Cultural Adaptation and Validation of the Quality of Dying in Long-Term Care Scale (QoD-LTC) for Spanish Nursing Homes

Background: There is a need for instruments that can evaluate the psychosocial quality of dying in nursing homes. The aim of this study was to adapt and validate the Quality of Dying in Long-Term Care scale (QoD-LTC) to the Spanish context. Methods: Descriptive cross-sectional study. Fourteen nurses from 7 facilities in southern Spain assessed 153 residents who died in the centers; validity, reliability, and feasibility were evaluated. Results: The Spanish version consists of 11 items with acceptable reliability (α = 0.681). Three factors model was validated by principal components analysis. A mean of 180.62 (SD = 86.66) seconds is needed to fill it in. An inter-observer 0.753 (95% CI: 0.391–0.900, p< 0.001) and intra-observer 0.855 (95% CI: 0.568–0.951 p = 0.001) reliability were observed. Weak correlation was observed; positive with mono-item question (0.322) and negative with Eastern Cooperative Oncology Group (ECOG) with a value of (−0.321) and Integrated Palliative outcome scale (IPOS) with a value of (−0.252). Conclusions: The QoD-LTC scale presents an adequate factorial structure, internal consistency, and feasibility to evaluate psychosocial quality of dying in nursing homes. It can be used as a quality indicator.Fundación Pública Andaluza Progreso y Salud, grant number (AP-0105-2016

A Fuzzy Delphi Consensus Methodology Based on a Fuzzy Ranking

Delphi multi-round survey is a procedure that has been widely and successfully used to aggregate experts’ opinions about some previously established statements or questions. Such opinions are usually expressed as real numbers and some commentaries. The evolution of the consensus can be shown by an increase in the agreement percentages, and a decrease in the number of comments made. A consensus is reached when this percentage exceeds a certain previously set threshold. If this threshold has not been reached, the moderator modifies the questionnaire according to the comments he/she has collected, and the following round begins. In this paper, a new fuzzy Delphi method is introduced. On the one hand, the experts’ subjective judgments are collected as fuzzy numbers, enriching the approach. On the other hand, such opinions are collected through a computerized application that is able to interpret the experts’ opinions as fuzzy numbers. Finally, we employ a recently introduced fuzzy ranking methodology, satisfying many properties according to human intuition, in order to determine whether the expert’s fuzzy opinion is favorable enough (comparing with a fixed fuzzy number that indicates Agree or Strongly Agree). A cross-cultural validation was performed to illustrate the applicability of the proposed method. The proposed approach is simple for two reasons: it does not need a defuzzification step of the experts’ answers, and it can consider a wide range of fuzzy numbers not only triangular or trapezoidal fuzzy numbers

Palliative Care Symptoms, Outcomes, and Interventions for Chronic Advanced Patients in Spanish Nursing Homes with and without Dementia

The aim of this study was to compare the symptomatology, palliative care outcomes, therapeutic procedures, diagnostic tests, and pharmacological treatments for people with dementia (PWD) and without dementia (PW/OD) admitted to Spanish nursing homes. Design: This was a cross-sectional study which is part of a long-term prospective follow-up of elderly people performed in nursing homes to measure end-of-life care processes. Participants: 107 nursing home patients with advanced or terminal chronic diseases were selected according to the criteria of the Palliative Care Spanish Society. Setting: Two trained nurses from each nursing home were responsible for participant selection and data collection. They must have treated the residents and had a minimum seniority of 6 months in the nursing home. Measurements: Sociodemographic data; Edmonton Symptom Assessment Scale; Palliative Care Outcome Scale; and prevalence of diagnostic tests, pharmacological treatments, and therapeutic procedures were evaluated. Results: Pain, fatigue, and nausea were found to be significantly higher in the nondementia group and insomnia, poor appetite, and drowsiness were significantly higher in the dementia group. Patient anxiety, support, feeling that life was worth living, self-worth, and practical matters management were higher in the nondementia group. Regarding drugs, use of corticoids was higher in the nondementia group, while use of anxiolytics was higher in the dementia group. Diagnostic procedures such as urine analysis and X-ray were higher in the dementia group. Conclusions: Differences in symptom perception, diagnostic tests, and pharmacological procedures were found between patients with and without dementia. Specific diagnostic tools need to be developed for patients with dementia.This work was supported by the Andalusia Ministry of Health (PI-0619-2011) and the Andalusian CICYE project AP-0105-2016

