Beyond Needles: Pioneering Pediatric Care with Virtual Reality (VR) for TIVAD Access in Oncology.

INTRODUCTION: Pediatric oncology patients use totally implantable venous access devices (TIVADs) to enable central venous access. Anxiety, pain and/or discomfort are common despite anesthesia. Virtual reality (VR) is a non-pharmacological approach that may reduce pain and anxiety in these patients. We aimed to assess the use of VR for reducing anxiety/pain in patients with TIVADs while facilitating the task of healthcare providers when accessing a TIVAD. METHODS: patients 4-18 years old with a TIVAD were prospectively randomized to an intervention group (IG) or a control group (CG). In the IG, VR goggles (Oculus Quest 2, Meta Platforms®, Menlo Park, CA, USA) were used displaying a relaxing video in the Raja Ampat environment (Ecosphere app from Phoria®) while the TIVAD was accessed. The CG was managed as per standard of care. Satisfaction and pain were measured by FPS-R and STAIC scales, respectively. RESULTS: this is the report of a prospective, randomized (60 per group)-unblinded-, single institution study of 120 pediatric oncology patients enrolled from January to April 2022. Median ages for IG and CG were 9.22 and 10.52 years, respectively. Satisfaction was higher in the IG (4.80) compared to the CG (3.92), p ≤ 0.0001. Regarding pain, mean FPS-R scores were 1.79 for the CG and 0.83 for the IG. Significantly different scores were found in the 12 to 18 years group, p ≤ 0.05. The healthcare professionals index of satisfaction was high (4.50 mean Likert score) for the IG compared to accessing the TIVAD without VR (3.73 mean Likert score). CONCLUSION: The use of VR helped reduce pain and/or discomfort in pediatric oncology patients, mainly in the older age group as they can better interact with VR. Healthcare providers were satisfied with the help of VR for TIVAD management.

Age-related oxidative stress confines damage-responsive Bmi1+ cells to perivascular regions in the murine adult heart.

Adult progenitor cells reside in specialized microenvironments which maintain their undifferentiated cell state and trigger regenerative responses following injury. Although these environments are well described in several tissues, the cellular components that comprise the cardiac environment where progenitor cells are located remain unknown. Here we use Bmi1CreERT and Bmi1GFP mice as genetic tools to trace cardiac damage-responsive cells throughout the mouse lifespan. In adolescent mice, Bmi1+ damage-responsive cells are broadly distributed throughout the myocardium. In adult mice, however, Bmi1+ cells are confined predominately in perivascular areas with low levels of reactive oxygen species (ROS) and their number decline in an age-dependent manner. In vitro co-culture experiments with endothelial cells supported a regulatory role of the endothelium in damage-responsive cell behavior. Accordingly, in vivo genetic decrease of ROS levels in adult heart disengaged Bmi1+ cells from the cardiovascular network, recapitulating an adolescent-like Bmi1 expression profile. Thus, we identify cardiac perivascular regions as low-stress microenvironments that favor the maintenance of adult damage-responsive cells.

Bmi1-Progenitor Cell Ablation Impairs the Angiogenic Response to Myocardial Infarction.

Objective- Cardiac progenitor cells reside in the heart in adulthood, although their physiological relevance remains unknown. Here, we demonstrate that after myocardial infarction, adult Bmi1+ (B lymphoma Mo-MLV insertion region 1 homolog [PCGF4]) cardiac cells are a key progenitor-like population in cardiac neovascularization during ventricular remodeling. Approach and Results- These cells, which have a strong in vivo differentiation bias, are a mixture of endothelial- and mesenchymal-related cells with in vitro spontaneous endothelial cell differentiation capacity. Genetic lineage tracing analysis showed that heart-resident Bmi1+ progenitor cells proliferate after acute myocardial infarction and differentiate to generate de novo cardiac vasculature. In a mouse model of induced myocardial infarction, genetic ablation of these cells substantially deteriorated both heart angiogenesis and the ejection fraction, resulting in an ischemic-dilated cardiac phenotype. Conclusions- These findings imply that endothelial-related Bmi1+ progenitor cells are necessary for injury-induced neovascularization in adult mouse heart and highlight these cells as a suitable therapeutic target for preventing dysfunctional left ventricular remodeling after injury.

Redox-dependent BMI1 activity drives in vivo adult cardiac progenitor cell differentiation.

Accumulation of reactive oxygen species (ROS) is associated with several cardiovascular pathologies and with cell cycle exit by neonanatal cardiomyocytes, a key limiting factor in the regenerative capacity of the adult mammalian heart. The polycomb complex component BMI1 is linked to adult progenitors and is an important partner in DNA repair and redox regulation. We found that high BMI1 expression is associated with an adult Sca1+ cardiac progenitor sub-population with low ROS levels. In homeostasis, BMI1 repressed cell fate genes, including a cardiogenic differentiation program. Oxidative damage nonetheless modified BMI1 activity in vivo by derepressing canonical target genes in favor of their antioxidant and anticlastogenic functions. This redox-mediated mechanism is not restricted to damage situations, however, and we report ROS-associated differentiation of cardiac progenitors in steady state. These findings demonstrate how redox status influences the cardiac progenitor response, and identify redox-mediated BMI1 regulation with implications in maintenance of cellular identity in vivo.

