"INTERGROWTH21st vs customized fetal growth curves in the assessment of the neonatal nutritional status: a retrospective cohort study of gestational diabetes"

Background Gestational diabetes mellitus is associated with increased incidence of adverse perinatal outcomes including newborns large for gestational age, macrosomia, preeclampsia, polyhydramnios, stillbirth, and neonatal morbidity. Thus, fetal growth should be monitored by ultrasound to assess for fetal overnutrition, and thereby, its clinical consequence, macrosomia. However, it is not clear which reference curve to use to define the limits of normality. Our aim is to determine which method, INTERGROWTH21st or customized curves, better identifies the nutritional status of newborns of diabetic mothers. Methods This retrospective cohort study compared the risk of malnutrition in SGA newborns and the risk of overnutrition in LGA newborns using INTERGROWTH21st and customized birth weight references in gestational diabetes. The nutritional status of newborns was assessed using the ponderal index. Additionally, to determine the ability of both methods in the identification of neonatal malnutrition and overnutrition, we calculate sensitivity, specificity, positive predictive value, negative predictive value and likelihood ratios. Results Two hundred thirty-one pregnant women with GDM were included in the study. The rate of SGA indentified by INTERGROWTH21st was 4.7% vs 10.7% identified by the customized curves. The rate of LGA identified by INTERGROWTH21st was 25.6% vs 13.2% identified by the customized method. Newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH21st. (RR 4.24 vs 2.5). LGA newborns according to the customized method also showed a higher risk of overnutrition than those classified as LGA according to INTERGROWTH21st. (RR 5.26 vs 3.57). In addition, the positive predictive value of the customized method was superior to that of INTERGROWTH21st in the identification of malnutrition (32% vs 27.27%), severe malnutrition (22.73% vs 20%), overnutrition (51.61% vs 32.20%) and severe overnutrition (28.57% vs 14.89%). Conclusions In pregnant women with DMG, the ability of customized fetal growth curves to identify newborns with alterations in nutritional status appears to exceed that of INTERGROWTH21s

A Student Assessment Tool for Standardized Patient Simulations (SAT-SPS): Psychometric analysis

Background: The evaluation of the level of clinical competence acquired by the student is a complex process that must meet various requirements to ensure its quality. The psychometric analysis of the data collected by the assessment tools used is a fundamental aspect to guarantee the student's competence level. Aim: To conduct a psychometric analysis of an instrument which assesses clinical competence in nursing students at simulation stations with standardized patients in OSCE-format tests. Method: The construct of clinical competence was operationalized as a set of observable and measurable behaviors, measured by the newly-created Student Assessment Tool for Standardized Patient Simulations (SATSPS), which was comprised of 27 items. The categories assigned to the items were ‘incorrect or not performed’ (0), ‘acceptable’ (1), and ‘correct’ (2). Participants: 499 nursing students. Data were collected by two independent observers during the assessment of the students' performance at a four-station OSCE with standardized patients. Descriptive statistics were used to summarize the variables. The difficulty levels and floor and ceiling effects were determined for each item. Reliability was analyzed using internal consistency and inter-observer reliability. The validity analysis was performed considering face validity, content and construct validity (through exploratory factor analysis), and criterion validity. Results: Internal reliability and inter-observer reliability were higher than 0.80. The construct validity analysis suggested a three-factor model accounting for 37.1% of the variance. These three factors were named ‘Nursing process’, ‘Communication skills’, and ‘Safe practice’. A significant correlation was found between the scores obtained and the students' grades in general, as well as with the grades obtained in subjects with clinical content. Conclusions: The assessment tool has proven to be sufficiently reliable and valid for the assessment of the clinical competence of nursing students using standardized patients. This tool has three main components: the nursing process, communication skills, and safety management

Diseño de una prueba de evaluación clínica objetiva estructurada de cuidados de enfermería del primer curso de prácticas clínicas

Objective: The aim of the present study was to design a content-valid nursing objective structured clinical examination attending a first-year clinical nursing practice program. Method: The examination was designed following a procedure based on the consensus of experts which was comprised of three phases: selection of the activities in which students should be competent according to the learning outcomes of the course, clinical case design, and integration of the clinical cases designed into the stations of the test. Results: Of the 44 surveys submitted for the design of the stations, 37 were answered, of which 31 respondents met the inclusion criteria of the panel of experts. The activities on which the experts reached the highest degrees of consensus were: basic physical assessment and monitoring of vital signs, assessment of hygiene and skin status, ability to develop care plans, management of safety principles in administration of medication and administration of oral medication. Based on the selected activities, the experts developed 20 clinical cases, from which a four-station nursing objective structured clinical examination was designed. Conclusion: The structured methodology based on the design of experts enabled the design of a content-valid objective structured clinical examination appropriate for the evaluation of the learning outcomes achieved by the students attending a clinical practice program

