Strategies for knowledge mobilization by advanced practice nurses in three hospitals in Spain: a qualitative study.

BACKGROUND: Evidence-based practice, in conjunction with optimum care quality, improves patients' clinical outcomes. However, its implementation in daily clinical practice continues to present difficulties. The aim of this study was to identify the strategies applied by Advanced Practice Nurses (APNs) to foster adherence to clinical practice guideline recommendations. METHODS: An exploratory qualitative study was conducted with six focus groups at three public hospitals belonging to the Balearic Islands Health Care Service (Spain). The study participants were 32 ward nurses and 5 advanced practice nurses working routinely with inpatients at these hospitals. The study was conducted from November 2020 to January 2021, using thematic analysis, based on the COREQ checklist. RESULTS: Four major themes related to the facilitation process were identified either by RNs and APNs: the context of the project, APN contribution to nursing team management, healthcare provision on the ward, and the acquisition and application of knowledge. CONCLUSIONS: The APNs adapted their actions to the characteristics and needs of the local context, employing strategies aimed at improving teamwork, healthcare, and knowledge management. Each of these contributions enhanced the sustainability of the changes made.

Virtual reality and critical care education in nursing: A cross-sectional study.

BACKGROUND: The nursing care of a critically ill patient in the intensive care unit requires specific training. Virtual reality can facilitate the nursing assessment of critically ill patients. OBJECTIVE: To evaluate the utility of virtual reality as a tool for teaching nursing assessment of critically ill patients. DESIGN: This is a cross-sectional study. SETTING: University of the Balearic Islands (Spain) during the 2022 academic year. PARTICIPANTS: Third-year nursing students. METHODS: A specific environment was designed for virtual reality immersion using a BNEXT head-mounted display. Data were collected using three questionnaires: perception of self-efficacy regarding skill-acquisition in the nursing care process; immersivity; utility and tool satisfaction. RESULTS: A total of 111 undergraduated nursing students responded, 86.8 % of whom had no previous intensive care units experience. They rated the virtual reality experience positively for learning the nursing care process, emphasising the need for skin and mucosal hygiene, patient mobilisation and family care, as well as an understanding of the therapeutic technology required. A total of 67.6 % felt as though they were physically present. They reported a high degree of acceptance and satisfaction. CONCLUSIONS: Virtual reality has facilitated the exposure of students to an unfamiliar environment such as the intensive care units, proving to be useful, satisfying, and motivating in teaching the nursing care process.

[Cognition in medical residents with and without anxiety in a specialist training hospital]. / Cognición en médicos residentes con y sin ansiedad en un hospital formador de especialistas.

Background: The resident doctor plays an important role in people's health care. Objective: To compare the cognition of medical residents with/without anxiety in a specialist training hospital. Material and methods: Comparative, prospective, cross-sectional study. Medical residents of any grade and specialty were included, who signed informed consent. Those with a diagnosis of cognitive impairment were excluded, and who did not complete the tests were eliminated. AMAS-A test was applied to assess anxiety and NEUROPSI: Attention and memory test for cognitive characteristics. Mann-Whitney's U and Spearman's rho were used, p≤0.05 was considered significant. Results: 155 residents were evaluated, 55.5% men, mean age 32.4 years. Internal Medicine was the predominant specialty (25.2%). AMAS-A identified 94.19% residents with anxiety. NEUROPSI reported Attention and memory domain (38.7%) in normal classification, Memory (34.2%) in high normal, and Attention and executive functions (32.3%) in severe alteration as predominant assessments. Only Memory showed a significant difference between residents with and without anxiety (p=0.015). Attention and executive functions-Physiological anxiety (r=-0.21, p=0.009) and Attention and memory-Social concern (r=-0.268, p=0.001) correlations were significant. Conclusions: The percentage of anxiety and cognitive alterations in residents physicians is high. Anxiety decisively affects memory capacity in these medical doctors.

