Impacto de una intervención informativa sobre el programa de cribado de cáncer colorrectal en profesionales de atención primaria

Objetivo: Evaluar el impacto de una intervención informativa a profesionales de atención pri-maria sobre sus conocimientos de cribado de cáncer colorrectal, recomendaciones de vigilanciaposterior y estrategias de derivación. Método diseÑo: Ensayo clínico controlado y aleatorizado por conglomerados. Emplazamiento:centros de atención primaria de L'Hospitalet de Llobregat (Barcelona). Participantes: médi-cos y enfermeras de atención primaria. Intervención: sesión informativa y envío de píldorasinformativas en 6 de 12 centros (seleccionados aleatoriamente) sobre el programa de cribadocáncer colorrectal. Mediciones principales: cuestionario ad hoc que recoge las característicasde los profesionales, los centros y 2 variables contextuales; implicación de los profesionalesen el programa de cribado; conocimientos sobre el cáncer colorrectal, los factores de riesgo,los procedimientos de cribado, las recomendaciones de seguimiento posterior a la exploracióndiagnóstica y las estrategias de derivación. Resultados: La media de la puntuación total en el primer cuestionario fue 8,07(1,38) sobre 11 yla del segundo 8,31(1,39). No se encontraron diferencias estadísticamente significativas entreel grupo intervención y control, sin embargo, en 9 preguntas se aumentó el porcentaje de res-puestas correctas en el grupo intervención, mayoritariamente relacionadas con el seguimientoposterior a la exploración diagnóstica. Conclusiones: La intervención mejora el porcentaje de respuestas correctas, sobre todo enaquellas en las que se obtuvo peor puntuación en el primer cuestionario. Este estudio muestraque los profesionales están familiarizados con el cribado de cáncer colorrectal, pero es impor-tante tener una comunicación frecuente con ellos para mantener actualizada la informaciónrelacionada con el cribado y fomentar su implicación con el mismo

Discomfort of the critically ill pediatric patient and correlated variables

Introduction: the care of critically ill children is usually invasive and aggressive, requiring numerous traumatic procedures that may cause fear, pain, and discomfort. Objectives: the aim of this study was to analyse the level of discomfort of patients admitted to the paediatric intensive care unit of a specialist children's hospital and to determine the sociodemographic and clinical variables that influence the degree of discomfort experienced by critically ill paediatric patients. Methods: we performed a descriptive observational cross-sectional study that included a total of 311 children with a median age of 5.07 y (interquartile range = 0.9-11.7). A team of 10 paediatric critical care nurses assessed the degree of discomfort once for each shift (morning, afternoon, and night) on 2 successive days using the COMFORT Behavior Scale-Spanish version. Results: in total, 49.8% (n = 155) of the patients were free of discomfort (score ≤10 points) vs. 50.2% (n = 156) who experienced discomfort. There was a significant negative correlation between discomfort and the length of stay in days (Rho = 0.16; p = 0.02), that is, the longer the stay, the less discomfort the patient felt. The correlation between age and degree of discomfort was found to be both positive and significant (Rho = 0.230, p < 0.001); the greater the age, the greater the discomfort. In comparison of all children who received analgosedation (n = 205), with discomfort levels of 10.77 ± 2.94, with those who did not receive analgosedation (n = 106), with discomfort levels of 11.96 ± 2.80, we did find a statistically significant difference (χ2 = -4.05; p < 0.001). Conclusions: half of the patients admitted to the paediatric intensive care unit experienced discomfort. Age and analgosedation were the two most important variables involved with a high degree of discomfort. Clinical care practices must consider these factors and try to plan activities designed to relieve discomfort in all critically ill paediatric patients

Cánceres de intervalo y sensibilidad de los programas poblacionales de cribado de cáncer colorrectal

Objetivo: Describir los cánceres de intervalo y la sensibilidad de los programas de cribado de cáncer colorrectal. Métodos: Revisión sistemática de la literatura con búsqueda en MEDLINE. La estrategia de búsqueda combina los términos 'cáncer de intervalo', 'falso negativo', 'cribado', 'cribado poblacional', 'detección precoz de cáncer' y 'cáncer colorrectal'. Los criterios de inclusión fueron programas poblacionales de cribado de cáncer colorrectal, artículos originales en inglés o español, y fechas de publicación comprendidas entre enero de 1999 y febrero de 2015. Se realizó una síntesis narrativa de los artículos incluidos, detallando las características de los programas de cribado y de los cánceres de intervalo, y la sensibilidad del cribado utilizando como indicador el número de cánceres detectados mediante el cribado dividido por el total de tumores diagnosticados en la población cribada (método tradicional) o la incidencia proporcional, calculada como la incidencia de cánceres de intervalo en relación con la incidencia esperada en ausencia de cribado. Resultados: Se incluyeron 13 artículos. La sensibilidad de los programas de cribado osciló entre el 42,2% y el 65,3% en los programas que utilizan el test del guayaco, y entre el 59,1% y el 87,0% con el test inmunológico. Se ha encontrado una mayor proporción de mujeres a las que se diagnosticó un cáncer de intervalo, y que estas lesiones estaban mayoritariamente localizadas en el colon proximal. Conclusión: Existe una gran variabilidad en la proporción de cánceres de intervalo en los programas poblacionales de cáncer colorrectal. Para garantizar la comparabilidad entre programas, es necesario un consenso en la definición operacional de cánceres de intervalo y en los métodos utilizados para su identificación y cuantificación

