Dynamic Culture of Mesenchymal Stromal/Stem Cell Spheroids and Secretion of Paracrine Factors.

In recent years, conditioned medium (CM) obtained from the culture of mesenchymal stromal/stem cells (MSCs) has been shown to effectively promote tissue repair and modulate the immune response in vitro and in different animal models, with potential for application in regenerative medicine. Using CM offers multiple advantages over the implantation of MSCs themselves: 1) simpler storage, transport, and preservation requirements, 2) avoidance of the inherent risks of cell transplantation, and 3) potential application as a ready-to-go biologic product. For these reasons, a large amount of MSCs research has focused on the characterization of the obtained CM, including soluble trophic factors and vesicles, preconditioning strategies for enhancing paracrine secretion, such as hypoxia, a three-dimensional (3D) environment, and biochemical stimuli, and potential clinical applications. In vitro preconditioning strategies can increase the viability, proliferation, and paracrine properties of MSCs and therefore improve the therapeutic potential of the cells and their derived products. Specifically, dynamic cultivation conditions, such as fluid flow and 3D aggregate culture, substantially impact cellular behaviour. Increased levels of growth factors and cytokines were observed in 3D cultures of MSC grown on orbital or rotatory shaking platforms, in stirred systems, such as spinner flasks or stirred tank reactors, and in microgravity bioreactors. However, only a few studies have established dynamic culture conditions and protocols for 3D aggregate cultivation of MSCs as a scalable and reproducible strategy for CM production. This review summarizes significant advances into the upstream processing, mainly the dynamic generation and cultivation of MSC aggregates, for de CM manufacture and focuses on the standardization of the soluble factor production.

Alzheimer's Disease, Mild Cognitive Impairment and Mediterranean Diet. A Systematic Review and Dose-Response Meta-Analysis.

Alzheimer's Disease (AD) is a pathology with increasing prevalence in the context of a more long-lived society and it is the first cause of dementia in western countries. It is important to investigate factors that can be protective and may influence its development, in order to act on them trying to reduce AD incidence and its progression. The aim of this study was to conduct a systematic review and meta-analysis to determine the effects of a higher adherence to Mediterranean diet (MD) on Mild Cognitive Impairment (MCI) and AD. A literature search in PubMed, The Cochrane Library Plus and Scopus was conducted, selecting articles that analyzed associations between MD adherence and AD biomarkers (Volumetry assessed by MRI and betamiloide and Tau deposits by PET); cognitive performance in patients at risk or presenting MCI and AD; and incidence or progression from MCI to AD. Out of the 589 studies screened, 22 studies met eligibility criteria for the systematic review and qualitative synthesis. Finally, 11 studies were included in the meta-analysis (12,458 participants). Higher adherence to MD was associated with a significantly lower risk of MCI (RR = 0.91, 95%CI = 0.85-0.97) and lower risk of AD (RR = 0.89, 95% CI = 0.84-0.93). Our results enhance the importance of taking health-promoting lifestyle measures like following Mediterranean dietary patterns in order to reduce AD risk.

Addressing medical errors: an intervention protocol for nursing professionals.

OBJECTIVE: To identify the types of interventions that should be included in an organizational protocol for responding to serious adverse events involving nursing staff. METHOD: A descriptive exploratory study was conducted in the Autonomous Community of Madrid, Spain using a questionnaire. RESULTS: 248 nurses have participated. The respondents prioritized the following interventions for inclusion in the protocol: legal advice (86.5% of participants) and counseling (82.4% of participants). Over two-thirds of the nurses (69.3%) showed that they would like to receive guidance on how to record adverse events on the patient's medical records, while 64.8% showed that they would like to receive advice on assurances and legal safeguards in relation to the health organization's medical error notification system and 54.5% endorsed refresher training. Compulsory temporary or permanent transfer of nursing staff involved in adverse events was one of the least popular interventions (3.3% of participants). CONCLUSION: The nurses prioritized counseling, legal advice, training in communication techniques, and refresher training to address the consequences of adverse events and discarded the possibility of compulsory temporary or permanent transfer.

