Nurses ́ knowledge and attitudestoward Advance Directives

Trabajo fin de grado en EnfermeríaIntroducción: Las voluntades anticipadas (VA) recogen los deseos de una persona sobre el tratamiento de su salud para que se cumplan cuando ya no sea capaz de expresarlos personalmente. Sin embargo, los conocimientos y actitudes de los profesionales enfermeros al respecto pueden impactar negativamente en su cumplimiento. Objetivo: Identificar los conocimientos y actitudes de los enfermeros respecto al documento de VA. Material y métodos: Revisión narrativa. Se realiza una búsqueda bibliográfica en las bases Pubmed, Cinhal, Cuiden, BVS y Psycinfo, de las que se preseleccionan 172 artículos. Tras leer a texto completo se seleccionan 11. También se realiza una búsqueda secundaria, seleccionando 5 artículos más. Resultados: Se revisan 16 artículos en total. Destaca la falta de conocimientos generalizada que muestran los enfermeros sobre el documento de VA, especialmente sobre la legislación que lo regula. Sin embargo, muestran una actitud positiva hacia el documento así como la posibilidad de tener uno propio en un futuro lejano. Conclusiones: Los profesionales de enfermería carecen de conocimientos suficientes sobre el documento de VA, aun así muestran una actitud positiva hacia éste. Se resalta la necesidad de cursos de formación para los profesionales sobre las VA y estudios que revelen la efectividad de esta formación.Introduction: Living Wills or Advance Directives is a document in which a person can define their wishes for medical care in case they cannot express it for themselves. However, compliance with this document is compromised by the lack of knowledge of health professionals. Objective: The aim of this study is to identify the knowledge and attitudes of nurses regarding Advance Directives. Method: Narrative review. A bibliographic search was carried out in the Pubmed, Cinhal, Cuiden, BVS and Psycinfo databases in which 172 articles are preselected. After reading the full text, 11 are selected. A secondary search is also carried out, selecting 5 more articles. A total of 16 articles are reviewed. Results: The lack of knowledge that nurses show about Advance Directives is highlighted, especially regarding the legislation that regulates it. However, they show a generally positive attitude toward the document as well as towards the possibility of having one of its own but in the distant future. Conclusion: The need for training courses of Advance Directives for professionals and studies that reveal the effectiveness of these courses is highlighted

Trx2p-dependent regulation of Saccharomyces cerevisiae oxidative stress response by the Skn7p transcription factor under respiring conditions

The whole genome analysis has demonstrated that wine yeasts undergo changes in promoter regions and variations in gene copy number, which make them different to lab strains and help them better adapt to stressful conditions during winemaking, where oxidative stress plays a critical role. Since cytoplasmic thioredoxin II, a small protein with thiol-disulphide oxidoreductase activity, has been seen to perform important functions under biomass propagation conditions of wine yeasts, we studied the involvement of Trx2p in the molecular regulation of the oxidative stress transcriptional response on these strains. In this study, we analyzed the expression levels of several oxidative stress-related genes regulated by either Yap1p or the co-operation between Yap1p and Skn7p. The results revealed a lowered expression for all the tested Skn7p dependent genes in a Trx2p-deficient strain and that Trx2p is essential for the oxidative stress response during respiratory metabolism in wine yeast. Additionally, activity of Yap1p and Skn7p dependent promoters by β-galactosidase assays clearly demonstrated that Skn7p-dependent promoter activation is affected by TRX2 gene deficiency. Finally we showed that deleting the TRX2 gene causes Skn7p hyperphosphorylation under oxidative stress conditions. We propose Trx2p to be a new positive efector in the regulation of the Skn7p transcription factor that controls phosphorylation events and, therefore, modulates the oxidative stress response in yeast. © 2013 Gómez-Pastor et al.This work has been supported by grants AGL 2008-00060 and AGL2011-24353 from the Spanish Ministry of Education and Science (MEC) to EM. EG was a predoctoral fellow of the FPI program from the MEC (Spanish Ministry of Education). RG-P was a predoctoral fellow of the I3P program from the CSIC (Spanish National Research Council). RP-T was a postdoctoral fellow of the JAEDOC program from the CSIC.Peer Reviewe