Introducción: el médico residente desempeña un papel importante en la atención a la salud de los pacientes. Objetivo: comparar la cognición de médicos residentes con y sin ansiedad en un hospital formador de especialistas. Material y métodos: estudio comparativo, prospectivo, transversal, en médicos residentes de cualquier grado y especialidad, que firmaron consentimiento informado. Se excluyeron aquellos con diagnóstico de alteración cognitiva y se eliminaron los que no completaron las pruebas realizadas. Se aplicaron AMAS-A para evaluar ansiedad y NEUROPSI: Atención y memoria para características cognitivas. Se utilizaron U de Mann-Whitney, y rho de Spearman. Se consideró significativa una p ≤ 0.05. Resultados: se evaluaron 155 residentes, 55.5% hombres, edad media 32.4 años. Medicina Interna fue la especialidad predominante (25.2%). Se identificó ansiedad en el 94.19% de los residentes. Predominaron los dominios Atención y memoria en clasificación normal (38.7%), Memoria en normal-alto (34.2%) y Atención y funciones ejecutivas en alteración severa (32.3%). Memoria mostró diferencia significativa entre residentes con y sin ansiedad (p = 0.015). Las correlaciones de Atención y funciones ejecutivas-Ansiedad fisiológica (r = -0.21, p = 0.009) y Atención y memoria-Preocupación social (r = -0.268, p = 0.001) resultaron significativas. Conclusiones: el porcentaje de ansiedad y alteraciones cognitivas en residentes es alto. La ansiedad afecta decisivamente la capacidad de memoria en estos médicos.

[Frequency of clinical characteristics and factors associated with mortality in patients hospitalized for COVID-19 in Puebla, Mexico]. / Frecuencia de características clínicas y factores asociados con mortalidad en pacientes hospitalizados por COVID-19 en Puebla, México.

BACKGROUND: Mexico has a very high mortality rate from COVID19, risk factors, clinical manifestations of our population are unknown. OBJECTIVE: To know risk factors for mortality from COVID19 in hospitalized patients of the Secretary of Health (SSA) Puebla, and clinical characteristics. MATERIAL AND METHODS: Case-control, observational, retrospective, cross-sectional study in COVID-19 patients. 2 groups: COVID-19 patients who died and those who did not die. RESULTS: 502  patients,  314  men  (62.5%  CI95%  58-66%),  188  women  (37.5%  CI95%  33-42%),  mean  age  54.14  +13.8,  interquartile  range  (IQR)  45-63, age interval 19 and 90 years, hospital stay (DEIH) 1-43 days, mean 9.8+7.8 days, median 8, IQR 4-13 days. Symptoms associated with mortality: dyspnea, chest pain, MR>1. Variables associated with mortality: age = or > 65 years, greater IHD, having > 2 comorbidities (OR 1.453), diabetes (OR 1.759), hypertension (OR 6.29) and chronic kidney failure (CRF) (OR 3.16) , (p<0.05). Ferritin >500ng/ml (OR 5.1799), DHL >400 IU/L (OR 3.313) and D-dimer >2000 m/ml (OR 2.868). CONCLUSIONS: Age > or = 65 years, greater IHD, > 2 comorbidities, diabetes, hypertension or CRF, increased ferritin, D-dimer or DHL, are risk factors for mortality from COVID-19.

OBJECTIVO: Identificar los factores de riesgo y las manifestaciones clínicas asociadas con mortalidad por COVID-19 en pacientes internados en hospitales de la Secretaria de Salud (SSA) del estado de Puebla, México. MATERIAL Y MÉTODOS: Estudio observacional, retrospectivo y transversal, llevado a cabo en pacientes con COVID-19, internados en hospitales de la Secretaria de Salud (SSA) del estado de Puebla, México. Los pacientes se dividieron en dos grupos: 1) fallecidos por COVID-19 y 2) supervivientes de COVID-19. RESULTADOS: Se registraron 502 pacientes: 314 hombres (62.5 % IC95% 58-66 %) y 188 mujeres (37.5% IC95% 33-42%), con edad promedio de 54.14 ± 13.8 años (rango intercuartil de 45-63, intervalo de edad de 19 y 90 años); estancia hospitalaria de 1 a 43 días (media 9.8 ± 7.8 días, me-diana 8, rango intercuartil 4-13 días). Los síntomas asociados con mortalidad por COVID-19 fueron: disnea y dolor torácico (RM >1). Las variables asociadas con mortalidad: edad igual o mayor de 65 años, estancia hospitalaria prolongada, coexistencia de dos o más comorbilidades (RM: 1.453), diabetes (RM: 1.759), hipertensión (RM: 6.29) e insuficiencia renal crónica (RM: 3.16; p<0.05); ferritina >500 ng/mL (RM: 5.1799), DHL >400 IU/L (RM: 3.313) y Dimero D >2000 m/ml (RM: 2.868). CONCLUSIONES: Este estudio demuestra que los principales factores de riesgo asociados con mortalidad por COVID-19 son: edad igual o mayor de 65 años, estancia hospitalaria prolongada, coexistencia de dos o más enfermedades, diabetes, hipertensión e insuficiencia renal crónica; además de concentraciones elevadas de ferritina, Dimero D y DHL.