A mild neurofibromatosis type 1 phenotype produced by the combination of the benign nature of a leaky NF1-splice mutation and the presence of a complex mosaicism

Here we analyze the genetic and molecular basis responsible for a very benign phenotype observed in an NF1 patient. Quantification of cells carrying the NF1 mutation in different samples derived from the three embryonic layers revealed mosaicism. Furthermore, the construction of a minigene with patient's mutation (c.3198 − 314G>A) confirmed its benign nature due to the leakiness of the splicing mechanism that generated a proportion of correctly spliced transcripts. Hence, we concluded that the mild phenotype observed in this patient is the result of the presence of mosaicism together with the benign nature of a leaky NF1-splice mutation. Finally, with the aim of developing a personalized therapeutic approach for this patient, we demonstrated correction of the splicing defect by using specific antisense morpholino oligomers. Our results provide an example of the molecular complexity behind disease phenotypes and highlight the importance of using comprehensive genetic approaches to better assess phenotype-genotype correlation

The role experience of advanced practice nurses in oncology: An interpretative phenomenological study.

Aim(s): To understand the experiences of advanced practice nurses working in cancer care. Design: Phenomenological qualitative study. Methods: Three focus groups were held to collect qualitative data. Participants were recruited through theoretical non-probabilistic sampling of maximum variation, based on 12 profiles. Data saturation was achieved with a final sample of 21 oncology advanced practice nurses who were performing advanced clinical practice roles in the four centers from December 2021 to March 2022. An interpretative phenomenological analysis was performed following Guba and Lincoln's criteria of trustworthiness. The centers' ethics committee approved the study, and all participants gave written informed consent. Data analysis was undertaken with NVivo 12 software. Results: Three broad themes emerged from the data analysis: the role performed, facilitators and barriers in the development of the role and nurses' lived experience of the role. Conclusion: Advanced practice nurses are aware that they do not perform their role to its full potential, and they describe different facilitators and barriers. Despite the difficulties, they present a positive attitude as well as a capacity for leadership, which has allowed them to consolidate the advanced practice nursing role in unfavourable environments. Implications for the profession: These results will enable institutions to establish strategies at different levels in the implementation and development of advanced practice nursing roles. Reporting method: Reporting complied with COREQ criteria for qualitative research. Patient or public contributions: No patient or public contribution

Interval cancers in a population-based screening program for colorectal cancer in Catalonia, Spain

Objective. To analyze interval cancers among participants in a screening program for colorectal cancer (CRC) during four screening rounds. Methods. The study population consisted of participants of a fecal occult blood test-based screening program from February 2000 to September 2010, with a 30-month follow-up (n = 30,480). We used hospital administration data to identify CRC. An interval cancer was defined as an invasive cancer diagnosed within 30 months of a negative screening result and before the next recommended examination. Gender, age, stage, and site distribution of interval cancers were compared with those in the screen-detected group. Results. Within the study period, 97 tumors were screen-detected and 74 tumors were diagnosed after a negative screening. In addition, 17 CRC (18.3%) were found after an inconclusive result and 2 cases were diagnosed within the surveillance interval (2.1%). There was an increase of interval cancers over the four rounds (from 32.4% to 46.0%). When compared with screen-detected cancers, interval cancers were found predominantly in the rectum (OR: 3.66; 95% CI: 1.51-8.88) and at more advanced stages (P = 0.025). Conclusion. There are large numbers of cancer that are not detected through fecal occult blood test-based screening. The low sensitivity should be emphasized to ensure that individuals with symptoms are not falsely reassured

Multidimensional characteristics of complex chronic patients in emergency services in primary care