A European questionnaire-based study on population awareness and risk perception of antimicrobial resistance

Versión post-printTo tackle antimicrobial resistance (AMR) is of outmost importance for the general population to understand the severity and the relevance of different routes of transmission. Respondents of different age groups, educational and occupational backgrounds, area of living, diet and household composition participated in an online survey with questions concerning socio-demographics, personal use of antibiotics, awareness, general knowledge, sources of information, behavior and attitude toward antibiotics, and risk perception on antibiotics and AMR. Descriptive and logistic regression analyses were carried out. A total of 1252 respondents, mainly from EU, participated in the survey. About 57.7% declared they consumed antibiotics in the last year and some misguided behaviors were identified, especially for those not having a food- or health-related background, who more frequently failed in giving the right answer to uncontroversial true/false questions (ANOVA, P < 0.05). The youngest respondents were less confident on the information received from traditional media (OR = 0.425), the national government (OR = 0.462), and consumer organizations (OR = 0.497), while they frequently obtained information from social networks and online media, which could therefore be exploited as a channel for educational campaigns targeting this population group. New measures, strategies and policy agenda at a European level aimed at improving awareness on AMR among targeted community groups must be taken into consideration.S

Posibilidades de las cuñas motrices en educación infantil: organización del alumnado, espacio, tiempo y materiales

Las cuñas motrices pueden ser un buen recurso didáctico para trabajar la motricidad en el aula integrando contenidos de otras áreas de conocimiento. Por ello, se propuso como objetivo de esta experiencia, analizar los aspectos relacionados con la organización de los elementos estructurales (alumnado, materiales, espacio y tiempo) para garantizar la calidad en el proceso didáctico de las cuñas motrices globales en Educación Infantil. Participaron un total de 23 niños y niñas de tercer curso en segundo ciclo de infantil de entre 5 y 6 años. Los resultados mostraron que la participación del alumnado fue activa, el espacio del aula fue suficiente, y el uso de los materiales limitó el tiempo de compromiso motor. Se concluye manifestando la importancia del diseño y puesta en práctica de las cuñas motrices interdisciplinares para favorecer el desarrollo global e integral del alumnado infantil

Late gadolinium enhancement‐MRI determines definite lesion formation most accurately at 3 months post ablation compared to later time points

Aims: Neither the long-term development of ablation lesions nor the capability of late gadolinium enhancement (LGE)-MRI to detect ablation-induced fibrosis at late stages of scar formation have been defined. We sought to assess the development of atrial ablation lesions over time using LGE-MRI and invasive electroanatomical mapping (EAM). Methods and results: Ablation lesions and total atrial fibrosis were assessed in serial LGE-MRI scans 3 months and >12 months post pulmonary vein (PV) isolation. High-density EAM performed in subsequent repeat ablation procedures served as a reference. Serial LGE-MRI of 22 patients were analyzed retrospectively. The PV encircling ablation lines displayed an average LGE, indicative of ablation-induced fibrosis, of 91.7% ± 7.0% of the circumference at 3 months, but only 62.8% ± 25.0% at a median of 28 months post ablation (p 12 months post ablation. Accordingly, the agreement with EAM regarding detection of ablation-induced fibrosis and functional gaps was good for the LGE-MRI at 3 months (κ .74; p < .0001), but only weak for the LGE-MRI at 28 months post-ablation (κ .29; p < .0001). Conclusion: While non-invasive lesion assessment with LGE-MRI 3 months post ablation provides accurate guidance for future redo-procedures, detectability of atrial ablation lesions appears to decrease over time. Thus, it should be considered to perform LGE-MRI 3 months post-ablation rather than at later time-points > 12 months post ablation, like for example, prior to a planned redo-ablation procedure

Ventricular tachycardia burden reduction after substrate ablation: predictors of recurrence.

