Development and psychometric properties of the nursing critical thinking in clinical practice questionnaire

Background and aim: A complex healthcare environment, with greater need for care based on the patient and evidence-based practice, are factors that have contributed to the increased need for critical thinking in professional competence. At the theoretical level, Alfaro-LeFevre () put forward a model of critical thinking made up of four components. And although these explain the construct, instruments for their empirical measurement are lacking. The purpose of the study was to develop and validate the psychometric properties of an instrument, the Nursing Critical Thinking in Clinical Practice Questionnaire (N-CT-4 Practice), designed to evaluate the critical thinking abilities of nurses in the clinical setting. Methods: A cross-sectional survey design was used. A pool of items was generated for evaluation by a panel of experts who considered their validity for the new instrument, which was finally made up of 109 items. Following this, validation was carried out using a sample of 339 nurses at a hospital in Barcelona, Spain. Reliability was determined by means of internal consistency and test-retest stability over time, although the validity of the construct was assessed by means of confirmatory factor analysis. Results: The content validity index of the N-CT-4 Practice was .85. Cronbach's alpha coefficient for the whole instrument was .96. The intraclass correlation coefficient was .77. Confirmatory factor analysis showed that the instrument was in line with the four-dimensional model proposed by Alfaro-LeFevre (2016). Linking evidence to action: The psychometric properties of theN-CT-4 Practice uphold its potential for use in measuring critical thinking and in future research related with the examination of critical thinking

Matched cohort study on the efficacy of tocilizumab in patients with COVID-19

Background: Tocilizumab has been proposed as a treatment for the new disease COVID-19, however, there is not enough scientific evidence to support this treatment. The objective of this study is to analyze whether the use of tocilizumab is associated with respiratory improvement and a shorter time to discharge in patients with COVID-19 and lung involvement. Methods: Observational study on a cohort of 418 patients, admitted to three county hospitals in Catalonia (Spain). Patients admitted consecutively were included and followed until discharge or up to 30 days of admission. A sub-cohort of patients treated with tocilizumab and a sub-cohort of control patients were identified, matched by a large number of risk factors and clinical variables. Sub-cohorts were also matched by the number of other treatments for COVID-19 that patients received. Increment in SAFI (inspired oxygen fraction / saturation) 48 h after the start of treatment, and time to discharge, were the primary outcomes. Mortality, which was a secondary outcome, was analyzed in the total cohort, by using logistic regression models, adjusted by confounders. Results: There were 96 patients treated with tocilizumab. Of them, 22 patients could be matched with an equivalent number of control patients. The increment in SAFI from baseline to 48 h of treatment, was not significantly different between groups (tocilizumab: −0.04; control: 0.09; p = 0.636). Also, no difference in time to discharge was found between the two sub-cohorts (logrank test: p = 0.472). The logistic regression models, did not show an effect of tocilizumab on mortality (OR 0.99; p = 0.990). Conclusions: We did not find a clinical benefit associated with the use tocilizumab, in terms of respiratory function at 48 h of treatment, or time to discharge

Proporción de carga asistencial generada por la diabetes mellitus en las consultas de enfermería de atención primaria de salut