Limitación del esfuerzo terapéutico. Opinión de estudiantes universitarios de Enfermería / Limitation of therapeutic effort. Opinion by Universtity Nursing Students

OBJETIVO: conocer la opinión de los estudiantes de Enfermería sobre la limitación del esfuerzo terapéutico (LET). MÉTODO: estudio descriptivo transversal sobres 97 alumnos de 3º y 4º curso de la Escuela Universitaria de Enfermería Virgen de las Nieves de Granada, mediante el cuestionario anónimo autoadministrado, validado por Llaja Rojas et al. (15). Otras variables: profesión, sexo, estado civil, edad, años de experiencia laboral y religión. Tratamiento y análisis de los datos: análisis descriptivo de las variables y análisis bivariante mediante la prueba Ji Cuadrado. RESULTADOS: el 48,4% se declaraba católico no practicante. Para el 91,8% la decisión de mayor peso en cuanto a la LET la tiene el paciente. En cuanto a la eutanasia, un 88,9% estaba de acuerdo con legalizarla y un 92,5% la aplicaría. El 92,5% de los católicos no practicantes estaban de acuerdo con legalizar la eutanasia, frente al 100% de los no creyentes (p< 0,000). Para un 90,9% de los no creyentes, frente a un 54,5% de los católicos practicantes, no hay calidad de vida si se está conectado a un ventilador mecánico (p= 0,026). CONCLUSIONES: los estudiantes de Enfermería tienen muy en cuenta la opinión del paciente ante la LET. Mayoritariamente están a favor de legalizar la eutanasia y aplicarla, así como la antidistanasia y ortotanasia. Las creencias religiosas tienen influencia sobre algunas de las cuestiones exploradas. Una gran mayoría considera que situaciones como vivir en silla de ruedas, tener colostomía permanente, recibir quimioterapia o tener traqueostomía definitiva, pueden otorgar cierta calidad de vida, mostrando una opinión muy positiva del proceso de enfermedad

OBJECTIVE: to identify what is known about the Spanish Red Cross Nurses-Ladies. METHOD: a historical research was conducted, based on a bibliographic review. Documentary sources: virtual catalogues of libraries and document archives, electronic databases, catalogues of journals specialized in history, and other internet sources. Descriptors used: the History of Nursing, the History of the Spanish Red Cross, Red Cross nurses, Queen Victoria Eugenia of Battemberg, Carmen Angoloti Mesa, Duchess de la Victoria, and Red Cross ladies/nurses/assistants/volunteers. RESULTS: the analysis included 42 documents from studies based on primary sources, and results were presented in five sections: overall historical development, functioning and organization, care and social work, and promoting leading figures. CONCLUSIONS: though there is currently a large volume of studies on the history of Nurses-Ladies, it is necessary to go deeper through new research on some aspects, such as the work they conducted during their career

Personalidad resistente y sentido de coherencia como predictores del burnout en personal sanitario de cuidados intensivos / Hardy personality and sense of coherence as predictors of burnout in critical care staff

El objetivo del presente trabajo se ha centrado en investigar la relación del síndrome de burnout con la personalidad resistente y el sentido de coherencia, con el fin de determinar si éstas pueden ser entendidas como predictores del burnout. Se realizó un estudio descriptivo y transversal con 144 profesionales sanitarios de Cuidados Intensivos que respondieron a varios cuestionarios: Cuestionario Breve de Burnout (CBB), Cuestionario de Personalidad Resistente (CPR), y la adaptación española del Cuestionario de Orientación a la vida (OLQ-13). Se detectó un grado medio-alto de burnout entre los participantes. Se encontró una correlación negativa entre la personalidad resistente (a nivel global y sus componentes) y burnout. Apenas se encontró correlación entre el sentido de coherencia y el burnout (únicamente la dimensión de comprensibilidad), ni entre la personalidad resistente y el sentido de coherencia (salvo la dimensión de comprensibilidad y control). Los análisis de regresión jerárquica mostraron que la personalidad resistente y la comprensibilidad, componente del sentido de coherencia, modulan los efectos de los estresores laborales (antecedentes del burnout) en el síndrome de burnout. Los resultados pueden tener especial relevancia en el diseño e implementación de programas de prevención del burnout en estos profesionales (AU)

The aim of this study was to analyse the relationship between burnout syndrome and two personality variables: Hardy Personality and Sense of Coherence, in order to determine whether these variables can be considered significant predictors of burnout. A descriptive and cross-sectional study was carried out with a sample of 144 Intensive Care professionals who responded to several questionnaires: the Brief Burnout Questionnaire (CBB), Resistant Personality Questionnaire (CPR) and the Spanish version of the Orientation to Life Questionnaire (OLQ-13). A higher than average level of burnout was detected in the population. There was a negative correlation between hardiness (globally and through its components) and burnout. No correlation was found between sense of coherence (except in the comprehensibility and control dimensions). Hierarchical regression analyses showed that hardiness and comprehensibility (a sense of coherence component) modulate the effects of occupational stress (a burnout antecedent) on burnout syndrome. These results may be especially relevant when designing and implementing burnout prevention programmes (AU)