Addressing medical errors: an intervention protocol for nursing professionals / Abordagem dos erros assistenciais: protocolo de intervenção para profissionais de enfermagem / Abordaje de los errores asistenciales: protocolo de intervención para profesionales de enfermería

ABSTRACT Objective: To identify the types of interventions that should be included in an organizational protocol for responding to serious adverse events involving nursing staff. Method: A descriptive exploratory study was conducted in the Autonomous Community of Madrid, Spain using a questionnaire. Results: 248 nurses have participated. The respondents prioritized the following interventions for inclusion in the protocol: legal advice (86.5% of participants) and counseling (82.4% of participants). Over two-thirds of the nurses (69.3%) showed that they would like to receive guidance on how to record adverse events on the patient's medical records, while 64.8% showed that they would like to receive advice on assurances and legal safeguards in relation to the health organization's medical error notification system and 54.5% endorsed refresher training. Compulsory temporary or permanent transfer of nursing staff involved in adverse events was one of the least popular interventions (3.3% of participants). Conclusion: The nurses prioritized counseling, legal advice, training in communication techniques, and refresher training to address the consequences of adverse events and discarded the possibility of compulsory temporary or permanent transfer.

RESUMO Objetivo: Conhecer as medidas e ações que deveriam incluir um protocolo de resposta institucional diante de eventos adversos graves que envolvam a equipe de enfermagem. Método: Estudo exploratório descritivo por meio de questionário com uma amostra de profissionais de Enfermagem, colegiados em Madri, Espanha. Resultados: Participaram 248 profissionais de Enfermagem. Um protocolo de resposta institucional diante de eventos adversos graves que envolvam a equipe de enfermagem deveria incluir a assessoria jurídica (86,5%) e psicológica (82,4%) como intervenções prioritárias. Cerca de 69,3% dos enfermeiros são partidários da assessoria sobre como registrar o evento adverso na história clínica. Aproximadamente 64,8% desejariam receber assessoria sobre as garantias e segurança jurídica do sistema de notificação de erros. Cerca de 54,5% dos enfermeiros apoiam protocolar oficinas de reciclagem de técnicas. A mudança ou troca forçosa de serviço de modo permanente é uma das estratégias menos desejadas entre os profissionais (3,3%). Conclusão: Os enfermeiros reivindicam receber assessoria psicológica e jurídica, técnicas de comunicação e reciclagem e não ser trocados de serviço, para abordar as consequências posteriores de um evento adverso.

RESUMEN Objetivo: Conocer las medidas y acciones que debería incluir un protocolo de respuesta institucional frente a eventos adversos graves que involucren al equipo de enfermería. Método: Estudio exploratorio descriptivo a través de cuestionario con una muestra de profesionales de Enfermería, colegiados en Madrid, España. Resultados: Participaron 248 profesionales de Enfermería. Un protocolo de respuesta institucional frente a eventos adversos graves que involucren al equipo de enfermería debería incluir el asesoramiento jurídico (86,5%) y psicológico (82,4%) como intervenciones prioritarias. Un 69,3% de los enfermeros son partidarios del asesoramiento sobre cómo registrar el evento adverso en la historia clínica. Un 64,8% desearían recibir asesoramiento sobre las garantías y seguridad jurídica del sistema de notificación de errores. Un 54,5% de los enfermeros apoyan protocolizar talleres de reciclaje de técnicas. El cambio o permuta forzosa de servicio de manera permanente, es una de las estrategias menos deseadas entre los profesionales (3,3%). Conclusión: Los enfermeros reclaman recibir asesoramiento psicológico y jurídico, técnicas de comunicación y reciclaje y no ser cambiados de servicio, para abordar las consecuencias posteriores de un evento adverso.

Jardineros de la Salud / Health Gardeners

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The impact of muscle relaxation techniques on the quality of life of cancer patients, as measured by the FACT-G questionnaire.

