Role of lateral suspension for the treatment of pelvic organ prolapse: a Delphi survey of expert panel.

INTRODUCTION AND HYPOTHESIS: Lateral suspension is an abdominal prosthetic surgical procedure used to correct apical prolapse. The procedure involves the placement of a T-shaped mesh on the anterior vaginal wall and on the isthmus or uterine cervix that is suspended laterally and posteriorly to the abdominal wall. Since its description in the late 90s, modifications of the technique have been described. So far, no consensus on the correct indications, safety, advantages, and disadvantages of this emerging procedure has been reached. METHODS: A modified Delphi process was used to build consensus within a group of 21 international surgeons who are experts in the performance of laparoscopic lateral suspension (LLS). The process was held with a first online round, where the experts expressed their level of agreement on 64 statements on indications, technical features, and other aspects of LLS. A subsequent re-discussion of statements where a threshold of agreement was not reached was held in presence. RESULTS: The Delphi process allowed the identification of several aspects of LLS that represented areas of agreement by the experts. The experts agreed that LLS is a safe and effective technique to correct apical and anterior prolapse. The experts highlighted several key technical aspects of the procedure, including clinical indications and surgical steps. CONCLUSIONS: This Delphi consensus provides valuable guidance and criteria for the use of LLS in the treatment of pelvic organ prolapse, based on expert opinion by large volume surgeons' experts in the performance of this innovative procedure.

Crystal structure, Hirshfeld surface analysis and DFT study of N-(2-nitro-phen-yl)male-imide.

The title compound [systematic name: 1-(2-nitro-phen-yl)pyrrole-2,5-dione], C10H6N2O4, crystallizes in the monoclinic system (space group P21/n) with two mol-ecules in the asymmetric unit, which are linked by C-H⋯O hydrogen bonds. Hirshfeld surface analysis showed that the most significant contributions to the crystal packing are from H⋯O/O⋯H, H⋯C/C⋯H and H⋯H inter-actions, which contribute 54.7%, 15.2% and 15.6%, respectively. A DFT study was conducted using three different levels of theory [(B3LYP/6-311+G(d,p), wB97XD/Def2TZVPP and LC-wpbe/6-311(2 d,2p)] in order to determine the stability, structural and electronic properties of the title mol-ecule with a view to its potential applications and photochemical and copolymer properties.

Chemical Constituents from Agave applanata and Its Antihyperglycemic, Anti-inflammatory, and Antimicrobial Activities Associated with Its Tissue Repair Capability.

Agave applanata is a Mexican agave whose fresh leaves are employed to prepare an ethanol tonic used to relieve diabetes. It is also applied to skin to relieve varicose and diabetic foot ulcers, including wounds, inflammation, and infections. In this study, the chemical composition of this ethanol tonic is established and its association with antihyperglycemic, anti-inflammatory, antimicrobial, and wound healing activities is discussed. The fresh leaves of A. applanata were extracted with ethanol : H2O (85 : 15). A fraction of this extract was lyophilized, and the remainder was partitioned into CH2Cl2, n-BuOH, and water. CH2Cl2 and n-BuOH fractions were subjected to a successive open column chromatography process. The structure of the isolated compounds was established using nuclear magnetic resonance and mass spectrometry spectra. The antihyperglycemic activity was evaluated through in vivo sucrose and glucose tolerance experiments, as well as ex vivo intestinal absorption and hepatic production of glucose. Wound healing and edema inhibition were assayed in mice. The minimum inhibitory concentrations (MICs) of the hydroalcoholic extract, its fractions, and pure compounds were determined through agar microdilution against the most isolated pathogens from diabetic foot ulcers. Fatty acids, ß-sitosterol, stigmasterol, hecogenin (1: ), N-oleyl-D-glucosamine, ß-daucosterol, sucrose, myo-inositol, and hecogenin-3-O-α-L-rhamnopyranosyl-(1 → 3)-ß-D-xylopyranosyl-(1 → 2)-[ß-D-xylopyranosyl-(1 → 3)-ß-D-glucopyranosyl-(1 → 3)]-ß-D-glucopyranosyl-(1 → 4)-ß-D-galactopyranoside (2: ) were characterized. This research provides evidence for the pharmacological importance of A. applanata in maintaining normoglycemia, showing anti-inflammatory activity and antimicrobial effects against the microorganisms frequently found in diabetic foot ulcers. This plant plays an important role in wound healing and accelerated tissue reparation.