Platelet Reactivity and Inflammatory Phenotype Induced by Full-Length Spike SARS-CoV-2 Protein and Its RBD Domain.

A state of immunothrombosis has been reported in COVID-19. Platelets actively participate in this process. However, little is known about the ability of SARS-CoV-2 virus proteins to induce platelet activity. Platelet-rich plasma (PRP) was incubated with spike full-length protein and the RBD domain in independent assays. We evaluated platelet activation through the expression of P-selectin and activation of glicoprotein IIbIIIa (GP IIbIIIa), determined by flow cytometry and the ability of the proteins to induce platelet aggregation. We determined concentrations of immunothrombotic biomarkers in PRP supernatant treated with the proteins. We determined that the spike full-length proteins and the RBD domain induced an increase in P-selectin expression and GP IIbIIIa activation (p < 0.0001). We observed that the proteins did not induce platelet aggregation, but favored a pro-aggregating state that, in response to minimal doses of collagen, could re-establish the process (p < 0.0001). On the other hand, the viral proteins stimulated the release of interleukin 6, interleukin 8, P-selectin and the soluble fraction of CD40 ligand (sCD40L), molecules that favor an inflammatory state p < 0.05. These results indicate that the spike full-length protein and its RBD domain can induce platelet activation favoring an inflammatory phenotype that might contribute to the development of an immunothrombotic state.

Impact of advanced practice nurses in hospital units on compliance with clinical practice guidelines: a quasi-experimental study.

BACKGROUND: Incorporating the best available evidence into clinical practice is a determining challenge for healthcare professionals and organisations. The role of advanced practice nurses is viewed as a facilitator to adapt guideline recommendations to suit specific contexts and to overcome barriers to implementation. In this study, we evaluate the impact of advanced practice nurses on clinical indicators of hospitalised patients and on adherence to recommendations derived from two clinical practice guidelines (pressure ulcer prevention and treatment and vascular access device management). METHODS: Quasi-experimental study in five intervention (IU) and five control (CU) hospital units at three hospitals in Spain (period 2018-19). Five advanced practice nurses were incorporated into IU, with the intention that would produce attitudinal changes and enhance the skills and knowledge of the nursing team regarding 18 clinical practice recommendations. In this study, 41 indicators were evaluated through direct observation of all patients admitted, at monthly intervals for 1 year. Outcomes were assessed by means of a descriptive, multi-line regression and association analysis. RESULTS: The study population was composed of 3742 inpatients admitted for pressure ulcer assessment and 2631 fitted with vascular access devices. By the end of the study period, all variables had improved in the IU, where average compliance with recommendations was statistically significantly higher (pressure ulcer guidance 7.9 ± 1.9 vs 6.0 ± 1.7. OR 1.86, 95% CI 1.67-2.05; vascular access devices guidance 5.4 ± 1.4 vs 4.4 ± 1,6. OR 1.06, 95% CI 0.95-1.17). The prevalence of pressure lesions and catheter-related adverse events decreased statistically significantly in the IU compared to the CU. The prevalence of pressure ulcers decreases (5.7% in IU vs 8.7% in CU p < 0.005) as well as the prevalence of adverse events related to the catheter (14% In IU vs 21.6% in CU p < 0.005). The unnecessary catheters decressed in IU 10.9% VS CU 15.8% (p < 0.005). CONCLUSIONS: The incorporation of an advanced practice nurse statistically significantly improves clinical indicators related to the prevention and treatment of pressure ulcers and to the management of vascular access devices. TRIAL REGISTRATION: ISRCTN18259923 retrospectively registered on 11/02/2022.

Efficacy of the Mechanistic Score and COVID-19 Mortality Risk scales to assess the risk of mortality in patients hospitalized for COVID-19.