INTRODUCTION: Patients with cancer frequently suffer from emotional distress, characterized by psychological symptoms such as anxiety or depression. The presence of psychological symptoms combined with the complex nature of oncology processes can negatively impact patients' quality of life. We aimed to determine the impact of a relaxation protocol on improving quality of life in a sample of oncological patients treated in the Spanish National Public Health System. MATERIALS AND METHODS: We conducted a multicenter interventional study without a control group. In total, 272 patients with different oncologic pathologies and showing symptoms of anxiety were recruited from 10 Spanish public hospitals. The intervention comprised abbreviated progressive muscle relaxation training, according to Bernstein and Borkovec. This was followed by weekly telephone calls to each patient over a 1-month period. We collected sociodemographic variables related to the disease process, including information about mental health and the intervention. Patients' quality of life was assessed using the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. Bivariate and univariate analyses were performed, along with an analysis of multiple correspondences to identify subgroups of patients with similar variations on the FACT-G. RESULTS: Patients showed statistically significant improvements on the FACT-G overall score (W = 16806; p<0.001), with an initial mean score of 55.33±10.42 and a final mean score of 64.49±7.70. We also found significant improvements for all subscales: emotional wellbeing (W = 13118; p<0.001), functional wellbeing (W = 16155.5; p<0.001), physical wellbeing (W = 8885.5; p<0.001), and social and family context (W = -1840; p = 0.037). CONCLUSIONS: Patients with cancer who learned and practiced abbreviated progressive muscle relaxation experienced improvement in their perceived quality of life as measured by the FACT-G. Our findings support a previous assumption that complementary techniques (including relaxation techniques) are effective in improving the quality of life of patients with cancer.

Association among presence of cancer pain, inadequate pain control, and psychotropic drug use.

INTRODUCTION: Pain is a common symptom in cancer patients, and its control and management are complex. Despite the high concomitant use of psychotropic drugs among such patients, the association among pain, inadequate pain control, and psychotropic drug use has not been fully determined. This study examined the prevalence of cancer pain and inadequate pain control and the association with psychotropic drug use. MATERIALS AND METHODS: In this cross-sectional study, we investigated 402 medical records obtained by simple random sampling of oncology patients at a hospital in northern Spain from July 2012 to July 2014. Adjusted odds ratios (ORs) were estimated together with their 95% confidence intervals (95% CIs) by unconditional logistic regression for each type of psychotropic drug (anxiolytics, hypnotics, and antidepressants). RESULTS: The mean patient age was 61.17 (standard deviation ± 13.14) years; 57.5% were women, 42.5% men. Pain was present in 18.4% of patients and inadequate pain control in 54.2%. We found a statistically significant association between the presence of cancer pain and anxiolytic use (adjusted OR, 3.15; 95% CI, 1.49-6.68) and hypnotic use (adjusted OR, 5.19; 95% CI, 1.77-15.25). Inadequate pain control was associated to a greater extent with the use of those drugs: adjusted OR for anxiolytic use, 4.74 (95% CI, 1.91-11.80); adjusted OR for hypnotic use, 6.09 (95% CI, 1.74-21.32). By contrast, no association was found between pain and antidepressant use (adjusted OR, 0.99). CONCLUSION: The presence of pain and (to a greater extent) poor pain control were associated with increased use of certain psychotropic drugs, such as anxiolytics and hypnotics. There appeared to be no association between pain and antidepressant use.

Continuing Education in Patient Safety: Massive Open Online Courses as a New Training Tool.