Epstein-Barr Virus Encoded BCL2, BHRF1, Downregulates Autophagy by Noncanonical Binding of BECN1.

γ-herpesviruses (γHVs) encode BCL2 homologues (vBCL2) that bind the Bcl-2 homology 3 domains (BH3Ds) of diverse proteins, inhibiting apoptosis and promoting host cell and virus survival. vBCLs encoded by Kaposi sarcoma-associated HV (KSHV) and γHV68 downregulate autophagy, a degradative cellular process crucial for homeostasis and innate immune responses to pathogens, by binding to a BH3D in BECN1, a key autophagy protein. Epstein-Barr virus (EBV) encodes a vBCL2 called BHRF1. Here we show that unlike the KSHV and γHV68 vBCL2s, BHRF1 does not bind the isolated BECN1 BH3D. We use yeast two-hybrid assays to identify the minimal region of BECN1 required and sufficient for binding BHRF1. We confirm that this is a direct, albeit weak, interaction via affinity pull-down assays and isothermal titration calorimetry. To understand the structural bases of BHRF1 specificity, we determined the 2.6 Šcrystal structure of BHRF1 bound to the BID BH3D, which binds ∼400-times tighter to BHRF1 than does BECN1, and performed a detailed structural comparison with complexes of diverse BH3Ds bound to BHRF1 and to other antiapoptotic BCL2s. Lastly, we used mammalian cell autophagy assays to demonstrate that BHRF1 downregulates autophagy and that a cell-permeable peptide derived from the BID BH3D inhibits BHRF1-mediated downregulation of autophagy. In summary, our results suggest that BHRF1 downregulates autophagy by noncanonical binding of a flexible region of BECN1 that includes but is not limited to the BH3D and that BH3D-derived peptides that bind better to BHRF1 can block downregulation of autophagy by BHRF1.

Active Surveillance of Antimicrobial Resistance and Carbapenemase-Encoding Genes According to Sites of Care and Age Groups in Mexico: Results from the INVIFAR Network.

We analyzed the antimicrobial resistance (AMR) data of 6519 clinical isolates of Escherichia coli (n = 3985), Klebsiella pneumoniae (n = 775), Acinetobacter baumannii (n = 163), Pseudomonas aeruginosa (n = 781), Enterococcus faecium (n = 124), and Staphylococcus aureus (n = 691) from 43 centers in Mexico. AMR assays were performed using commercial microdilution systems (37/43) and the disk diffusion susceptibility method (6/43). The presence of carbapenemase-encoding genes was assessed using PCR. Data from centers regarding site of care, patient age, and clinical specimen were collected. According to the site of care, the highest AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from ICU patients. In contrast, in A. baumannii, higher AMR was observed in isolates from hospitalized non-ICU patients. According to age group, the highest AMR was observed in the ≥60 years age group for E. coli, E. faecium, and S. aureus, and in the 19-59 years age group for A. baumannii and P. aeruginosa. According to clinical specimen type, a higher AMR was observed in E. coli, K. pneumoniae, and P. aeruginosa isolates from blood specimens. The most frequently detected carbapenemase-encoding gene in E. coli was blaNDM (84%).

Enhancing structural plasticity of PC12 neurons during differentiation and neurite regeneration with a catalytically inactive mutant version of the zRICH protein.