Objetivo La mayoría de enfermos con diabetes mellitus tipo 2 (DM2) se controla en atención primaria de salud (APS). La atención y educación proporcionadas por enfermería son clave para controlar la glucemia y prevenir las complicaciones macro y microangiopáticas de la DM. El objetivo de este trabajo es conocer la proporción de carga asistencial atribuible a la DM en consultas de enfermería de APS. Material y método Estudio observacional, analítico y transversal. Durante 2 semanas consecutivas se registraron datos de todos los enfermos que acudieron a 15 consultas de enfermería de APS ubicadas en 14 Áreas Básicas de Salud (ABS) de la provincia de Barcelona. Las variables de estudio fueron: edad, sexo, situación laboral, motivo de consulta, duración de la visita, presencia de DM y, en los enfermos diabéticos, el tipo de tratamiento. La recogida de datos se realizó en 2 períodos. El primero entre noviembre del año 2003 y enero del 2004 y el segundo en abril de 2005. Se realizó un análisis descriptivo de estas variables con un intervalo de confianza del 95% y la asociación entre variables mediante el programa SPSS v.11.1. Resultados Tenía DM el 29% de los pacientes. La DM es el primer motivo de consulta (29,1%), aumenta con la edad y llega al 40% en mayores de 65 años. La duración media de una visita por DM es de 14,59 min, un 30,8% más elevada que la duración media del resto de los problemas de salud. Globalmente, las mujeres consultan más que los varones (56,6%) excepto en DM, curas y hábito tabáquico. Conclusiones La DM es el problema de salud que genera más demanda y consume más tiempo de enfermería en la APS. Esta realidad y el futuro que se prevé con relación al incremento de la prevalencia de DM exigen considerar nuevas estrategias organizativas y formativas, y establecer criterios para mejorar la gestión de recursos y promover estrategias educativas más efectivas

Self-assembled coumarin- and 5-fluorouracil-PEG micelles as multifunctional drug delivery systems

The copper(I)-catalyzed azide/alkyne cycloaddition is recognized as one of the most successful click reactions to access self-assembling amphiphilic polymer-drug conjugates (PDCs). In this way, poor water-soluble drugs can be linked covalently to hydrophilic poly(ethylene glycol) (PEG) to obtain PEGylated drug micelles that can be used as versatile carriers for the delivery of diverse therapeutic agents. In this work, two novel amphiphilic PDCs that combine PEG with privileged scaffolds well-known for their anticancer properties, such as coumarin and 5-fluorouracil, have been synthesized and characterized. These conjugates were able to self-assemble into micelles at relatively high critical micellar concentration, probably due to the large portion of hydrophilic PEG. The micelles allowed to load other anticancer drugs (paclitaxel, curcumin, and gemcitabine), providing a unique opportunity to develop promising co-delivery carriers for synergistic cancer therapy. The Korsmeyer-Peppas mathematical model was used for describing the in vitro kinetics of drug release from the micelles. Similar sustained and controlled drug release profiles were obtained for paclitaxel and curcumin in both conjugates, which was attributed to the excellent stability driven by the strong interaction between polymeric conjugates and drugs in the micelle core. In contrast, the high instability observed for the gemcitabine-loaded micelles provided an initial uncontrolled burst release of drug. A preliminary in vitro cytotoxicity study of the micelles against human pancreatic cancer cells PANC-1 and BxPC-3 was also carried out, demonstrating that both coumarin and 5-fluorouracil retain their anticancer properties after conjugation with PEG.La cicloadición de azida/alquino catalizada por cobre (I) se reconoce como una de las reacciones de clic más exitosas para acceder a conjugados de polímero-fármaco anfifílicos (PDC) autoensamblados. De esta manera, los fármacos poco solubles en agua se pueden unir covalentemente al poli(etilenglicol) (PEG) hidrofílico para obtener micelas de fármacos PEGilados que se pueden utilizar como vehículos versátiles para la administración de diversos agentes terapéuticos. En este trabajo, dos PDC anfifílicos novedosos que combinan PEG con andamios privilegiados conocidos por sus propiedades anticancerígenas, como la cumarina .y 5-fluorouracilo, han sido sintetizados y caracterizados. Estos conjugados pudieron autoensamblarse en micelas a una concentración micelar crítica relativamente alta, probablemente debido a la gran porción de PEG hidrofílico. Las micelas permitieron cargar otros medicamentos contra el cáncer (paclitaxel, curcumina y gemcitabina), lo que brinda una oportunidad única para desarrollar portadores de administración conjunta prometedores para la terapia sinérgica contra el cáncer. Se utilizó el modelo matemático de Korsmeyer-Peppas para describir la cinética in vitro de la liberación del fármaco desde las micelas. Se obtuvieron perfiles similares de liberación sostenida y controlada del fármaco para paclitaxel.y curcumina en ambos conjugados, lo que se atribuyó a la excelente estabilidad impulsada por la fuerte interacción entre los conjugados poliméricos y los fármacos en el núcleo de la micela. Por el contrario, la alta inestabilidad observada para las micelas cargadas con gemcitabina proporcionó una liberación inicial descontrolada del fármaco. También se llevó a cabo un estudio preliminar de citotoxicidad in vitro de las micelas contra las células de cáncer de páncreas humano PANC-1 y BxPC-3, demostrando que tanto la cumarina como el 5-fluorouracilo conservan sus propiedades anticancerígenas después de la conjugación con PEG