OBJECTIVES: Describe the use of two massive open online courses designed to provide education on patient safety. Review follow-up evaluation data from the courses. DISCLOSURE STATEMENT: Neither the planners nor the authors have any conflicts of interest to disclose. BACKGROUND: The Nursing School of the University of Cantabria conducted a training session on patient safety through two massive open online courses (MOOCs) aimed at the general population and especially Spanish-speaking health professionals. This study aimed to analyze the profile of health professionals who have completed the courses, their degree of satisfaction, and the percentage of completion. METHOD: In this retrospective and observational study, two MOOCs on clinical safety were created through an online platform (MiríadaX). Quantitative analysis of the profile of health professionals, their degree of satisfaction, and the percentage of completion was performed. RESULTS: A total of 12,400 students were enrolled, and the average completion rate was 32%. The profile of the average student was female, 37 years old, college educated, a nurse in a hospital, and interested in the course because it may be useful for performing her work. Fifty-five percent of students were very satisfied with the course. CONCLUSION: MOOCs are considered to be effective and easily accessible, with quality content for professional continuing education that encourages interdisciplinary work and meeting professionals from around the world.

Negación de la muerte y su repercusión en los cuidados / Denial of death and its impact on carers

Introducción: Pocos estudios exploran con detalle los contextos hospitalarios donde los profesionales sanitarios comparten la experiencia, los significados, y las claves interpretativas de los procedimientos aplicados en los momentos próximos a la muerte del paciente. Objetivo: identificar la representación social de la muerte y los efectos que la institucionalización de la misma tienen sobre los médicos y enfermeras de un hospital de agudos. Métodos: Hemos realizado un total de 11 grupos de discusión y 15 entrevistas semidirigidas a profesionales que trabajan en UCI, Urgencias y Plantas de hospitalización de adultos, en un hospital de agudos. Resultados principales: el 100% de los profesionales opina que la UCI y las Urgencias no son los lugares más apropiados para morir, y que las Plantas de hospitalización no cuentan con espacios adecuados para ofrecer una muerte digna. Demandan formación en Cuidados Paliativos. Identifican distintos tipos de muerte según el servicio donde ocurra la muerte, así como prejuicios que las familias elaboran sobre su relación con la muerte. En los discursos de estos profesionales emerge con mucha fuerza la familia como objeto de cuidados y la importancia de la variable información en el proceso de la muerte. Conclusiones: En la estructura social hospitalaria, nuevas formas de organizar, hablar y pensaren la muerte disminuirían el sufrimiento y la soledad de los pacientes, de sus familias y de los propios sanitarios (AU)

Introduction: There are few studies that look in depth at hospital situations in which professional health workers share their knowledge, meanings and key concepts of the procedures applied when a patient is near death. Aim: To identify the social representation of death and the effects that its institutionalization has on physicians and nurses in an acute care hospital. Approach: We carried out 11 discussion groups and 15 semi-directed interviews with professional health workers of an Intensive Care Unit, an Emergency Room, and various adult Stay Units in an Acute Care Hospital. Main results: All health workers think that Intensive Care Units and Emergency Rooms are not the most appropriate places to die, and that Hospital Stay Units lack suitable space for adignified death. They demand more training in Palliative Care, and they identify different types of death depending on the unit where it occurs, and also to identify the prejudices family members have about death. In these professional health workers’ discourses, the family strongly emerges as an object of care, as well as the importance that information has in the process of dying. Conclusions: New ways of organizing, talking and thinking about death in the social structure of hospitals could decrease the solitude and suffering that patients, family members and health workers go through when dealing with death (AU)

Comparative analysis of moral distress and values of the work organization between American and Spanish podiatric physicians.

BACKGROUND: Moral distress is a stress symptom arising from situations that involve ethical dimensions where the health-care provider believes that he or she is unable to preserve all interests and values at stake. The aims of this study were to evaluate the impact of, and identify possible differences in, moral distress in podiatric physicians in the United States and Spain and to determine the ethical principles most closely related to moral distress. METHODS: A 2008 e-mail survey of 93 US podiatric physicians and 93 Spanish podiatric physicians (N = 186) presented statements about different ethical dilemmas, values, and goals in the workplace. RESULTS: Although moral distress is strongly present across the sample for all of the questions, the US sample shows higher levels of any kind of moral distress concerning questions about patients' treatment and economic constraints, overload of paperwork, and acting against one's conscience. In the US sample, 91.4% of physicians agreed mostly or completely with the statement that they often had to compromise their own values to cope with the demands of the workplace; 89.25% of US podiatric physicians indicated that their own professional values were congruent with the values of the organization; and a similar percentage (77.5%) reported a strong identification with the goals and framework of their work organization. The Spanish sample had similar results. CONCLUSIONS: The results underline the significance of moral distress for both samples, mainly related to time constraints and organizational aspects concerning patients and lack of resources.