BACKGROUND Substrate-based ventricular tachycardia (VT) ablation is a first-line treatment in patients with structural cardiac disease and sustained VT refractory to medical therapy. Despite technological improvements and increased knowledge of VT substrate, recurrence still is frequent. Published data are lacking on the possible reduction in VT burden after ablation despite recurrence. OBJECTIVE The purpose of this study was to assess VT burden reduction during long-term follow-up after substrate ablation and identify predictors of VT recurrence. METHODS We analyzed 234 consecutive VT ablation procedures in 207 patients (age 63 6 14.9 years; 92% male; ischemic heart disease in 65%) who underwent substrate ablation in a single center from 2013 to 2018. RESULTS After follow-up of 3.14 6 1.8 years, the VT recurrence rate was 41.4%. Overall, a 99.6% reduction in VT burden (median VT episodes per year: preprocedural 3.546 [1.347-13.951] vs postprocedural 0.001 [0-0.689]; P 5 .001) and a 96.3% decrease in implantable cardioverter-defibrillator (ICD) shocks (preprocedural 1.145 [0.118-4.467] vs postprocedural 0.042 [0-0.111] per year; P 5 .017) were observed. In the subgroup of patients who experienced VT recurrences, VT burden decreased by 69.2% (median VT episodes per year: preprocedural 2.876 [1.105-8.801] vs postprocedural 0.882 [0.505-2.283]; P ,.001). Multivariable analysis showed persistence of late potentials (67% vs 19%; hazard ratio 3.18 [2.18- 6.65]; P ,.001) and lower left ventricular ejection fraction (EF) (30 [25-40] vs 39 [30-50]; P 5 .022) as predictors of VT recurrence. CONCLUSION Despite a high recurrence rate during long-term follow-up, substrate-based VT ablation is related to a large reduction in VT burden and a decrease in ICD therapies. Lower EF and persistence of late potentials are predictors of recurrence. KEYWORDS Arrhythmic burden reduction; Implantable cardioverter-defibrillator shock prevention; Ventricular tachycardia ablation; Ventricular tachycardia recurrence predictors; Ventricular tachycardia storm; Ventricular tachycardia substrate ablatio

Accuracy of standard bipolar amplitude voltage thresholds to identify late potential channels in ventricular tachycardia ablation

Background: Ventricular tachycardia (VT) is caused by the presence of a slow conduction channel (CC) of border zone (BZ) tissue inside the scar-core tissue. Electroanatomic mapping can depict this tissue by voltage mapping. Areas of slow conduction can be detected as late potentials (LPs) and their abolition is the most accepted ablation endpoint. In the current guidelines, bipolar voltage thresholds for BZ and core scar are 1.5 and 0.5 mV respectively. The performance of these values is controversial. The aim of the study is to analyze the diagnostic yield of current amplitude thresholds in voltage map to define VT substrate in terms of CCs of LPs. Predictors of usefulness of current thresholds will be analyzed. Methods: All patients with structural heart disease who underwent VT ablation in Hospital Clinic in 2016-2017 were included. Maps with delineation of CCs based on LPs were created with contact force sensor catheter. Thresholds were adjusted for every patient based on CCs. Diagnostic yield and predictors of performance of conventional thresholds were analyzed. Results: During study period, 57 consecutive patients were included (age: 60.4 ± 8.5; 50.2% ischemic cardiomyopathy, LVEF 39.8 ± 13.5%). Cutoff voltages that better identified the scar and BZ according to the LP channels were 0.32 (0.02-2 mV) and 1.84 (0.3-6 mV) respectively. Current voltage thresholds identified correctly core and BZ in 87.7% and 42.1% of the patients respectively. Accuracy was worse in non-ischemic cardiomyopathy (NICM) especially for BZ (28.6% vs 55.2%, p = 0.042). Conclusions: Accuracy of standard voltage thresholds for scar and BZ is poor in terms of LPs detection. Diagnostic yield is worse in NICM patients specially for border zone