In print como método não invasivo de coleta de amostra para o diagnóstico molecular da leishmaniose cutânea em população militar da Colômbia

Taking into account that the traditional methods of sampling and diagnosis for cutaneous leishmaniasis , have limitations, such as direct smear, whose sensitivity depends on the professional's expertise, the lesion aspiration that can be used to detect parasites in the lamina, dna or cultures takes a long time and is demanding, and the biopsy of the lesion that is invasive and painful were compared with the imprinting method on the filter paper of the ulcerative lesion against the traditional method of aspiration by means of the conventional pcr technique using as a target a dna region of the parasite kinetoplast. In this present work, pcr obtained an imprinting sensitivity of 90.07% compared to the aspirate of 86.3%, which, besides being a non-invasive sampling method, with few transport requirements, it can be taken directly in the area of operations at a very low cost, which turns out to be beneficial to be used in patients with cutaneous leishmaniasis of the National Army of Colombia, who are in different operations areas.Teniendo en cuenta que los métodos tradicionales de toma de muestra y diagnóstico para la leishmaniosis cutánea presentan limitaciones, como el frotis directo, cuya sensibilidad depende de la pericia del profesional, el aspirado de lesión que puede ser usado para detección de parásitos en lámina, su adn o para cultivos es demorado y exigente, y la biopsia de la lesión que es invasiva y dolorosa se comparó con el método de impronta en papel filtro de la lesión ulcerativa contra el método tradicional de aspirado mediante la técnica de pcr convencional utilizando como blanco una región del adn del kinetoplasto del parásito. En el presente trabajo, la pcr obtuvo una sensibilidad para impronta del 90,07% comparado con el aspirado, el 86,3%, que, además, por ser un método de toma de muestra no invasivo, con pocas exigencias para el transporte, se puede tomar directamente en el área de operaciones a muy bajo costo, resulta ser beneficioso para ser usado en los pacientes con leishmaniosis cutánea del Ejército Nacional de Colombia, que se encuentran en las diferentes áreas de operaciones.Considerando que os métodos tradicionais de coleta de amostra e diagnóstico para a leishmaniose cutânea apresentam limitações, como exame direto de esfregaços, cuja sensibilidade depende da perícia do profissional, o raspado de lesão que pode ser usado para a detecção de parasitas em lâmina, seu dna ou para culturas é demorado e exigente, e a biopsia da lesão que é invasiva e dolorosa, comparou-se com o método in print em papel filtro da lesão ulcerativa contra o método tradicional de aspirado mediante a técnica de pcr convencional utilizando como alvo uma região do dna do cinetoplasto do parasita. No presente trabalho, a pcr obteve uma sensibilidade para in print de 90,07% comparado com o aspirado, 86,3%, que, além disso, por ser um método de coleta de amostra não invasivo, com poucas exigências para o transporte, pode ser coletado diretamente na área de operações a muito baixo custo, resulta ser benéfico para ser usado nos pacientes com leishmaniose cutânea do Exército Nacional da Colômbia, que se encontram nas diferentes áreas de operações

Cost Effective Use of a Thiosulfinate-Enriched Allium sativum Extract in Combination with Chemotherapy in Colon Cancer