BACKGROUND: Studies of the molecular mechanisms of nerve regeneration have led to the discovery of several proteins that are induced during successful nerve regeneration. RICH proteins were identified as proteins induced during the regeneration of the optic nerve of teleost fish. These proteins are 2',3'-cyclic nucleotide, 3'-phosphodiesterases that can bind to cellular membranes through a carboxy-terminal membrane localization domain. They interact with the tubulin cytoskeleton and are able to enhance neuronal structural plasticity by promoting the formation of neurite branches. RESULTS: PC12 stable transfectant cells expressing a fusion protein combining a red fluorescent protein with a catalytically inactive mutant version of zebrafish RICH protein were generated. These cells were used as a model to analyze effects of the protein on neuritogenesis. Differentiation experiments showed a 2.9 fold increase in formation of secondary neurites and a 2.4 fold increase in branching points. A 2.2 fold increase in formation of secondary neurites was observed in neurite regeneration assays. CONCLUSIONS: The use of a fluorescent fusion protein facilitated detection of expression levels. Two computer-assisted morphometric analysis methods indicated that the catalytically inactive RICH protein induced the formation of branching points and secondary neurites both during differentiation and neurite regeneration. A procedure based on analysis of random field images provided comparable results to classic neurite tracing methods.

Properties and cellular uptake of photo-triggered mixed metallosurfactant vesicles intended for controlled CO delivery in gas therapy.

The scientific relevance of carbon monoxide has increased since it was discovered that it is a gasotransmitter involved in several biological processes. This fact stimulated research to find a secure and targeted delivery and lead to the synthesis of CO-releasing molecules. In this paper we present a vesicular CO delivery system triggered by light composed of a synthetized metallosurfactant (TCOL10) with two long carbon chains and a molybdenum-carbonyl complex. We studied the characteristics of mixed TCOL10/phosphatidylcholine metallosomes of different sizes. Vesicles from 80 to 800 nm in diameter are mainly unilamellar, do not disaggregate upon dilution, in the dark are physically and chemically stable at 4 °C for at least one month, and exhibit a lag phase of about 4 days before they show a spontaneous CO release at 37 °C. Internalization of metallosomes by cells was studied as function of the incubation time, and vesicle concentration and size. Results show that large vesicles are more efficiently internalized than the smaller ones in terms of the percentage of cells that show TCOL10 and the amount of drug that they take up. On balance, TCOL10 metallosomes constitute a promising and viable approach for efficient delivery of CO to biological systems.

Blends of nitrophenylmaleimide isomers with carboxymethylcellulose for the preparation of supramolecular polymers.

Novel water-compatible supramolecular polymers (WCSP) based on the non-covalent interaction between carboxymethylcellulose (CMC) and o, m, and p-nitrophenylmaleimide isomers are proposed. The non-covalent supramolecular polymer was obtained from high viscosity CMC with a degree of substitution 1.03 with o, m, and p-nitrophenylmaleimide molecules that were synthesized from maleic anhydride and its corresponding nitroaniline. Subsequently, blends were made at different nitrophenylmaleimide concentrations, stirring rate, and temperatures, with 1.5% CMC, to select the best conditions for each case and to evaluate the rheological properties. The selected blends were used to form films and analyze spectroscopic, physicochemical, and biological properties. Then, the interaction between a CMC monomer and each isomer of nitrophenylmaleimide was investigated using quantum chemistry computational calculations with the B3LYP/6-311 + G (d,p) method, providing a detailed explanation of their intermolecular interactions. The supramolecular polymers obtained exhibit an increase in viscosity of blends between 20% and 30% compared to CMC, a shift in the wavenumber of the OH infrared band by approximately 66 cm-1, and the first decomposition peak at the glass transition temperature occurring between 70 and 110 °C. These changes in properties are attributed to the formation of hydrogen bonds between the species. However, the degree of substitution and the viscosity of the CMC affects the physical, chemical, and biological properties of the polymer obtained. The supramolecular polymers are biodegradable regardless of the type of blends made and are easily obtainable. Notably, the CMC with m-nitrophenylmaleimide yields the polymer with the best properties.

Whole genome analysis of Gram-negative bacteria using the EPISEQ CS application and other bioinformatic platforms.