Background: In Spain, people between 65 and 74 years old have an average of 2.8 chronic problems or diseases, rising to 3.2 among people aged 75 and older. Aims: We aimed to describe the multidimensional characteristics of complex chronic patients who sought urgent care. Design: We conducted a descriptive, cross-sectional, retrospective study, drawing on a large electronic health record database in primary care in Barcelona, Spain. Methods: We used health record data about subjects' clinical state, functional state, mental health state, social state, nutritional state, and movement. A descriptive analysis was carried out to determine percentages and means, given a standard deviation. Finding: In 2019, 3,732 complex chronic patients sought urgent care at the centres under study. Subjects had a mean age of 82.5 ± 9.8 years, and 58.7% (n = 2,189) were women. Frailty was present in 69.3% (n = 2,586), and 81.7% (n = 3,050) were adherent to therapy. There were 2,470 visits to hospital emergency rooms (66.2%) and 1,651 hospital admissions (44.2%). Malnutrition was evident in 46.5% (n = 1,623) and 27.9% (n = 1,042) had low risk of social exclusion. Discussion: Having such descriptive information can help health services from all areas and levels of care to use comprehensive, collaborative practices to care for complex chronic patients and their noninstitutional caregivers. Conclusion: We noted a high proportion of emergency room visits and hospital admissions among complex chronic patients. Low-level depression and malnutrition were detected. Proactive multidisciplinary interventions could improve the situation of these patients

Testing behavioral interventions to optimize participation in a population-based colorectal cancer screening program in Catalonia

The aim of the study was to measure the effect of three cost-neutral behavioral interventions on participation compared to the standard invitation letter in a population-based colorectal cancer screening program in 2014. For that purpose, a four-arm randomized field trial was conducted among 5077 individuals aged 50 to 69 years. Over an 8-week period, each week was randomly allocated to the intervention or the control conditions. Individuals assigned to the intervention conditions additionally received a prompt to write down the date to pick up the screening test in a pharmacy. Two of the three intervention groups also included an additional paragraph in the invitation letter on either: 1) the high proportion of individuals participating regularly (social norms condition) or 2) the importance of regular participation (benefit condition). We measured screening participation before and after receiving a reminder letter six weeks after the screening invitation. An overall 8.0 percentage point increase in CRC screening was achieved as a direct result of receiving a reminder letter; however none of the intervention strategies influenced participation. The only significant difference was found for newly invited individuals. There, participation rates decreased from 34.9% to 24.2% when the invitation mailing mentioned the importance of regular participation (OR: 0.60; 95% CI: 0.38-0.95). While none of the intervention strategies improved participation rates we found that praising the benefit of regular screening may discourage individuals who have never been invited before as the continuous behavior may be perceived as a large request. Nevertheless, the reminder letter boosted participation rates independently of the intervention assigned

Critical thinking among institutional academic advisors and sociodemographic, professional and academic variables: a multicenter correlation study

Background: In nursing education, essential skills include Critical Thinking (CT). There is scant evidence on how nurse educators could promote CT in students in a clinical context. Objective: To analyse the level of CT and correlated variables in healthcare nurses overseeing the clinicals of nursing undergraduates. Methods The study population were all nurse educators for clinicals at hospitals with nursing undergraduates. To evaluate the CT skills of nurses the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 practice) was administered. Frequencies, percentages and measures of central tendency and scatter were obtained. A bivariate analysis was performed to analyze the correlation between the nurse educators' CT level and the sociodemographic, professional and academic levels. The nonparametric Mann-Whitney and Kruskal-Wallis tests were used to compare two independent groups. Statistical significance was defined as P <.05. Results: The total number of participants was 639. The highest mean CT level was seen in clinical nurses involved in undergraduate nursing instruction and with experience of up to 10 years (mean CT score = 372 (33.3), p=.007). Global CT levels were similar in women and men (mean CT score: 364 (31.9) in women and 358 (40.5) in men, p=.187), with statistically significant differences only observed in the intellectual and cognitive indicator (P =.022). Conclusions: CT levels are high in teaching healthcare professionals in the clinical environment

National validation of the Nursing Intensive-Care Satisfaction Scale: research protocol

Aim: Validate the Nursing Intensive-Care Satisfaction Scale in ICUs throughout Spain. Identify the improvement strategies recommended by the patients and professionals. Design: Quantitative psychometric methodology and a cross-sectional descriptive correlational design.Methods: The study population will be all patients discharged from 19 participating ICUs in Spain. Consecutive sampling (n= 564). Once discharged from the ICUs, they will receive the questionnaire and then, after 48 hours it will be given to them again to analyse the temporal stability. To validate the questionnaire, the internal consistency (Cronbach's Alpha) and temporal stability (test-retest) will be analysed. Results: Improve the quality of nursing care by modifying, changing or strengthening behaviours, skills, attitudes or areas for improvement involved in the proces