171 research outputs found

    Ense帽ar estrategias de razonamiento y pensamiento cr铆tico a los estudiantes de Enfermer铆a

    Full text link
    La ense帽anza basada en las competencias es m谩s compleja que la aplicaci贸n de saberes y la realizaci贸n de casos pr谩cticos espec铆ficos, siendo necesaria la ejecuci贸n de operaciones mentales abstractas que permitan consolidar los conocimientos, las habilidades y las actitudes necesarias para demostrar el ser competente. Algunas de las competencias transversales que orientan el dise帽o de la formaci贸n y la evaluaci贸n en el Grado en Enfermer铆a son las que hacen referencia al razonamiento y a la capacidad reflexiva previa a la toma de decisiones. Para que el estudiante aprenda este proceso debe, en primer lugar, saber identificar las operaciones mentales implicadas, as铆 como representarlas o expresarlas de forma manuscrita y esquematizada. De este modo, va integrando la estrategia de razonamiento m谩s id贸nea en cada caso. La asignatura de"Resoluci贸n de casos desde un enfoque enfermero" del Departamento de Enfermer铆a Fundamental y M茅dico-quir煤rgica de la Universidad de Barcelona nace con la intenci贸n de dar respuesta a esa necesidad, ense帽ando el marco te贸rico de estrategias de pensamiento cr铆tico para resolver casos cl铆nicos de forma m谩s efectiva y completa