Manual de Casos Clínicos Simulados

El documento de trabajo titulado “Manual de Casos Clínicos Simulados” es producto de una actuación avalada presentada a la convocatoria de innovación docente 11-12 de la UCA. Este manual está enfocado a la mejora del aprendizaje a través de la simulación de situaciones clínicas reales de la práctica profesional enfermera.Este manual está enfocado a la mejora del aprendizaje a través de la simulación de situaciones clínicas reales de la práctica profesional enfermera. Esta metodología permite el refuerzo y la integración de los conocimientos previos. Permite una formación estandarizada, repetible, sin riesgo, que posibilita la capacitación de acuerdo al progreso individual, así como la formación para el trabajo en equipo y el desarrollo de estrategias de resolución de problemas con diferente y progresivo nivel de complejidad. El Manual de Casos Clínicos Simulados constituye una guía de usuario de esta metodología. Describe cómo se elabora un escenario de simulación, el diseño de los casos, la selección de situaciones reales de la práctica profesional enfermera que se pretenden simular y la evaluación de los mismos, así como los recursos necesarios.Archivo en formato pdf, 55 páginas.El Manual está estructurado en tres partes: En la primera parte se expone información básica sobre la simulación como metodología de aprendizaje, sus aplicaciones, ventajas e inconvenientes, el uso de la simulación clínica en Enfermería, las fases de la simulación y unas recomendaciones de buenas prácticas. Esta parte del Manual pretende servir de marco teórico para el uso de la simulación como metodología de aprendizaje. En la segunda parte se exponen las plantillas o formularios base de los diferentes prototipos o modelos de casos clínicos simulados. Para cada uno de ellos, se presentan las instrucciones del formulario, la plantilla y un ejemplo del prototipo de caso. Hasta ahora hemos desarrollado la plantilla para la construcción de simulaciones de pacientes de alta fidelidad. La tercera parte, consta una recopilación del material disponible y las personas de referencia para la implementación de los casos. El Manual también cuenta con un apartado de Bibliografía de consulta y recursos digitales internacionales y nacionales sobre simulación. Para usar el manual recomendamos: La lectura de la primera parte. Una vez que se decida utilizar la simulación, se recomienda seguir las fases de la simulación descritas en el texto y las normas de buenas prácticas recomendadas por la Asociación Internacional para el aprendizaje por simulación en Enfermería. A continuación procedería el diseño de los casos utilizando de base la plantilla, según el prototipo o modelo de caso planificado, con la ayuda de las instrucciones de la misma y tomando el ejemplo como punto de partida

Colección de documentos para la valoración, planificación y registro clínico en enfermería

Conjunto de documentos propuestos para la realización y desarrollo del Proceso Enfermero (valoración, diagnóstico, planificación, ejecución y evaluación) con el objetivo de unificar, facilitar y optimizar el aprendizaje.Con este conjunto de documentos, se pretende optimizar el aprendizaje y facilitar la realización y desarrollo del Proceso Enfermero (valoración, diagnóstico, planificación, ejecución y evaluación), aportando y unificando el material básico y la metodología a usar en las distintas actividades y experiencias formativas tanto en el ámbito académico como en el clínico, y que se desarrollan en las asignaturas y en los practicum que conforman el Grado en Enfermería. Para ello, en esta colección incluimos formatos específicos que guíen la práctica clínica a lo largo de todo el proceso de aprendizaje. Entre los documentos que se incluyen se encuentran: - Diferentes formatos para la recogida de datos/valoración (descriptivos, abiertos, semiestructurados, etc), estructurados según las 14 Necesidades Básicas de Virginia Henderson, los 11 Patrones Funcionales de Salud (PFS) de Marjory Gordon, y en aquellos casos en los que ha sido posible, según la adaptación a los 13 Dominios de la NANDA de los Patrones Funcionales de Salud de Gordon. Con esto se recogen los esquemas más utilizados actualmente en nuestro entorno clínico. - Formato desarrollado en el que se unifican las valoraciones que aparecen en las aplicaciones DIRAYA (Historia Digital de Salud) y AZAHAR (Módulo de Gestión de Cuidados) del Servicio Andaluz de Salud. - Clasificación de los Cuestionarios, test e índices más frecuentemente usados en la Valoración de Enfermería ordenados según las 14 Necesidades de Henderson, los 11 Patrones Funcionales de Salud de Gordon y los 13 Patrones Funcionales de Salud de Gordon modificados/adaptados a la clasificación de diagnósticos de enfermería de la NANDA. - Documentos básicos para el registro de constantes y medicación. - Formatos para el desarrollo de Planes de Cuidados y el registro de la evolución y la evaluación. - Documentos / formatos integrados para la Valoración, Planes de Cuidados y registro de la evolución y evaluación.109 páginas. Incluye 28 documentos

