ENIGMA resource to support clinical variant classification

Abstract The multifactorial likelihood analysis method has demonstrated utility for quantitative assessment of variant pathogenicity for multiple cancer syndrome genes. Independent data types currently incorporated in the model for assessing BRCA1 and BRCA2 variants include clinically calibrated prior probability of pathogenicity based on variant location and bioinformatic prediction of variant effect, co-segregation, family cancer history profile, co-occurrence with a pathogenic variant in the same gene, breast tumor pathology, and case-control information. Research and clinical data for multifactorial likelihood analysis were collated for 1395 BRCA1/2 predominantly intronic and missense variants, enabling classification based on posterior probability of pathogenicity for 734 variants: 447 variants were classified as (likely) benign, and 94 as (likely) pathogenic; 248 classifications were new or considerably altered relative to ClinVar submissions. Classifications were compared to information not yet included in the likelihood model, and evidence strengths aligned to those recommended for ACMG/AMP classification codes. Altered mRNA splicing or function relative to known non-pathogenic variant controls were moderately to strongly predictive of variant pathogenicity. Variant absence in population datasets provided supporting evidence for variant pathogenicity. These findings have direct relevance for BRCA1 and BRCA2 variant evaluation, and justify the need for gene-specific calibration of evidence types used for variant classification. This article is protected by copyright. All rights reserved.Peer reviewe