INTRODUCTION: Chronic diseases are associated with a higher risk of mortality from COVID-19. OBJECTIVE: To compare the efficacy of the Mechanistic Score and COVID-19 Mortality Risk scales for assessing the risk of mortality in patients hospitalized for COVID-19. METHODS: Comparative, observational, retrospective study. The mortality rate of COVID-19-positive patients was assessed by comparing both scales, according to information obtained from the records of patients hospitalized for COVID-19 in a specialty hospital. RESULTS: Two-hundred and twenty-one patients were evaluated, out of whom 61% were men and 39% were women; 89% had comorbidity: obesity (88%), hypertension (40%), diabetes mellitus (31%) and cancer (6%). At discharge, 65% survived. The COVID-19 Mortality Risk scale showed a sensitivity of 79% and specificity of 88% for predicting mortality risk. In patients with low risk, the Mechanistic Score showed a sensitivity and specificity of 24 and 97%, respectively; in cases with mild risk, 44 and 97%; with moderate risk, 57 and 77%; with high risk, 95 and 91%; and with remarkably high risk, 100 and 100%. CONCLUSION: The COVID-19 Mortality Risk scale has higher efficacy than the Mechanistic Score for assessing mortality risk in patients with COVID-19.

INTRODUCCIÓN: Las enfermedades crónicas se asocian a riesgo mayor de mortalidad por COVID-19. OBJETIVO: Comparar la eficacia de las escalas Mechanistic Score y COVID-19 Mortality Risk para evaluar el riesgo de mortalidad en pacientes hospitalizados por COVID-19. MÉTODOS: Estudio comparativo, observacional, retrospectivo. Se valoró la tasa de mortalidad de los pacientes positivos a COVID-19, mediante la comparación de las dos escalas, de acuerdo con información de los expedientes de pacientes hospitalizados por COVID-19 en un hospital de especialidades. RESULTADOS: Se evaluaron 221 pacientes, 61 % hombres y 39 % mujeres; 89 % presentó alguna comorbilidad: obesidad (88 %), hipertensión (40 %), diabetes mellitus (31 %) y cáncer (6 %). Al egreso, 65 % sobrevivió. La escala COVID-19 Mortality Risk presentó sensibilidad de 79 % y especificidad de 88 % para predecir riesgo de mortalidad. Respecto al riesgo bajo, Mechanistic Score presentó sensibilidad y especificidad de 24 y 97 %, respectivamente; 44 y 97 % respecto al riesgo leve, 57 y 77 % en el riesgo moderado, 95 y 91 % en el riesgo alto y 100 y 100 % en el riesgo muy alto. CONCLUSIÓN: La escala COVID-19 Mortality Risk presenta eficacia mayor que Mechanistic Score para evaluar el riesgo de mortalidad en pacientes con COVID-19.

Xanthogranulomatous appendicitis; a diagnostic challenge: Clinical Case / Apendicitis xantogranulomatosa; un desafío diagnóstico: Caso Clínico

Introduction: Xanthogranulomatous inflammation is a chronic inflammatory process, rarely located in the appendix. A case of xanthogranulomatous appendicitis is presented. Clinical case. A 77-year-old male presents with intermittent pain in the right hemiabdomen and hyperthermia of one month's evolution. Physical examination showed a tumor in the iliac fossa and right abdomen. He underwent surgery for a probable incarcerated right inguinal hernia, acute perforated appendicitis was found, with inflammation and adhesions, purulent fluid in the right hemiabdomen and abdominal wall dissection. The histopathological result was xanthogranulomatous appendicitis. The evolution of the patient was favorable. Conclusion. Xanthogranulomatous appendicitis simulates a typical picture of acute appendicitis. Histopathologically, pathologies such as Crohn's disease, malacoplakia and tuberculous appendicitis were ruled out.

Introducción. La inflamación xantogranulomatosa es un proceso inflamatorio crónico, rara vez se localiza en apéndice. Se presenta un caso de apendicitis xantogranulomatosa. Caso clínico. Masculino de 77 años, presenta con dolor intermitente en hemiabdomen derecho e hipertermia de un mes de evolución. La exploración física mostró tumoración en fosa iliaca y abdomen derecho. Se sometió a cirugía por probable hernia inguinal derecha incarcerada, se encontró apendicitis aguda perforada, con inflamación y adherencias, líquido purulento en hemiabdomen derecho y disección en pared abdominal. El resultado histopatológico fue apendicitis xantogranulomatosa.  La evolución del paciente fue favorable. Conclusión. La apendicitis xantogranulomatosa simula un cuadro típico de apendicitis aguda. Histopatológicamente se descartan patologías como enfermedad de Crohn, malacoplaquia y apendicitis tuberculosa.

Analysis of the Direct Cost of Medical and Surgical Care for Testicular Cancer in Early and Advanced Stages in a Third Level Medical Facility of the Mexican Social Security Institute.