In this work, we sought to investigate the effects of a thiosulfinate-enriched garlic extract, co-administered with 5-fluorouracil (5-FU) or oxaliplatin chemotherapy, on the viability of colon cancer cells (Caco-2 and HT-29). We also addressed the economic feasibility of a new combined treatment of this thiosulfinate-enriched garlic extract, with oxaliplatin that could reduce the dosage and costs of a monotherapy. The thiosulfinate-enriched garlic extract not only enhanced the impact of 5-FU and oxaliplatin (500 µM) in decreasing Caco-2 and HT-29 viability, but also showed a higher effect than standard 5-FU and oxaliplatin chemotherapy as anti-cancer agents. These results provided evidences for the combination of lyophilized garlic extract and 5-FU or oxaliplatin as a novel chemotherapy regimen in colon cancer cells that may also reduce the clinical therapy costs.En este trabajo, buscamos investigar los efectos de un extracto de ajo enriquecido con tiosulfinato, coadministrado con quimioterapia con 5-fluorouracilo (5-FU) u oxaliplatino, sobre la viabilidad de las células de cáncer de colon (Caco-2 y HT-29). . También abordamos la viabilidad económica de un nuevo tratamiento combinado de este extracto de ajo enriquecido con tiosulfinato, con oxaliplatino que podría reducir la dosis y los costes de una monoterapia. El extracto de ajo enriquecido con tiosulfinato no solo mejoró el impacto del 5-FU y el oxaliplatino (500 µM) en la disminución de la viabilidad de Caco-2 y HT-29, sino que también mostró un efecto mayor que el 5-FU estándar y la quimioterapia con oxaliplatino como anticancerígeno agentes

Trabecular bone score in active or former smokers with and without COPD

Background Smoking is a recognized risk factor for osteoporosis. Trabecular bone score (TBS) is a novel texture parameter to evaluate bone microarchitecture. TBS and their main determinants are unknown in active and former smokers. Objective To assess TBS in a population of active or former smokers with and without Chronic Obstructive Pulmonary Disease (COPD) and to determine its predictive factors. Methods Active and former smokers from a pulmonary clinic were invited to participate. Clinical features were recorded and bone turnover markers (BTMs) measured. Lung function, low dose chest Computed Tomography scans (LDCT), dual energy absorptiometry (DXA) scans were performed and TBS measured. Logistic regression analysis explored the relationship between measured parameters and TBS. Results One hundred and forty five patients were included in the analysis, 97 (67.8%) with COPD. TBS was lower in COPD patients (median 1.323; IQR: 0.13 vs 1.48; IQR: 0.16, p = 0.003). Regression analysis showed that a higher body mass index (BMI), younger age, less number of exacerbations and a higher forced expiratory volume-one second (FEV1%) was associated with better TBS (β = 0.005, 95% CI:0.000–0.011, p = 0.032; β = -0.003, 95% CI:-0.007(-)-0.000, p = 0.008; β = -0.019, 95% CI:-0.034(-)-0.004, p = 0.015; β = 0.001, 95% CI:0.000–0.002, p = 0.012 respectively). The same factors with similar results were found in COPD patients. Conclusions A significant proportion of active and former smokers with and without COPD have an affected TBS. BMI, age, number of exacerbations and the degree of airway obstruction predicts TBS values in smokers with and without COPD. This important information should be considered when evaluating smokers at risk of osteoporosis

Randomized Clinical Trial of the Need for Antibiotic Treatment for Low-Risk Catheter-Related Bloodstream Infection Caused by Coagulase-Negative Staphylococci