Knowledge and positions on bioethical dilemmas in a sample of Spanish nursing students: a questionnaire study.

This study, performed in Madrid, Spain, evaluates nursing students' understanding and attitudes about bioethical dilemmas that they will likely confront as health care providers. We asked 86 juniors in the King Juan Carlos University Nursing baccalaureate program about their knowledge of and personal attitudes on five biomedical advances: eugenics, experimentation with unimplanted embryos, human cloning, abortion, and euthanasia. Students reported being most knowledgeable about abortion and euthanasia and least familiar with eugenics. Examining the data for a correlation between the two phenomenon (knowledge and position) with respect to each of these five biomedical issues, the students reported significantly Conversely, they held significantly neutral positions on eugenics, a virtually unfamiliar topic for them (r = 0.618, p < 0.0001). The data also revealed a significantly direct correlation between knowledge and position for experimentation with non-implanted embryos (correlation coefficient = 0.380, p < 0.0001), that is, little knowledge and neutral attitudes. The trend findings for abortion and cloning were not significant. Based on these data, we concluded that the nursing program would benefit from additional biomedical curriculum.

Patients, intimate partners and family experiences of implantable cardioverter defibrillators: qualitative systematic review.

AIM: This paper is a report of an interpretive review of qualitative research on how an implantable cardioverter defibrillator affects adult recipients and their significant others. BACKGROUND: An implantable cardioverter defibrillator detects pathological cardiac rhythms and automatically converts the rhythm with electrical counter shocks. DATA SOURCES: A systematic literature search was conducted for qualitative research papers published between January 1999 and January 2009. PubMed, Medline, ISI Web of Knowledge and CINAHL databases were searched with the following key words: internal defibrillator, implantable defibrillator and qualitative research. REVIEW METHODS: Twenty-two papers were included. The critical appraisal skills programme and prompts were used to appraise studies. Thematic analysis and synthesis approaches were used to interpret evidence. FINDINGS: People with an implantable cardioverter defibrillator were found to experience physical, psychological and social changes. Shocks produce fear and anxiety, affecting relationships and sexual relations. The use of support groups and the use of the Internet are important in helping adjustment to an implantable cardioverter defibrillator. Women's responses to an implantable cardioverter defibrillator appear different than men's responses and include concerns about physical appearance and relationship issues. Postdischarge follow-up and educational programmes are still underdeveloped. CONCLUSION: Patients need additional education, support and follow-up care after hospital discharge. Patients and significant others benefit from collaboration between patient associations and healthcare professional societies. Future research is needed to identify the specific challenges that women recipients face.

Sudden cardiac death: the perspectives of Spanish survivors.

Sudden cardiac death is an episode of sudden death from cardiac causes in previously healthy patients. The aim of this study was to investigate the life experiences of patients who were resuscitated successfully following a sudden cardiac death. Purposeful sampling was used to recruit the nine participants through the snowball technique. Unstructured interviews were carried out until data saturation was reached. The Giorgi method of analysis, which seeks to reduce the participant's experience to minimal thematic units, common thematic groups, and essential themes in order to describe it, was used. Four essential themes were found: "facing fear"; "the search for meaning"; "feeling death up close and personal"; and "loneliness and estrangement". Nurses must integrate the lifestyle changes of patients who survive a cardiac death in order to provide adequate care following hospital discharge. Patients should undertake follow-up programs in order to receive counseling from health professionals. As a result, the creation of interdisciplinary support groups and the implementation of follow-up programs after hospital discharge are fundamental. Survivors' experiences can inform the development of nursing programs and hospital follow-up services that address the survival of cardiac death.