BACKGROUND: The testicular cancer prevails in the third decade of life, the care cost increases with higher staging of the disease. OBJECTIVE: Compare the direct costs of medical and surgical attention for testicular cancer in early and advanced stages in a Third Level Medical Facility. MATERIAL AND METHODS: Process study, direct costs of medical attention are evaluated. Number of laboratory studies, imaging studies, and medical and surgical treatment were analyzed. The patients were divided into 2 groups: group 1 early stages and group 2 advanced stages. Mann Whitney U test was used for the difference between groups. RESULTS: There were 10 patients in each group, Group 1: 8 (80%) seminomas and 2 (20%) non-seminoma, Group 2: 4 (40%) seminomas and 6 (60%) non-seminomas. The average cost of care in Group 2 is higher than in Group 1, $288,827.90 and $145,911.70 Mexican pesos respectively (p=0.00578). CONCLUSIONS: The direct cost of medical attention is higher in the advanced stages compared to the early stages.

Eficacia de las escalas Mechanistic-Score y COVID-19 Mortality Risk para evaluar el riesgo de mortalidad en pacientes hospitalizados por COVID-19 / Efficacy of the Mechanistic Score and COVID-19 Mortality Risk scales to assess the risk of mortality in patients hospitalized for COVID-19

Resumen Introducción: Las enfermedades crónicas se asocian a riesgo mayor de mortalidad por COVID-19. Objetivo: Comparar la eficacia de las escalas Mechanistic Score y COVID-19 Mortality Risk para evaluar el riesgo de mortalidad en pacientes hospitalizados por COVID-19. Métodos: Estudio comparativo, observacional, retrospectivo. Se valoró la tasa de mortalidad de los pacientes positivos a COVID-19, mediante la comparación de las dos escalas, de acuerdo con información de los expedientes de pacientes hospitalizados por COVID-19 en un hospital de especialidades. Resultados: Se evaluaron 221 pacientes, 61 % hombres y 39 % mujeres; 89 % presentó alguna comorbilidad: obesidad (88 %), hipertensión (40 %), diabetes mellitus (31 %) y cáncer (6 %). Al egreso, 65 % sobrevivió. La escala COVID-19 Mortality Risk presentó sensibilidad de 79 % y especificidad de 88 % para predecir riesgo de mortalidad. Respecto al riesgo bajo, Mechanistic Score presentó sensibilidad y especificidad de 24 y 97 %, respectivamente; 44 y 97 % respecto al riesgo leve, 57 y 77 % en el riesgo moderado, 95 y 91 % en el riesgo alto y 100 y 100 % en el riesgo muy alto. Conclusión: La escala COVID-19 Mortality Risk presenta eficacia mayor que Mechanistic Score para evaluar el riesgo de mortalidad en pacientes con COVID-19.

Abstract Introduction: Chronic diseases are associated with a higher risk of mortality from COVID-19. Objective: To compare the efficacy of the Mechanistic Score and COVID-19 Mortality Risk scales for assessing the risk of mortality in patients hospitalized for COVID-19. Methods: Comparative, observational, retrospective study. The mortality rate of COVID-19-positive patients was assessed by comparing both scales, according to information obtained from the records of patients hospitalized for COVID-19 in a specialty hospital. Results: Two-hundred and twenty-one patients were evaluated, out of whom 61% were men and 39% were women; 89% had comorbidity: obesity (88%), hypertension (40%), diabetes mellitus (31%) and cancer (6%). At discharge, 65% survived. The COVID-19 Mortality Risk scale showed a sensitivity of 79% and specificity of 88% for predicting mortality risk. In patients with low risk, the Mechanistic Score showed a sensitivity and specificity of 24 and 97%, respectively; in cases with mild risk, 44 and 97%; with moderate risk, 57 and 77%; with high risk, 95 and 91%; and with remarkably high risk, 100 and 100%. Conclusion: The COVID-19 Mortality Risk scale has higher efficacy than the Mechanistic Score for assessing mortality risk in patients with COVID-19.

Use of simulation to improve nursing students' medication administration competence: a mixed-method study.