According to clinical guidelines, the management of catheter-related bloodstream infections (CRBSI) due to coagulase-negative staphylococci (CoNS) includes catheter removal and antibiotic treatment for 5 to 7 days. However, in low-risk episodes, it remains uncertain whether antibiotic therapy is necessary. This randomized clinical trial aims to determine whether the non-administration of antibiotic therapy is as safe and effective as the recommended strategy in low-risk episodes of CRBSI caused by CoNS. With this purpose, a randomized, open-label, multicenter, non-inferiority clinical trial was conducted in 14 Spanish hospitals from 1 July 2019 to 31 January 2022. Patients with low-risk CRBSI caused by CoNS were randomized 1:1 after catheter withdrawal to receive/not receive parenteral antibiotics with activity against the isolated strain. The primary endpoint was the presence of any complication related to bacteremia or to antibiotic therapy within 90 days of follow-up. The secondary endpoints were persistent bacteremia, septic embolism, time until microbiological cure, and time until the disappearance of a fever. EudraCT: 2017-003612-39 INF-BACT-2017. A total of 741 patients were assessed for eligibility. Of these, 27 were included in the study; 15 (55.6%) were randomized to the intervention arm (non-antibiotic administration) and 12 (44.4%) to the control arm (antibiotic therapy as per standard practice). The primary endpoint occurred in one of the 15 patients in the intervention group (septic thrombophlebitis) and in no patients in the control group. The median time until microbiological cure was 3 days (IQR 1-3) in the intervention arm and 1.25 days (IQR 0.5-2.62) in the control arm, while the median time until fever resolution was zero days in both arms. The study was stopped due to the insufficient number of recruited patients. These results seem to indicate that low-risk CRBSI caused by CoNS can be managed without antibiotic therapy after catheter removal; efficacy and safety are not affected

Uso de los modelos 3D de los corazones fetales en la docencia multidisciplinar del diagnóstico tratamiento y pronóstico de las cardiopatías congénitas complejas

Como continuidad a un proyecto de innovación docente previo basado en el desarrollo de los modelos 3D del corazón fetal, normal y patológico, en estos momentos somos más conscientes como esta tecnología La tecnología 3D supone un cambio de paradigma en docencia en la que pueden participar, obstetras, pediatras, cirujanos cardiacos infantiles y además anatomopatólogos. Como hemos destacado los modelos 3d son un tipo de manufactura aditiva que permite transformar un modelo digital en un objeto tridimensional real y tangible. Esto permite una docencia teórico-práctica innovadora que se enmarca en el contexto moderno de una atención médica personalizada (medicina de precisión centrada en el paciente, visible y comprensible por el estudiante, comprensión en el proceso de comunicación médica con el paciente y con el resto de profesionales médicos que atienden a los pacientes, ayuda en la toma de decisiones ante el diagnostico de entidades patológicas, entre otras cuestiones)

Infections after spine instrumentation: effectiveness of short antibiotic treatment in a large multicentre cohort

REIPI (Spanish Network for Research in Infectious Disease)/GEIO–SEIMC (Group for the Study of Osteoarticular Infections – Spanish Society of Infectious Diseases and Clinical Microbiology).[Background and objectives] Available information about infection after spine instrumentation (IASI) and its management are scarce. We aimed to analyse DAIR (debridement, antibiotics and implant retention) prognosis and evaluate effectiveness of short antibiotic courses on early forms.[Methods] Multicentre retrospective study of patients with IASI managed surgically (January 2010–December 2016). Risk factors for failure were analysed by multivariate Cox regression and differences between short and long antibiotic treatment were evaluated with a propensity score-matched analysis.[Results] Of the 411 IASI cases, 300 (73%) presented in the first month after surgery, 48 in the second month, 22 in the third and 41 thereafter. Infections within the first 2 months (early cases) occurred mainly to older patients, with local inflammatory signs and predominance of Enterobacteriaceae, unlike those in the later periods. When managed with DAIR, prognosis of early cases was better than later ones (failure rate 10.4% versus 26.1%, respectively; P = 0.02). Risk factors for DAIR failure in early cases were female sex, Charlson Score, large fusions (>6 levels) and polymicrobial infections (adjusted HRs of 2.4, 1.3, 2.6 and 2.26, respectively). Propensity score matching proved shorter courses of antibiotics (4–6 weeks) as effective as longer courses (failure rates 11.4% and 10.5%, respectively; P = 0.870).[Conclusions] IASIs within the first 2 months could be managed effectively with DAIR and shorter antibiotic courses. Clinicians should be cautious when faced with patients with comorbidities, large fusions and/or polymicrobial infections.E.B. was supported with a grant of the Instituto de Salud Carlos III – Ministry of Science and Innovation (FI 16/00397). This research was carried out as part of our routine work.Peer reviewe