OBJECTIVES: To determine genomic characteristics and molecular epidemiology of carbapenem non-susceptible Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii, and Pseudomonas aeruginosa from medical centres of Mexico using whole genome sequencing data analysed with the EPISEQⓇ CS application and other bioinformatic platforms. METHODS: Clinical isolates collected from 28 centres in Mexico included carbapenem-non-susceptible K. pneumoniae (n = 22), E. coli (n = 24), A. baumannii (n = 16), and P. aeruginosa (n = 13). Isolates were subjected to whole genome sequencing using the Illumina (MiSeq) platform. FASTQ files were uploaded to the EPISEQⓇ CS application for analysis. Additionally, the tools Kleborate v2.0.4 and Pathogenwatch were used as comparators for Klebsiella genomes, and the bacterial whole genome sequence typing database was used for E. coli and A. baumannii. RESULTS: For K. pneumoniae, both bioinformatic approaches detected multiple genes encoding aminoglycoside, quinolone, and phenicol resistance, and the presence of blaNDM-1 explained carbapenem non-susceptibility in 18 strains and blaKPC-3 in four strains. Regarding E. coli, both EPISEQⓇ CS and bacterial whole genome sequence typing database analyses detected multiple virulence and resistance genes: 20 of 24 (83.3%) strains carried blaNDM, 3 of 24 (12.4%) carried blaOXA-232, and 1 carried blaOXA-181. Genes that confer resistance to aminoglycosides, tetracyclines, sulfonamides, phenicols, trimethoprim, and macrolides were also detected by both platforms. Regarding A. baumannii, the most frequent carbapenemase-encoding gene detected by both platforms was blaOXA-72, followed by blaOXA-66. Both approaches detected similar genes for aminoglycosides, carbapenems, tetracyclines, phenicols, and sulfonamides. Regarding P. aeruginosa, blaVIM, blaIMP, and blaGES were the more frequently detected. Multiple virulence genes were detected in all strains. CONCLUSION: Compared to the other available platforms, EPISEQⓇ CS enabled a comprehensive resistance and virulence analysis, providing a reliable method for bacterial strain typing and characterization of the virulome and resistome.

A simple drying solution that minimizes cracking during air-drying of polyacrylamide gels.

Sodium dodecyl sulfate-polyacrylamide gel electrophoresis is a routine technique used in biochemistry. Air-drying is an economical method of gel preservation that does not require expensive equipment. Our laboratory uses drying frames from RPI, which recommends a drying solution of 20% ethanol and 10% glycerol. The solution performs well for gels up to 10% acrylamide and 0.75 mm thickness; however, crack formation may occur if nicks or bubbles are present. The literature shows various drying methods and combinations of alcohol (30-100%) and glycerol (5-35%), but still reports cracking problems. Tests were conducted to independently evaluate the effects of ethanol and glycerol concentration on gel cracking. Here we introduce a simple solution that does not require glycerol or modified frames to generate preserved, crack-free sodium dodecyl sulfate-polyacrylamide gel electrophoresis gels.

Bacterial incidence and drug resistance from pathogens recovered from blood, cerebrospinal and pleural fluids in 2019-2020. Results of the Invifar network.