BACKGROUND: Medication administration errors are among the most important adverse events in healthcare systems. To minimise the risk of this occurring, nursing training programmes should emphasise the overriding priority of patient safety. In this respect, simulation can be a valuable resource in teaching procedures, for patient safety in general and safe medication administration in particular. In this study, we evaluate the use of a simulation-based activity for students to acquire skills in safe medication administration, and consider the students' perceptions of this activity. METHODS: Second-year nursing students enrolled in the subject of pharmacology at a Spanish university during the academic year 2018-2019 were invited to participate in this mixed-method study. Their acquisition of professional competencies via a simulation exercise was evaluated according to the 'six rights'. Before the simulation, each student completed a researcher-developed online questionnaire. The simulation was evaluated by the students' tutor, using a checklist. A descriptive analysis was made of the data obtained from the questionnaire and during the simulation. At the end of the semester, the students' opinions were recorded in the questionnaire, in response to an open question. A content analysis was made of the responses to the open question. RESULTS: The simulation exercise was performed by 179 students, of whom 73 had previously completed the questionnaire. Analysis showed that, in comparison with the pre-simulation questionnaire results, compliance with the six rights improved in all dimensions except data documentation: right patient (from 64.4% to 83.3%); right medication (from 60.3% to 95.8%); right dose (from 60.3% to 100%); right route (from 54.8% to 95.8%); right time (from 24.7% to 70.8%); the right documentation result fell from 54.8% to 45.8%. The students expressed their satisfaction with the simulation method, affirming that it brought them closer to the reality of health care. CONCLUSIONS: Simulation is a useful tool for the acquisition of skills in medication administration. The students were satisfied with the simulation capacity to bridge the gap between theory and practice. Moreover, simulation represents an added teaching resource in the nursing degree curriculum and is expected to enhance patient safety.

Respuesta a Temozolomida en pacientes con melanoma metastásico en un hospital de tercer nivel de atención / Response to Temozolomide in patients with metastatic melanoma in a third level medical facility

Introducción: El melanoma es un problema de salud pública, representa 4% de los tumores malignos de la piel y es responsable de 80% de las muertes por este tipo de neoplasias. Objetivo: presentar la respuesta a Temozolomida en pacientes con melanoma metastásico. Métodos: Estudio descriptivo, transversal. Se analizó la respuesta clínica de pacientes con melanoma metastásico, manejados con Temozolomida 200 mg/m2 una vez al día, durante 5 días cada 28 días. Los factores de riesgo analizados fueron: variedad histológica, región topográfica de lesión primaria, metástasis, ulceración y Breslow. Se utilizó estadística descriptiva, para normalidad Kolmogorov-Smirnoff, t de Student, así como regresión logística binaria. Resultados: Fueron 51 expedientes, 47 cumplieron con los criterios; 25 hombres, 22 mujeres, edad media 54.45, mínima 22, máxima 85 años, Se obtuvo una respuesta completa en 3(6.3%), respuesta parcial 7(14.8%), enfermedad estable en 10(21%) y progresión de la enfermedad en 27(57.44%) pacientes. La presencia de ulceración se asocia a mayor índice de Breslow, y como resultado, mayor riesgo de progresión de la enfermedad. Conclusiones: Temozolomida como monoterapia es un tratamiento que presenta bajas tasas de respuesta completa y respuesta parcial, mostrando mejores resultados en pacientes con metástasis ganglionares.

Introduction.Melanoma is a public health problem; it represents 4% of malignant skin tumors and is responsible for 80% of deaths from this type of neoplasm. Objective: Show the response to Temozolomide in patients with metastatic melanoma. Methods: Descriptive, cross-sectional study. The clinical response of patients with metastatic melanoma, managed with Temozolomide 200 mg/m2 once a day was analyzed for 5 days every 28 days. The risk factors analyzed were: histological variety, topographic region of the primary lesion, metastasis, ulceration, and Breslow. Descriptive statistics were used for normality Kolmogorov-Smirnoff, Student's t-test, and binary logistic regression. Results: There were 51 les, 47 met the criteria; 25 men, 22 women, mean age 54.45, minimum 22, maximum 85 years, Complete response was obtained in 3 (6.3%), partial response in 7 (14.8%), stable disease in 10 (21%) and disease progression in 27 (57.44%) patients. The presence of ulceration is associated with a higher Breslow index and, as a result, a higher risk of disease progression. Conclusions: Temozolomide as monotherapy is a treatment that presents low rates of complete response and partial response, showing better results in patients with lymph node metastases.

Students and teachers' satisfaction and perspectives on high-fidelity simulation for learning fundamental nursing procedures: A mixed-method study.