Living with life insurance: a qualitative analysis of the experience of male implantable defibrillator recipients in Spain.

BACKGROUND AND OBJECTIVES: The implantation of defibrillators should not be studied simply on the basis of clinical improvement or quality of life: it is also important to understand the significance, which the recipients attach to the defibrillator and their experiences with it. The aim of this work was, therefore, to determine the experience of Spanish implantable defibrillator recipients. DESIGN: A qualitative phenomenological study. METHODS: Purposeful sampling of male implantable defibrillator recipients older than 18 years of age attended at the defibrillator consultancy at the Hospital Fuenlabrada or belonging to the Heart Patients' Association (Asociación de Pacientes Coronarios, APACOR). A secondary, theoretical sampling was also carried out to gain a more in-depth understanding of certain aspects identified in the first sampling, such as living with the discharges and difficulties during sexual activity. Data were collected using unstructured and semi-structured questionnaires and applying a question guide, field notes and the recipients' personal diaries/letters. Data collection was terminated once theoretical saturation was reached. Data were analysed using the Giorgi method. Finally, the seven themes, which showed what it means to be an implantable cardioverter-defibrillator recipient, were described. RESULTS: The defibrillator is perceived positively and is considered to be a form of life insurance, whereas the discharges are a limiting factor. The recipient's outlook on life changes. Acceptance of the changes resulting from the implant leads to the development of strategies to facilitate everyday life. CONCLUSIONS: An understanding of the significance attached by recipients to their disease, diagnosis and treatment allows their behaviour and expectations to be understood. RELEVANCE TO CLINICAL PRACTICE: Provide the basis for nursing assessment after discharge, understand the effects of the device in the recipient and track the process of adapting the recipient to daily life.

Experience of elderly Spanish men with an implantable cardioverter-defibrillator.

AIM: An implantable cardioverter-defibrillator is the treatment of choice for ventricular arrhythmias and sudden death. Clinical trials and qualitative studies normally exclude elderly patients. The aim of this study was to describe the experience of elderly Spanish men with an implantable cardioverter-defibrillator. METHODS: This was a qualitative phenomenological study. Sampling was purposeful and used the snowball technique. Unstructured interviews and recipients' personal accounts were collected. Data collection finished with information saturation. Analysis was performed using the Giorgi proposal with triangulation between research-team members. Data were audited by an external researcher. RESULTS: The change and the need to adapt to the new situation can be perceived as a loss of independence by the elderly. The significance of the partner in the Spanish context is particularly relevant during the narration. Also, their view of the world is transformed, they experience an internal change. Additionally, the elderly patient may become confined to their home and shut off from their surroundings, accompanied by a sensation of being "stuck" and "imprisoned" by their own process. CONCLUSION: Elderly recipients can end up "clinging on" to customs as they are felt to define the recipient's identity and utility within their social and personal context. Their partner is of huge significance for elderly recipients. The geriatric health personnel must contribute to promote and maintain activities of daily living in elderly. Future qualitative studies taking an in-depth look at the experience and readjustment process of elderly recipients and the relationship among older people and technological equipment should be further conducted.

Plantar pressures in children with and without sever's disease.

BACKGROUND: a case-control study was conducted to compare static plantar pressures and distribution of body weight across the two lower limbs, as well as the prevalence of gastrocnemius soleus equinus, in children with and without calcaneal apophysitis (Sever's disease). METHODS: the participants were 54 boys enrolled in a soccer academy, of which eight were lost to follow-up. Twenty-two boys with unilateral Sever's disease comprised the Sever's disease group and 24 healthy boys constituted a control group. Plantar pressure data were collected using pedobarography, and gastrocnemius soleus equinus was assessed. RESULTS: peak pressure and percentage of body weight supported were significantly higher in the symptomatic feet of the Sever's disease group than in the asymptomatic feet of the Sever's disease group and the control group. Every child in the Sever's disease group had bilateral gastrocnemius equinus, while nearly all children in the control group had no equinus. CONCLUSIONS: high plantar foot pressures are associated with Sever's disease, although it is unclear whether they are a predisposing factor or a result of the condition. Gastrocnemius equinus may be a predisposing factor for Sever's disease. Further research is needed to identify other factors involved in the disease and to better understand the factors that contribute to abnormal distribution of body weight in the lower limbs.