    Interactions between titanium surfaces and biological components

    Get PDF
    El conocimiento de las interacciones entre c茅lula/prote铆na/biomaterial es fundamental para la ingenier铆a de superficies debido a las numerosas aplicaciones biom茅dicas y biotecnol贸gicas que se est谩n desarrollando as铆 como al 茅xito cl铆nico que han alcanzado muchos implantes. La respuesta biol贸gica final inducida por los implantes est谩 fuertemente influenciada por las interacciones superficiales entre los componentes biol贸gicos y el material sint茅tico. Las propiedades f铆sicas y qu铆micas de la superficie de un biomaterial, en lugar de las propiedades en su masa, influyen directamente en la capa de prote铆nas que se adsorben sobre el biomaterial y, como consecuencia de ello, en la respuesta celular a la misma, tanto in vitro como in vivo.El objetivo de esta tesis doctoral es profundizar en el conocimiento de las interacciones material-biosistema, con el 茅nfasis en el descubrimiento de relaciones entre las propiedades superficiales de las superficies de titanio y su respuesta biol贸gica in vitro.El titanio comercialmente puro (Ti c.p.) est谩 siendo ampliamente utilizado con 茅xito durante muchos a帽os como biomaterial para implantes en cirug铆a 贸sea. Su excelente biocompatibilidad se basa en sus adecuadas propiedades mec谩nicas y, con mayor importancia, en su excelente resistencia a la corrosi贸n. Esta 煤ltima se debe principalmente a la formaci贸n espontanea de una fina pel铆cula de 贸xido de titanio que le confiere protecci贸n natural contra los ataques degradativos. La modificaci贸n de la topograf铆a de la superficie del titanio ha sido objeto de investigaci贸n en el pasado con el fin de mejorar la osteointegraci贸n. El granallado de part铆culas es una de las tecnolog铆as m谩s utilizadas para conferir rugosidad a las superficies del titanio. La rugosidad 贸ptima y el tipo de part铆culas abrasivas del granallado para una respuesta 贸ptima in vitro e in vivo fue previamente determinada en nuestro laboratorio. Sin embargo, todav铆a est谩n por determinar cu谩les son las causas 煤ltimas que llevan al biomaterial a su exitosa respuesta biol贸gica.En este trabajo se han estudiado superficies pulidas y rugosas de Ti c.p. obtenidas mediante el granallado con part铆culas abrasivas de diferente composici贸n qu铆mica(Al2O3 y SiC) y diferentes tama帽os (212-300μm; 425-600μm; 1000-1400μm). La completa caracterizaci贸n de las propiedades f铆sica y qu铆mica de la superficie, incluyendo la rugosidad, la composici贸n qu铆mica, la mojabilidad/energ铆a libre y la carga el茅ctrica de las superficies ensayadas ha llevado a una serie de relevantes conclusiones. Entre ellas, cabe destacar que a) la composici贸n qu铆mica de las part铆culas de granallado, as铆 como el m茅todo de esterilizaci贸n fueron los principales factores que influyeron en la mojabilidad y la energ铆a libre superficial de las superficies de titanio estudiadas, b) el m茅todo de esterilizaci贸n cambi贸 en la energ铆a superficial el car谩cter de donante de electrones de las superficies mediante el cambio de la cantidad y la naturaleza de las sustancias adsorbidas, y c) la composici贸n qu铆mica de las part铆culas de granallado no influy贸 en la carga el茅ctrica a pH fisiol贸gico ni en el punto isoel茅ctrico de las superficies.Un segundo paso consisti贸 en el uso de una microbalanza de cristal de cuarzo con monitorizaci贸n de la energ铆a de disipaci贸n, para el estudio de la cin茅tica de adsorci贸n (cantidad y conformaci贸n) y de los procesos de adsorci贸n competitiva de tres prote铆nas de especial inter茅s en los procesos de curaci贸n del hueso - la alb煤mina de suero bovino (BSA), el fibrin贸geno (Fbg), y la fibronectina (Fn)- en sensores lisos recubiertos de TiO2. Se determinaron diferentes modelos de procesos de adsorci贸n con una, dos o m煤ltiples pasos distinguibles en funci贸n de las prote铆nas en soluci贸n. La capa adsorbida de BSA mostr贸 los cambios m谩s significativos en sus propiedades mec谩nicas, de conformaci贸n y de incorporaci贸n de agua hasta que se alcanzaron las condiciones estables de adsorci贸n de prote铆nas. La BSA, la m谩s peque帽a de las prote铆nas ensayadas, desplaz贸 la Fn y el Fbg cuando se ensay贸 en condiciones de la competencia por la adsorci贸n, indicando su mayor afinidad por las superficies de TiO2. Tambi茅n se emplearon t茅cnicas de marcaje fluorescente para el estudio de la adsorci贸n proteica en superficies rugosas granalladas. En este estudio, por un parte, se pudo determinar que la cantidad de Fn y BSA adsorbidas en las superficies granalladas est谩 directamente correlacionada con su energ铆a superficial. Por otra parte, se visualiz贸 la adsorci贸n de fibronectina en soluci贸n sobre muestras granalladas rugosas de Ti. La Fn form贸 un patr贸n irregular de adsorci贸n con una mayor cantidad de prote铆na adsorbida en los picos que en los valles de la topograf铆a.Tambi茅n se evalu贸 la organizaci贸n espacial de la matriz extracelular de los osteoblastos, ECM, sobre superficies de Ti lisas y rugosas por medio de la visualizaci贸n de las fibrillas de Fn te帽idas con marcador fluorescente. Las c茅lulas osteobl谩sticas depositaron las fibrillas de Fn con un determinado patr贸n organizado dentro de la matriz total secretada. Aparecen como una pel铆cula que cubre la parte superior de las diferentes superficies rugosas de titanio. Un resultado relevante es que el espesor de esta capa aument贸 con la rugosidad de la topograf铆a subyacente. Sin embargo no m谩s de la mitad de la m谩xima distancia pico-valle se cubri贸 con la prote铆na secretada y/o reorganizada.Por 煤ltimo, teniendo en cuenta las diferencias en la organizaci贸n de la ECM y laadsorci贸n de Fn en las superficies ensayadas de Ti, se realiz贸 un estudio de qRT-PCR para determinar la influencia de las propiedades superficiales del titanio, con y sin preadsorci贸n de Fn, en la respuesta osteobl谩stica. La expresi贸n g茅nica de la subunidad 5 de la integrina celular, como marcador de la adhesi贸n celular, se increment贸 en las superficies granalladas con SiC en comparaci贸n con las granalladas con al煤mina. Este resultado fue correlacionado con la mayor cantidad