BACKGROUND: High-fidelity clinical simulation enables skills to be acquired safely and securely by bridging the gap between theory and clinical practice. This method has traditionally been used to address complex clinical scenarios. Students often report high levels of satisfaction and self-confidence, as this method allows them to put techniques and procedures into practice in a safe environment. Most studies assess simulation solely from the students' perspective, disregarding the opinions of teaching staff. OBJECTIVES: To assess the implementation of high-fidelity simulation as a teaching tool for fundamental nursing procedures from the perspectives of students and teachers. DESIGN: A two-phase mixed-methods study. SETTING: A simulation centre environment at the University of the Balearic Islands (Spain) during the 2018 academic year. PARTICIPANTS: Second-year nursing students and staff teaching practical classes on basic patient assessment and monitoring of vital signs. METHODS: Satisfaction with clinical experience simulation scale, including an open-ended question for students, was used. A focus group session was also held with teachers. RESULTS: A total of 91 students completed the scale, yielding an overall satisfaction score of 9.3 out of 10. The practical dimension attained the highest scores. Motivation to attend class was the lowest-rated aspect of this dimension, although students' expectations and satisfaction increased during the class. In the open-ended question and the debriefing session, students described the simulation as a playful learning method allowing them to put their theoretical knowledge into practice and helping them to manage their fears before coming into contact with real care settings. In the focus group session, teachers analysed their own experiences and described how they perceived students' satisfaction and practical skills. CONCLUSIONS: High-fidelity simulation produces good academic outcomes and is highly satisfying for students and teachers.

Platelet activation and aggregation response to dengue virus nonstructural protein 1 and domains.

BACKGROUND: Platelets are now recognized as immunological sentries in the first line of defense that participate in the detection and response to pathogens. This frequently results in a decrease in the number of circulating platelets. Different mechanisms have been hypothesized to explain the thrombocytopenia in patients with severe dengue, one of them is the participation of the non-structural protein 1 (NS1) of dengue virus (DENV), which can be secreted into circulation during DENV infection and promotes a more efficient infection. OBJECTIVE: The present study aimed to investigate the ability of platelet response to stimulation with full-length DENV NS1 protein and its domains. METHODS: DENV NS1 plasmid was transfected into HEK-293T. Proteins were purified by Niquel Sepharose affinity chromatography. Secreted proteins were assessed by sodium dodecylsulfate polyacrylamide gel electrophoresis, Coomassie staining and western blot. Platelet-rich plasma was directly incubated with DENV NS1 proteins. Platelet activation was confirmed by expression of αIIbßIII and P-selectin by flow cytometry. Platelet aggregation was also assessed using DENV NS1 protein and its individual domains as agonists. RESULTS: DENV NS1 protein and its domains induce P-selectin and αIIbß3 complex expression on platelet surfaces. DENV NS1 induce a stable platelet aggregation after the addition of a minimal dose of adenosine diphosphate (ADP), epinephrine (EPI), or collagen. Interestingly, only EPI could induce the formation of platelet aggregates after incubation with the protein domains of NS1. CONCLUSION: Our results suggest that the full DENV NS1 protein and also its domains promote platelet recognition, activation, and aggregation.

Inflammatory and Prothrombotic Biomarkers Associated With the Severity of COVID-19 Infection.

Among COVID-19 hospitalized patients, high incidence of alterations in inflammatory and coagulation biomarkers correlates with a poor prognosis. Comorbidities such as chronic degenerative diseases are frequently associated with complications in COVID-19 patients. The aim of this study was to evaluate inflammatory and procoagulant biomarkers in COVID-19 patients from a public hospital in Mexico. Blood was sampled within the first 48 h after admission in 119 confirmed COVID-19 patients that were classified in 3 groups according to oxygen demand, evolution and the severity of the disease as follows: 1) Non severe: nasal cannula or oxygen mask; 2) Severe: high flow nasal cannula and 3) Death: mechanical ventilation eventually leading to fatal outcome. Blood samples from 20 healthy donors were included as a Control Group. Analysis of inflammatory and coagulation biomarkers including D-dimer, interleukin 6, interleukin 8, PAI-1, P-selectin and VWF was performed in plasma. Routine laboratory and clinical biomarkers were also included and compared among groups. Concentrations of D-dimer (14.5 ± 13.8 µg/ml) and PAI-1 (1223 ± 889.6 ng/ml) were significantly elevated in severe COVID-19 patients (P < 0.0001). A significant difference was found in interleukin-6, PAI-1 and P-selectin in non-severe and healthy donors when compared to Severe COVID-19 and deceased patients (P < 0.001). VWF levels were also significantly different between severe patients (153.5 ± 24.3 UI/dl) and non-severe ones (133.9 ± 20.2 UI/dl) (P < 0.0001). WBC and glucose levels were also significantly elevated in patients with Severe COVID-19. Plasma concentrations of all prothrombotic biomarkers were significantly higher in patients with a fatal outcome.