Background: Antimicrobial resistance is a global concern. Analysis of sterile fluids is essential because microorganisms are defined as significant in most cases. Blood, cerebrospinal, and pleural fluids are frequently received in the microbiology lab because they are associated with considerable rates of morbi-mortality. Knowledge of epidemiology in these samples is needed to choose proper empirical treatments due to the importance of reducing selection pressure. Methods: We used retrospective laboratory data of blood, CSF, and pleural fluid collected from patients in Mexico between 2019 and 2020. Each laboratory identified the strains and tested susceptibility using its routine methods. For Streptococcus pneumoniae, a comparative analysis was performed with data from the broth microdilution method. Results: Forty-five centers participated in the study, with 30,746 clinical isolates from blood, 2,429 from pleural fluid, and 2,275 from CSF. For blood and CSF, Staphylococcus epidermidis was the most frequent. For blood, among gram negatives, the most frequent was Escherichia coli. Among Enterobacterales, 9.8% of K. pneumoniae were carbapenem-resistant. For S. pneumoniae, similar resistance percentages were observed for levofloxacin, cefotaxime, and vancomycin. For CSF, the most frequent gram-negative was E. coli. In Acinetobacter baumannii, carbapenem resistance was 71.4%. The most frequent species detected for pleural fluid was E. coli; in A. baumannii, carbapenem resistance was 96.3%. Conclusion: Gram-negative bacteria, with E. coli most prevalent, are frequently recovered from CSF, blood, and pleural fluid. In S. pneumoniae, the routine, conventional methods showed good agreement in detecting resistance percentages for erythromycin, levofloxacin, and vancomycin.

Low-cost modular systems for agarose gel documentation.

While conducting recombinant DNA technology procedures, such as DNA purification, agarose gel electrophoresis is often used for identification, characterization and quantification of DNA. The collection of data for experiments involving such techniques frequently involves capturing images using systems that are expensive and/or proprietary, such that they are not user-serviceable when they malfunction or become antiquated. In response to these limitations, work was done to replace the authors' existing aging Mac OS-based modular system with open-source software and generic hardware. Several versions of a modular imaging system that can be adjusted to fit nearly all use cases are described. The systems developed can accommodate diverse uses from research laboratories to educational environments where commercial systems could be unaffordable.

Increment Antimicrobial Resistance During the COVID-19 Pandemic: Results from the Invifar Network.

Aim: This study aims to assess the changes in antimicrobial resistance among some critical and high-priority microorganisms collected previously and during the coronavirus disease 2019 (COVID-19) pandemic in Mexico. Methods: We collected antimicrobial susceptibility data for critical and high-priority microorganisms from blood, urine, respiratory samples, and from all specimens, in which the pathogen may be considered a causative agent. Data were stratified and compared for two periods: 2019 versus 2020 and second semester 2019 (prepandemic) versus the second semester 2020 (pandemic). Results: In the analysis of second semester 2019 versus the second semester 2020, in blood samples, increased resistance to oxacillin (15.2% vs. 36.9%), erythromycin (25.7% vs. 42.8%), and clindamycin (24.8% vs. 43.3%) (p ≤ 0.01) was detected for Staphylococcus aureus, to imipenem (13% vs. 23.4%) and meropenem (11.2% vs. 21.4) (p ≤ 0.01), for Klebsiella pneumoniae. In all specimens, increased ampicillin and tetracycline resistance was detected for Enterococcus faecium (p ≤ 0.01). In cefepime, meropenem, levofloxacin, and gentamicin (p ≤ 0.01), resistance was detected for Escherichia coli; and in piperacillin-tazobactam, cefepime, imipenem, meropenem, ciprofloxacin, levofloxacin, and gentamicin (p ≤ 0.01), resistance was detected for Pseudomonas aeruginosa. Conclusion: Antimicrobial resistance increased in Mexico during the COVID-19 pandemic. The increase in oxacillin resistance for S. aureus and carbapenem resistance for K. pneumoniae recovered from blood specimens deserves special attention. In addition, an increase in erythromycin resistance in S. aureus was detected, which may be associated with high azithromycin use. In general, for Acinetobacter baumannii and P. aeruginosa, increasing resistance rates were detected.

Drug resistance phenotypes and genotypes in Mexico in representative gram-negative species: Results from the infivar network.