INTERGROWTH-21st versus a customized method for the prediction of neonatal nutritional status in hypertensive disorders of pregnancy

Background Hypertensive disorders of pregnancy (HDP) generate complications and are one of the principal causes of maternal, foetal, and neonatal mortality worldwide. It has been observed that in pregnancies with HDP, the incidence of foetuses small for their gestational age (SGA) is twice as high as that in noncomplicated pregnancies. In women with HDP, the identification of foetuses (SGA) is substantially important, as management and follow-up are determined by this information. Objective The objective of this study was to evaluate whether the INTERGROWTH-21st method or customized birthweight references better identify newborns with an abnormal nutritional status resulting from HDP. Method A comparative analysis study was designed with two diagnostic methods for the prediction of neonatal nutritional status in pregnancies with HDP. The performance of both methods in identifying neonatal malnutrition (defined by a neonatal body mass index < 10(th) centile or a ponderal index < 10(th) centile) was assessed by calculating sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratio, Youden's index and probability ratios. Results The study included 226 pregnant women diagnosed with HDP. The customized method identified 45 foetuses as small for gestational age (19.9%), while the INTERGROWTH-21st method identified 27 newborns with SGA (11.9%). The difference between proportions was statistically significant (p < 0.01). Using body mass index (< 10(th) centile) as a measure of nutritional status, newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH-21st (RR: 4.87 (95% CI: 1.86-12.77) vs. 3.75 (95% CI: 1.49-9.43)) (DOR: 5.56 (95% CI: 1.82-16.98) vs. 4.84 (95% CI: 1.51-15.54)) Even when using Ponderal index (< 10(th) centile), newborns identified as SGA by the customized method showed a higher risk of malnutrition than those identified as SGA by INTERGROWTH-21st (RR 2.37 (95% CI: 1.11-5.05) vs. 1.68 (95% CI: 0.70-4.03))(DOR 2.62 (95% CI: 1.00-6.87) vs. 1.90 (95% CI: 0.61-5.92)). Conclusion In pregnant women with HDP, the predictive ability of the customized foetal growth curves to identify neonatal malnutrition appears to surpass that of INTERGROWTH-21st

Teaching empathy to nursing students: A randomised controlled trial

Background: Empathy has been reported to produce a positive effect on improving patient health outcomes, becoming a fundamental skill in any health personnel-patient relationship. Objective: To evaluate the effectiveness of an intervention designed to improve the nursing students' empathy, the learning perception, the improvement of the perception in the understanding of the content, and in the degree of difficulty as well as the acquisition of skills. Design: Multicentre randomised controlled trial. Setting: This research was conducted at two schools of nursing at a public university in the Southwest of Spain. Participants: 116 nursing students were randomly assigned to an experimental ora control group (delayed intervention group once the post-training analysis was completed) during the second semester of the 2015/ 2016 academic year. Methods: Pre-test, post-test, and follow-up data were obtained for each group using a simulated clinical interview. Empathy was the primary outcome (The Consultation and Relational Empathy Measure, Jefferson Scale of Empathy student version, Reynolds Empathy Scale, and Carkhuff Scale). The students' perceived knowledge, the learning perception, the self-esteem (Rosenberg Self-Esteem Scale) and the understanding of the content and acquisition of skills (ad-hoc questions) were also analysed. Results: The results were improved in ali the measures conducted in the experimental groups at the different centres after the intervention. The mean post-test simulation seores were higher than the pre-test with statistically significan! differences. The results were maintained in the follow-up. The student's perception of learning and the perception of understanding of the content and the acquisition of ski lls were improved as well. Conclusion: The study support that training in empathic competence is effective

Índice de desempeño ambiental del territorio

El modelo que subyace a los índices de desempeño ambiental están circunscrito a variables que desarrollen medidas de evaluación del estado de cada uno de las dimensiones, las presiones a las que estas dimensiones han venido siendo sometidas y las respuestas que desde la gobernanza de los diversos actores que interactúan, pretenden o disminuir las presiones o disminuir la vulnerabilidad de los elementos que componen las dimensiones social, económica y ecológica.Bogotá D.C

Current international projects in the Duero and Miño-Sil basins

[EN] This paper summarizes the research work that is being carried out within the framework of three international projects with a lifetime between 2022 and 2026: (1) LIFE-IP-Duero; (2) Supporting stakeholders for adaptive, resilience and sustainable water management; (3) IGCP- 730. (1) and (2) are developed in the Duero river basin and are funded by the European Commission meanwhile (3) is being developed in the Duero and Miño-Sil basins and is funded by the International Geosciences Programme (IGCP) of UNESCO.Peer reviewe