de Fn adsorbida debido a la mayor energ铆a superficial de las superficies granalladas con SiC. El aumento de la rugosidad, as铆 como la presencia de part铆culas de al煤mina en las superficies rugosas increment贸 la actividad de ALP y la expresi贸n g茅nica de ALP mRNA por los osteoblastos, y por lo tanto su diferenciaci贸n.The understanding of cell/protein/biomaterial interactions is critical to the engineering of substrates for numerous biomedical and biotechnological applications and to the clinical success of implants. The final biological response induced by implants is strongly influenced by the biological-components/synthetic-material surface interactions. It is well accepted that the physical and chemical surface properties of a biomaterial rather than its bulk properties will influence the protein adlayer and then the cell response to it, both in vitro and in vivo.The aim of this PhD thesis is to gain an increased understanding of the materialbiosystem interactions, with an emphasis on establishing correlations between surface properties of titanium surfaces and its in vitro biological response.Commercially pure titanium (c.p. Ti) is being widely and successfully used implant biomaterial in bone surgery over many years. Its excellent biocompatibility is based in its appropriate mechanical properties and, more importantly, in its excellent corrosion resistance, which is mainly due to the presence of a naturally-occurring thin protective titanium oxide film. Modification of titanium surface topography has been a subject of research in the past with the purpose of improving its osseointegration. Grit blasting is one of the most used technologies to roughen titanium surfaces for this purpose. The optimal roughness and type of abrasive blasting-particles for a better in vitro and in vivo response was previously determined in our lab. However, which and how different relevant surface properties of the blasted titanium surfaces induce that optimal biological behavior is still poorly understood.Smooth/polished and rough c.p. Ti surfaces obtained by blasting with abrasiveparticles of different chemical composition (Al2O3 and SiC) and different sizes (212-300μm; 425-600μm; 1000-1400μm) were studied. The comprehensive characterization of physical and chemical surface properties, including roughness, chemical composition, wettability/free energy and electrical charge of the tested surfaces led to a series of relevant conclusions. Among them, it is worth noting that a) the chemical composition of the grit-blasting particles as well as the method of sterilization were found the main factors influencing wettability and surface free energy of the titanium surfaces; b) the sterilization method changed the electron donor character of the surfaces by changing the amount/nature of physisorbed substances on the surfaces, and c) the chemical composition of the blasting particles did not influence on the electrical charge at physiological pH and the isoelectric point of the surfaces.A second step consisted in the use of a quartz crystal microbalance with monitoring of the energy dissipation to study the adsorption kinetics (amount and conformation) and adsorption competition processes of three proteins of special interest in the healing processes of bone -bovine serum albumin (BSA), fibrinogen (Fbg), and fibronectin (Fn)-on smooth TiO2-coated sensors. Different patterns of adsorption with processes in one, two or multiple distinguishable steps were determined depending of the protein in solution. The BSA adlayers showed the most significant changes in their mechanical properties/conformation/incorporation of water until steady protein-adsorption conditions were reached. BSA, the smallest of the tested proteins, displaced Fn and Fbg when in competition for adsorption, which is an indication of its higher affinity for TiO2 surfaces. Fluorescent labelling techniques where used to study protein adsorption on blasted rough surfaces. Most significantly, the amount of Fn and BSA adsorbed on blasted surfaces was positively correlated with their surface energy. The adsorption of fibronectin from solution on shot-blasted rough titanium surfaces resulted in an irregular pattern of adsorption with a higher amount of protein adsorbed on peaks than on valleys of the topography.Further, the spatial organization of the osteoblast extracellular matrix, ECM, on smooth and rough Ti surfaces was evaluated by visualizing fluorescently-stained Fn-fibrils. Osteoblast-like cells deposited Fn- fibrils in a specific facet-like pattern that was organized within the secreted total matrix. It appeared as a film overlying the top of the different rough titanium surfaces. Interestingly, the thickness of this layer increased with the roughness of the underlying topography, but no more than half of the total maximum peak-to-alley distance was covered.Finally, taking into consideration the differences in ECM organization and Fn adsorption on the tested Ti surfaces a qRT-PCR study was carried out to elucidate the influence of titanium surface properties with and without Fn-precoatings on the osteoblast response. The expression of 5 integrin subunit gene, as a marker for cell adhesion, was increased in SiC-blasted surfaces compared to alumina-blasted surfaces. This was related to the higher amount of adhesive-protein Fn adsorbed caused by the higher surface energy of SiC-blasted surfaces. The increase of roughness as well as the presence of alumina particles on blasted surfaces increased ALP activity and ALP mRNA gene expression by osteoblasts, and so their differentiation.This research work contribute to increase our knowledge on the interactions taking place at the bio/non-bio interface between different biological components -water, proteins, cells- and materials of clinical relevance, such as rough titanium. Theintertwined effects of the different properties of the synthetic surfaces appear as a challenge to unravel the ultimate causes that determine the fate of cells on synthetic biomaterials