Orthogonal high-density mapping with ventricular tachycardia isthmus analysis vs. pure substrate ventricular tachycardia ablation: A case–control study

Substrate-based ablation has become a successful technique for ventricular tachycardia (VT) ablation. High-density (HD) mapping catheters provide high-resolution electroanatomical maps and better discrimination of local abnormal electrograms. The HD Grid Mapping Catheter is an HD catheter with the ability to map orthogonal signals on top of conventional bipolar signals, which could provide better discrimination of the arrhythmic substrate. On the other hand, conventional mapping techniques, such as activation mapping, when possible, help to identify the isthmus of the tachycardia.The purpose of this study was to compare clinical outcomes after using two different VT ablation strategies: one based on extensive mapping with the HD Grid Mapping Catheter, including VT isthmus analysis, and the other based on pure substrate ablation.Forty consecutive patients undergoing VT ablation with extensive HD mapping method in the hospital clinic (November 2018-November 2019) were included. Clinical outcomes were compared with a historical cohort of 26 consecutive patients who underwent ablation using a scar dechanneling technique before 2018.The density of mapping points was higher in the extensive mapping group (2370.24 ± 920.78 vs. 576.45 ± 294.46; p < 0.001). After 1 year of follow-up, VT recurred in 18.4% of patients in the extensive mapping group vs. 34.6% of patients in the historical control group (p = 0.14), with a significantly greater reduction of VT burden: VT episodes (81.7 ± 7.79 vs. 43.4 ± 19.9%, p < 0.05), antitachycardia pacing (99.45 ± 2.29 vs. 33.9 ± 102.5%, p < 0.001), and implantable cardioverter defibrillator (ICD) shocks (99 ± 4.5 vs. 64.7 ± 59.9%, p = 0.02).The use of a method based on extensive mapping with the HD Grid Mapping Catheter and VT isthmus analysis allows better discrimination of the arrhythmic substrate and could be associated with a greater decrease in VT burden.Copyright © 2022 Vázquez-Calvo, Garre, Sanchez-Somonte, Borras, Quinto, Caixal, Pujol-Lopez, Althoff, Guasch, Arbelo, Tolosana, Brugada, Mont and Roca-Luque

Scar channels in cardiac magnetic resonance to predict appropriate therapies in primary prevention.

Background Scar characteristics analyzed by late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) are related with ventricular arrhythmias. Current guidelines are based only on the left ventricular ejection fraction to recommend an implantable cardioverter-defibrillator (ICD) in primary prevention. Objectives Our study aims to analyze the role of imaging to stratify arrhythmogenic risk in patients with ICD for primary prevention. Methods From 2006 to 2017, we included 200 patients with LGE-CMR before ICD implantation for primary prevention. The scar, border zone, core, and conducting channels (CCs) were automatically measured by a dedicated software. Results The mean age was 60.9 ± 10.9 years; 81.5% (163) were men; 52% (104) had ischemic cardiomyopathy. The mean left ventricular ejection fraction was 29% ± 10.1%. After a follow-up of 4.6 ± 2 years, 46 patients (22%) reached the primary end point (appropriate ICD therapy). Scar mass (36.2 ± 19 g vs 21.7 ± 10 g; P 10 g (25.31% vs 5.26%; hazard ratio 4.74; P = .034) and the presence of CCs (34.75% vs 8.93%; hazard ratio 4.07; P = .003) were also strongly associated with the primary end point. However, patients without channels and with scar mass < 10 g had a very low rate of appropriate therapies (2.8%). Conclusion Scar characteristics analyzed by LGE-CMR are strong predictors of appropriate therapies in patients with ICD in primary prevention. The absence of channels and scar mass < 10 g can identify patients at a very low risk of ventricular arrhythmias in this population