AIM: This report presents phenotypic and genetic data on the prevalence and characteristics of extended-spectrum ß-lactamases (ESBLs) and representative carbapenemases-producing Gram-negative species in Mexico. MATERIAL AND METHODS: A total of 52 centers participated, 43 hospital-based laboratories and 9 external laboratories. The distribution of antimicrobial resistance data for Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae complex, Acinetobacter baumannii complex, and Pseudomonas aeruginosa in selected clinical specimens from January 1 to March 31, 2020 was analyzed using the WHONET 5.6 platform. The following clinical isolates recovered from selected specimens were included: carbapenem-resistant Enterobacteriaceae, ESBL or carbapenem-resistant E. coli, and K. pneumoniae, carbapenem-resistant A. baumannii complex, and P. aeruginosa. Strains were genotyped to detect ESBL and/or carbapenemase-encoding genes. RESULTS: Among blood isolates, A. baumannii complex showed more than 68% resistance for all antibiotics tested, and among Enterobacteria, E. cloacae complex showed higher resistance to carbapenems. A. baumannii complex showed a higher resistance pattern for respiratory specimens, with only amikacin having a resistance lower than 70%. Among K. pneumoniae isolates, blaTEM, blaSHV, and blaCTX were detected in 68.79%, 72.3%, and 91.9% of isolates, respectively. Among E. coli isolates, blaTEM, blaSHV, and blaCTX were detected in 20.8%, 4.53%, and 85.7% isolates, respectively. For both species, the most frequent genotype was blaCTX-M-15. Among Enterobacteriaceae, the most frequently detected carbapenemase-encoding gene was blaNDM-1 (81.5%), followed by blaOXA-232 (14.8%) and blaoxa-181(7.4%), in A. baumannii was blaOXA-24 (76%) and in P. aeruginosa, was blaIMP (25.3%), followed by blaGES and blaVIM (13.1% each). CONCLUSION: Our study reports that NDM-1 is the most frequent carbapenemase-encoding gene in Mexico in Enterobacteriaceae with the circulation of the oxacillinase genes 181 and 232. KPC, in contrast to other countries in Latin America and the USA, is a rare occurrence. Additionally, a high circulation of ESBL blaCTX-M-15 exists in both E. coli and K. pneumoniae.

Dementia and Falls Management in Underserved Populations: The Cognition and Mobility Care Management Program.

BACKGROUND/OBJECTIVES: Cognitive and mobility impairments are common and underdiagnosed chronic conditions that afflict community-dwelling older adults. This study describes the organization, implementation, and evaluation of an intervention for underserved and ethnically diverse older patients with dementia and/or falls risk. DESIGN: Observation, baseline and 1 year after intervention. SETTING: Community-based primary care county clinics in inland southern California. PARTICIPANTS: A total of 272 persons, aged 70 years and older, who screened positive for falls and/or dementia and enrolled in the Cognition and Mobility Care Management program during the study period. INTERVENTION: A nurse care manager performed a patient and caregiver evaluation and created and implemented a care plan with medical, behavioral, and psychosocial interventions in partnership with patients and their primary care providers. MEASUREMENTS: Process outcomes included rates of positive screening for dementia and fall risk, referral, enrollment, and visit completion. Patient outcomes included fall history, mobility and cognitive assessments, and depression scales. Patients and/or caregivers completed questionnaires rating perceived benefits of enrollment after 1 year in the program. RESULTS: Medical assistants screened 573 patients aged 70 years and older during the study period; 78% screened positive for dementia and/or fall risk. Of the patients who screened positive, 94% were referred; 91% of contacted patients elected to enroll, and 272 patients completed an intake visit (meanage = 77 years; 65% female; 75% Latino; 10% African American). The patients and caregivers who completed satisfaction questionnaires 1 year after enrollment rated the program highly, and 92% would recommend the program to others. CONCLUSION: A primary care-based screening and comanagement program to identify and manage dementia and falls risk in primarily Latino and African American older adult patients living in an underserved area was well received, with high satisfaction and perceived benefit from patients and caregivers.