    Binder jetting additive manufacturing of biodegradable Zn

    Get PDF
    Biodegradable materials avoid second surgeries and long-term associated risks of conventional inert implants. Zn arose as a potential candidate for bioresorbable implants due to its proper degradation behaviour and biocompatibility [1]. However, its low melting point induces uncontrolled porosity in LPBF, promoting the future cracking of the implant. Therefore, new fabrication techniques need to be explored. In this work, binder jetting 3d printing (BJ3P) was studied for Zn powders. The samples were printed and sintered under different conditions. It is concluded that, the increase the temperature almost up to melting point leads to higher densification, at the same time, the rise of temperature provokes the formation and growth of oxidized layer on the surface of the powders

    Micropatterned 3D-printed PLLA/PLCL bioresorsable stents: degradation and influence of sterilization

    Get PDF
    Bioresorbable stents (BRS) are cylindrical scaffolds designed to provide a temporary support to the vessel wall while the structure slowly degrades until completely resorbed [1]. Current stent fabrication technology hinders local modification of the surface topography. This work presents a novel solvent-cast direct-write (SC-DW) 3D printing system to manufacture inner patterned BRS. Poly-L-lactic acid (PLLA) and poly(lactic-co-caprolactone) (PLCL) stents were obtained by cylindrical printing onto a 脴 3 mm rotating mandrel (Figure 1a) [2]. The ink consisted in a solution of high Mw PLLA or PLCL copolymer (95:5) in chloroform at 10% w/v and 12.5% w/v, respectively. Steel mandrels were modified by direct laser interference patterning with a femtosecond laser to obtain a linear micropatterning with a periodicity of 10 渭m, which was transferred onto stents' luminal surface (Figure 1b). Stents biodegradation was characterized by an accelerated degradation assay in PBS at 50oC over 4 months and characterized in terms of mass loss, SEM, DSC, mechanical tests, GPC and 1 H-NMR. PLLA and PLCL stents underwent bulk degradation, with a sustained decrease in molecular weight and an increase in crystallinity as degradation proceeded. PLCL stents degraded 1.5 times faster than PLLA stents due to higher water penetration in amorphous regions. Finally, two sterilization methods were evaluated: 纬-irradiation (8 kGy) and ethylene oxide (EtO). Whereas 纬- irradiation induced chain scission and a marked decrease in molecular weight, no structural or chemical alterations were found after EtO sterilization (Figure 1c). In conclusion, customizable PLLA and PLCL BRS were successfully fabricated through SC-DW technique, showing luminal micropatterning for enhanced endothelialization and adequate degradation timeframe for resorption

    Translation and psychometric properties of the 'Ethical Conflict in Nursing Questionnaire-Critical Care Version' in Iran

    Get PDF
    Introduction: Ethical conflict is one of ICU nurses' main problems, which rise for several reasons that must be measured. Unfortunately, there is no native instrument for measuring ethical conflicts for ICU nurses in Iran. One of the more suitable and new tools for the measurement of ethical conflict is called the "Ethical Conflict in Nursing Questionnaire: Critical Care Version (ECCNQ-CCV)." This study was aimed to translate and investigate psychometric properties of the ECCNQ-CCV in Iranian nurses. Methods: In this methodological study, after translation and cultural adaptation, face validity, content validity, and construct validity were assessed. Then, internal consistency and stability were measured for reliability. Two software programs (SPSS version 20 and AMOS) were used for data analysis. Result: Face and content validities were acceptable. Confirmatory factor analysis was not fitted. Thus, exploratory factor analysis was done, which showed five factors. However, some of the scenarios in a factor were not compatible with each other, and choosing the fit name for factors was not possible. Thus, all the scenarios were put into one factor, which has been proposed by the developer in the original version. The alpha Cronbach was 0.92 for the total scale. Conclusions: Findings show that the one factor Persian version of the ECNQ-CCV has acceptable psychometric properties. It can be used to evaluate ethical conflicts in Iranian ICU nurses

    Actitudes frente a la cultura de seguridad del paciente en el 谩mbito hospitalario y variables correlacionadas