Prospective Evaluation of Intensity of Symptoms, Therapeutic Procedures and Treatment in Palliative Care Patients in Nursing Homes

The aim of the study is to evaluate the intensity of symptoms, and any treatment and therapeutic procedures received by advanced chronic patients in nursing homes. A multi-centre prospective study was conducted in six nursing homes for five months. A nurse trainer selected palliative care patients from whom the sample was randomly selected for inclusion. The Edmonton Symptoms Assessment Scale, therapeutic procedures, and treatment were evaluated. Parametric and non-parametric tests were used to evaluate month-to-month differences and differences between those who died and those who did not. A total of 107 residents were evaluated. At the end of the follow-up, 39 had (34.6%) died. All symptoms (p < 0.050) increased in intensity in the last week of life. Symptoms were more intense in those who had died at follow-up (p < 0.05). The use of aerosol sprays (p = 0.008), oxygen therapy (p < 0.001), opioids (p < 0.001), antibiotics (p = 0.004), and bronchodilators (p = 0.003) increased in the last week of life. Peripheral venous catheters (p = 0.022), corticoids (p = 0.007), antiemetics (p < 0.001), and antidepressants (p < 0.05) were used more in the patients who died. In conclusion, the use of therapeutic procedures (such as urinary catheters, peripheral venous catheter placement, and enteral feeding) and drugs (such as antibiotics, anxiolytics, and new antidepressant prescriptions) should be carefully considered in this clinical setting.This paper has been partially supported by the Junta de Andalucía, by project FQM-235 and the Andalusian CICYE project AP-0105-201

Una herramienta electrónica para la enseñanza de las técnicas de muestreo

Dentro de la ense&ntilde;anza del muestreo en poblaciones finitas se detecta como una necesidad el uso de datos reales para ilustrar y discutir la particularidad de llevar a la pr&aacute;ctica un esquema de muestreo a un problema concreto. El desarrollo de aplicaciones inform&aacute;ticas que permitan implementar los desarrollos te&oacute;ricos para su aplicaci&oacute;n a datos reales, permiten al alumno resolver casos pr&aacute;cticos m&aacute;s adecuados a la posterior vida laboral, a la vez que reduce su recelo e incertidumbre sobre el manejo de este tipo de datos.En este trabajo se presentan los principales resultados en el desarrollo de una aplicaci&oacute;n inform&aacute;tica en Visual Basic y la elaboraci&oacute;n de un cuaderno de pr&aacute;cticas de muestreo, dise&ntilde;ados como complemento del material te&oacute;rico-pr&aacute;ctico utilizado en la ense&ntilde;anza de muestreo en poblaciones finitas

Diseño de actividades de escape room para dinamizar el trabajo en grupo en un contexto de docencia semipresencial

Diseñar actividades de escape room encuadradas como aprendizaje gamificado con el objetivo de incrementar la motivación, participación, interacción así como el desarrollo de habilidades de trabajo en grupo en un contexto de docencia semipresencialDepto. de Organización de EmpresasFac. de Ciencias Económicas y EmpresarialesFALSEsubmitte

Use of seasonal forecasts for water resources management in Spain

Presentación realizada en: 15th Annual Meeting of the European Meteorological Society (EMS) /12th European Conference on Applications of Meteorology (ECAM) celebrado en Sofía, Bulgaria del 7 al 11 de septiembre de 2015

Effect of mTORC1/mTORC2 inhibition on T cell function: potential role in graft-versus-host disease control