Perfil social y económico de los pacientes diagnosticados con trastornos del humor del Hospital Departamental Psiquiátrico Universitario del Valle, Cali / Social and economic profile of patients diagnosed with Mood disorders at the hospital Departamental psiquiátrico Universitario del Valle-Cali"

El objetivo de este artículo consiste en dar a conocer un perfil social, económico y demográfico de la población registrada con SISBÉN en el Hospital Departamental Psiquiátrico Universitario del Valle (HDPUV) entre el 2009 y el 2018, cuyo diagnóstico se encuentra dentro del grupo de los trastornos del humor (correspondiente al espectro de códigos del CIE-10 que va desde F30 a F39, episodio maníaco, trastorno bipolar, episodio depresivo, trastorno depresivo recurrente, trastorno del humor persistente, otros trastornos del humor, trastorno del humor sin especificación). Se optó por un trabajo en el que se complementó la información entre las bases de datos del SISBÉN de Cali y la del HDPUV para profundizar en datos sobre pobreza y vulnerabilidad de las personas que son potenciales beneficiarios de programas sociales estatales. Se identificaron 5.280 pacientes diagnosticados con trastornos del humor, en su mayoría mujeres (70,4 %) en condiciones de vulnerabilidad económicas, sociales y de acceso a servicios de salud, que representan otro factor más de riesgo para su salud mental.

The aim of this article is to provide a social, economic and demographic profile of the population registered with SISBÉN at the Hospital Departamental Psiquiátrico Universitario del Valle (HDPUV) between 2009 and 2018, whose diagnosis is within the group of mood disorders, (corresponding to the spectrum of ICD- 10 codes ranging from F30 to F39, manic episode, bipolar disorder, depressive episode, recurrent depressive disorder, persistent mood disorder, other mood disorders, mood disorder without specification). We opted for a study in which we complemented the information between the Cali SISBÉN and HDPUV databases to deepen in data on poverty and vulnerability of people who are potential beneficiaries of state social programs. We identified 5,280 patients diagnosed with mood disorders, mostly women (70.4%) in conditions of economic, social and access to health services vulnerability, which represent yet another risk factor for their mental health.

Anise Essential Oil as a Sustainable Substrate in the Multicomponent Double Povarov Reaction for Julolidine Synthesis.

The use of star anise oil from a natural source as a dienophile in the multicomponent double Povarov reaction (MCPRs) to produce highly substituted julolidines with diverse technological applications is described. Within the framework of green chemistry, these MCPRs have many advantages such as (i) use of water in the reaction, (ii) creation of up to six bonds in one sequence, (iii) water as a sole waste, (iv) 100% of carbon economy, (v) a metal-free process, and (vi) nontoxic and reusable organocatalysts. These advantages, along with a simple workup procedure, make this protocol greener for the synthesis of julolidines.

Moving Evidence into Practice by Advanced Practice Nurses in Hospitalization Wards. Protocol for a Multicentre Quasi-Experimental Study in Three Hospitals in Spain.

Evidence-based practice (EBP) combined with quality of care improves patient outcomes. However, there are still difficulties for its implementation in daily clinical practice. This project aims to evaluate the impact of the incorporation of the Advanced Practice Nurse (APN) role on the implementation of EBP at three levels: context, nurses' perceptions, and clinical outcomes. Mixed-methods study in two phases is proposed. Phase 1: a quasi-experimental design where five APNs are included in five hospitalization wards that are compared with another five similar wards without APNs. Variables from Practice-Environment-Scale-Nursing-Work-Index, Health-Science-Evidence-Based-Practice-Questionnaire, and Advanced-Practice-Nursing-Competency-Assessment-Instrument are used. Clinical outcomes are followed-up with monthly. A descriptive and exploratory analysis is performed. Phase 2: an exploratory qualitative design through focus groups at the intervention wards after one year of APNs implementation. Explicative data are gathered to explain the progression of change and how actors perceive and attribute triggers, barriers, and facilitators for change. An inductive thematic analysis is performed. The inclusion of APN in hospitalization context is insufficiently studied. It is hoped that these figures provide solutions to the multiple barriers in the development of EBP in these sceneries and contribute to resolve the gap between research results and healthcare practice.