    Get PDF
    Objetivo: Describir las actitudes frente a la cultura de la seguridad en trabajadores de un hospital y la influencia de variables sociodemogr谩ficas y profesionales. M茅todos: En una muestra de profesionales y auxiliares de enfermer铆a se administr贸 el cuestionario Hospital Survey on Patient Safety Culture. Se consider贸 como fortaleza m谩s del 75% de respuestas positivas y como oportunidad de mejora m谩s del 50% de respuestas negativas. Resultados: El 59% (n=123) calific贸 la seguridad entre 7 y 8. El 53% (n=103) no realiz贸 ninguna declaraci贸n de incidente en el 煤ltimo a帽o. Como fortaleza se identific贸 芦trabajo en equipo en la unidad/servicio禄, y como oportunidad de mejora, 芦dotaci贸n de personal禄. Se obtuvo una cultura de seguridad m谩s positiva en los servicios ambulatorios, en profesionales de enfermer铆a y en contrataci贸n a jornada parcial. Conclusiones: El estudio ha permitido medir la cultura de la seguridad, hecho que facilitar谩 su seguimiento y orientar谩 las estrategias de mejora trabajando los puntos d茅biles y reforzando los potenciales

    Aprofitem el moment de la 'postcoital'

    Get PDF
    S贸n moltes les informacions i opinions diverses que han sorgit 煤ltimament sobre l'anticoncep颅ci贸 postcoital. Els mitjans de comunicaci贸 no nom茅s han donat a con猫ixer aquest anticon颅ceptiu d'emerg猫ncia sin贸 que a m茅s, han fet ress贸 del debat que suscita aquest producte en el nostre context social actual. Per aix貌, per tractar tot el referent a la postcoital, s'ha de tenir present que aquest no 茅s un tema nou d'ara, i que s'ha d'aprofitar aquest 'boom' informatiu i medi脿tic per a reflexionar respec颅te altres aspectes de la postcoital relacionats amb la sexualitat i l'adolesc猫ncia. Aquest article d'opini贸 no vol donar m茅s informaci贸 sobre la contracepci贸, sin贸 que vol fer p煤bliques algunes reflexions al voltant de la contracepci贸 d'emerg猫ncia i remarcar el paper de la infermera com a educadora per a la salut sexual i reproductiva de la poblaci贸

    Conflict sources and management in ICU setting before and during COVID-19: a scoping review of the literature

    Full text link
    Introduction. Conflicts are an inherent part of work within any organisation. They can arise between members of an interdisciplinary team (or between teams representing different departments), between patients and team members/family members, and patients' families and team members. Various conflict situations among employees may occur, therefore it is very important to identify their causes and take preventive or targeted corrective measures. The aim of this study was to review the available literature concerning conflicts arising in ICUs驴their types, methods of expression as well as their management and mitigation. In addition, we reviewed the available literature on the impact of the pandemic on the ICU environment caring for COVID-19 patients. Methods. The databases were searched. Single key words or their combinations using AND or OR operators were entered. Eventually, 15 articles were included in our review, which included two identical papers. Results. Conflicts occurred occasionally or rarely; researchers describing ethical conflicts demonstrated a moderate level of exposure to conflicts. The pandemic created many challenges and ethical dilemmas that are a source of ethical conflict. Conclusions. As conflict by nature remains inevitable, adequate procedures in conflict management should be developed and the leadership of managing personnel should be reinforced, because team members frequently expect guidance from their supervisors. The importance of training in interpersonal communication and crisis situation management in healthcare should therefore be emphasised

    Persons with mental disorders and assisted dying practices in Spain: an overview

    Full text link
    On 25 June 2021, the Law on Euthanasia in Spain came into force, providing for two modes of helping an individual end their life: euthanasia and/or medically assisted suicide. Among the requisites that a request for euthanasia has to fulfil are that the individual must be suffering a severe, chronic and debilitating condition or a severe and incurable disease, at the same time as that person shows the necessary competence to decide. The possibility exists that a patient suffering mental health problems submits such a request; however, the specific characteristics of a mental health disorder make such a request considerably more complex. In this article, based on a narrative review of the law itself and the related literature, the requisites established under the law are analysed from an ethical-legal perspective with the aim of defining when a request for euthanasia from a person with a mental health disorder may be deemed legitimate and in line with legal provisions. This should help clinicians make rational, reasoned decisions when dealing with a request of this type
    corecore