Self-reported musculoskeletal disorders in podiatrists at work.

UNLABELLED: OBJECTOVE: The objective of the study was two-fold: (1) to ascertain the prevalence of musculoskeletal disorders in podiatrists in Spain, and (2) to identify relationships between intensity and duration of pain and socio-demographic variables. METHODS: Epidemiological analysis of Spanish self-employed or salaried podiatrists who had at least 1 year's experience, worked at least 20 hours per week, and had five patients per working day. The survey consisted of (1) identification of musculoskeletal disorders using the Standardized Nordic questionnaire for analysis of musculoskeletal symptoms; (2) assessment of perceived pain using the Borg CR-IO scale; and (3) analysis of specific socio-demographic variables. We used basic descriptive statistics to analyse the socio-demographic characteristics and perceived pain. Chi squared, Student's t-test, and ANOVA were used to determine differences between variables. RESULTS: The sample consisted of 274 women (65.08%) and 147 men (34.92%), for a total of 421 podiatrists. The females were older and reported a higher pain score compared to the males, however neither values showed statistical significance. When combining genders, pain intensity was significantly related to marital status (p = 0.006, IC 95%). The most frequently reported locations for musculoskeletal symptoms during the previous 7 days were the lower back, upper back and neck (33.02%, 21.85% and 21.62% respectively). They were also the most frequently reported locations for the previous 12 months (21.38%, 13.06% and 13.54% respectively). Female podiatrists and younger podiatrists reported more musculoskeletal complaints in the previous 7 days and younger podiatrists during previous 12 months. CONCLUSION: There is a significant prevalence of musculoskeletal complaints in daily podiatry work and the most affected body areas are the lower back, upper back and neck. The most affected demographic classes seem to be the younger age groups, females and married podiatrists.

Modelos enfermeros como marcos de referencia para el análisis de datos cualitativos / Nursing models as reference frameworks for the analysis of qualitative data

El análisis de los datos cualitativos es un proceso complejo que depende,en gran parte, de la sensibilidad interpretativa o teórica del investigador. Para potenciar esta sensibilidad teórica, una de las estrategias más comunes es la consulta de la literatura en busca de marcos conceptuales de referencia. Sin embargo, la utilización de los marcos de referencia ha de realizarse de manera crítica y justificada,respetando el proceso inductivo sin que suponga una limitación para la generación de teoría a partir de los datos. Las grandes teorías enfermeras, las de rango medio y las situacionales-específicas constituyen marcos conceptuales de elección para que la investigación en cuidados se desarrolle en congruencia con los valores y pilares filosóficos de la disciplina enfermera.En este artículo se describen las fases del proceso de investigación cualitativa y, mediante un ejemplo práctico, se ilustra cómo utilizar los modelos conceptuales enfermeros como marcos de referencia en cada una de ellas (AU)

The analysis of qualitative data is a complex process that greatly depends on the researcher’s interpretive or theoretical sensitivity. In orderto boost this theoretical sensitivity, one of the most common strategies is the consultation of the literature in search of reference conceptual frameworks. However, the use of reference frameworks has to be carried out in a critical and justified manner, respecting the induction process without this representing a limitation for the generation of theory from the data. The large nursing theories, the middle range theories and the situational-specific theories constitute the conceptual frameworks of choice for care research to be developed in accord with the values and philosophical pillars of the nur -sing field.This article describes the phases of the qualitative research process and,using a practical example, illustrates how conceptual nursing models can be used as reference frameworks in each one of these phases (AU)