Producción CientíficaThe mechanistic target of rapamycin (mTOR) pathway is crucial for the activation and function of T cells, which play an essential role in the development of graft-versus-host disease (GvHD). Despite its partial ability to block mTOR pathway, the mTORC1 inhibitor rapamycin has shown encouraging results in the control of GvHD. Therefore, we considered that simultaneous targeting of both mTORC1 and mTORC2 complexes could exert a more potent inhibition of T cell activation and, thus, could have utility in GvHD control. To assess this assumption, we have used the dual mTORC1/mTORC2 inhibitors CC214-1 and CC214-2. In vitro studies confirmed the superior ability of CC214-1 versus rapamycin to block mTORC1 and mTORC2 activity and to reduce T cell proliferation. Both drugs induced a similar decrease in Th1/Th2 cytokine secretion, but CC214-1 was more efficient in inhibiting na€ıve T cell activation and the expression of Tcell activation markers. In addition, CC214-1 induced specific tolerance against alloantigens, while preserving anti-cytomegalovirus response. Finally, in a mouse model of GvHD, the administration of CC214-2 significantly improved mice survival and decreased GvHD-induced damages. In conclusion, the current study shows, for the first time, the immunosuppressive ability of CC214-1 on T lymphocytes and illustrates the role of CC214-2 in the allogeneic transplantation setting as a possible GvHD prophylaxis agent.Gerencia Regional de Salud de Castilla y León (Proyecto GRS 726/A13

Mesenchymal stromal cells (MSC) from JAK2+ myeloproliferative neoplasms differ from normal MSC and contribute to the maintenance of neoplastic hematopoiesis

[EN]There is evidence of continuous bidirectional cross-talk between malignant cells and bone marrow-derived mesenchymal stromal cells (BM-MSC), which favors the emergence and progression of myeloproliferative neoplastic (MPN) diseases. In the current work we have compared the function and gene expression profile of BM-MSC from healthy donors (HDMSC) and patients with MPN (JAK2V617F), showing no differences in the morphology, proliferation and differentiation capacity between both groups. However, BM-MSC from MPN expressed higher mean fluorescence intensity (MIF) of CD73, CD44 and CD90, whereas CD105 was lower when compared to controls. Gene expression profile of BM-MSC showed a total of 169 genes that were differentially expressed in BM-MSC from MPN patients compared to HD-MSC. In addition, we studied the ability of BM-MSC to support the growth and survival of hematopoietic stem/progenitor cells (HSPC), showing a significant increase in the number of CFU-GM colonies when MPN-HSPC were co-cultured with MPN-MSC. Furthermore, MPN-MSC showed alteration in the expression of genes associated to the maintenance of hematopoiesis, with an overexpression of SPP1 and NF-kB, and a downregulation of ANGPT1 and THPO. Our results suggest that BM-MSC from JAK2+ patients differ from their normal counterparts and favor the maintenance of malignant clonal hematopoietic cell

Integrative epigenomics in Sjögren´s syndrome reveals novel pathways and a strong interaction between the HLA, autoantibodies and the interferon signature

Primary Sjögren's syndrome (SS) is a systemic autoimmune disease characterized by lymphocytic infiltration and damage of exocrine salivary and lacrimal glands. The etiology of SS is complex with environmental triggers and genetic factors involved. By conducting an integrated multi-omics study, we confirmed a vast coordinated hypomethylation and overexpression effects in IFN-related genes, what is known as the IFN signature. Stratified and conditional analyses suggest a strong interaction between SS-associated HLA genetic variation and the presence of Anti-Ro/SSA autoantibodies in driving the IFN epigenetic signature and determining SS. We report a novel epigenetic signature characterized by increased DNA methylation levels in a large number of genes enriched in pathways such as collagen metabolism and extracellular matrix organization. We identified potential new genetic variants associated with SS that might mediate their risk by altering DNA methylation or gene expression patterns, as well as disease-interacting genetic variants that exhibit regulatory function only in the SS population. Our study sheds new light on the interaction between genetics, autoantibody profiles, DNA methylation and gene expression in SS, and contributes to elucidate the genetic architecture of gene regulation in an autoimmune population