Aplicación y evaluación de la Guía de buenas prácticas: lactancia materna / Application and evaluation of the best practice guideline: Breastfeeding

OBJETIVO: Analizar la evolución de los cuidados para favorecer la lactancia materna (LM) y describir los resultados de la lactancia materna tras la implantación de la guía RNAO en diversos tipos de centros sanitarios nacionales. MÉTODO: Estudio descriptivo cuantitativo longitudinal de los resultados de la aplicación de las recomendaciones de la guía RNAO-LM en 9 centros sanitarios nacionales siguiendo la metodología del programa Best Practice Spotlight Organization®. Se recogen variables de proceso y resultado en el ámbito hospitalario y en atención primaria mediante el registro en la plataforma CAREVID. Los resultados globales se expresan como media ponderada de los centros participantes. RESULTADOS: La implantación de las recomendaciones de la guía de LM se asoció a un incremento relativo de: contacto piel con piel 57,7% (p < 0,000), LM exclusiva (LME) en la 1ª toma 47,8% (p < 0,000), LME al alta hospitalaria 18,4% (p < 0,000) y educación prenatal 63,95% (p < 0,00). CONCLUSIÓN: La implantación de la guía RNAO-LM en diversos centros en el ámbito nacional ha incrementado la aplicación de las recomendaciones, consiguiendo generalizar los cuidados adecuados en LM (como educación prenatal, aplicación del contacto piel con piel y LME en la primera toma), aproximándose significativamente a las recomendaciones internacionales sobre LM

OBJECTIVE: To analyse the progress of care in the promotion of breastfeeding and describe breastfeeding results following the implementation of the RNAO guideline in various types of national health centres. METHOD: Quantitative descriptive longitudinal study of the results of implementing the recommendations of the RNAO-Breastfeeding guideline in 9 national health centres following the implementation methodology of the programme of the Best Practice Spotlight Organization®. Process and result variables are collected at hospital level and in primary care by registering on the CAREVID platform. The weighted mean was calculated as a summary statistic. RESULTS: The implementation of the recommendations of the Breastfeeding guideline was associated with a relative increase in: skin-to-skin contact 57,7% (p < 0,000), exclusive breastfeeding in the 1st intake 47,8% (p < 0,000), exclusive breastfeeding on hospital discharge 18,4% (p < 0,000) and prenatal education 63,95% (p < 0,00). CONCLUSION: The implementation of the RNAO-Breastfeeding guideline in different national health centres has increased the application of the recommendations based on scientific evidence, generalising appropriate breastfeeding care (such as prenatal education, application of skin-to-skin contact and exclusive breastfeeding in the first intake) and is consequently significantly approaching the international recommendations on breastfeeding

Resultados de la implantación de la Guía de valoración y manejo del dolor en Centros Comprometidos con la Excelencia en Cuidados (CCEC) en España / Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO)

OBJETIVO: Analizar la evolución de la implantación de las recomendaciones de proceso de la guía RNAO Valoración y manejo del dolor y de los resultados en salud. MÉTODO: Estudio observacional, longitudinal, retrospectivo, realizado en 3hospitales de tercer nivel de España. Se incluyó a todos los pacientes dados de alta los últimos 5 días de cada mes de las unidades seleccionadas en el proceso de implantación. Se evaluaron datos estructurales, estancia media, estrategia de implantación y grado de implantación de recomendaciones de proceso según la guía RNAO durante los 3primeros años de implantación y resultados. Se realizó un análisis descriptivo mediante el cálculo de medias y frecuencias absolutas y relativas por periodos: basal (T0) y anual durante los 3primeros años de implantación (T1, T2 y T3, respectivamente) e inferencial. RESULTADOS: Se ha incluido a 8.128 pacientes. Se ha realizado contraste de hipótesis entre los diferentes periodos. La valoración inicial del dolor en las primeras 24h de ingreso o poscirugía se incrementó tras el periodo basal en todos los hospitales, especialmente en aquellos en los que no se cumplían los requisitos de la guía al inicio, y continuó creciendo de forma progresiva hasta a los 3 años de implantación (alcanzando un 94,6% en el hospital 2). En cambio, la implantación del plan de cuidados no ha llegado a superar el 37,5 o el 38,5% de los hospitales 1 y 3, respectivamente. Respecto a los indicadores de resultado, la prevalencia de dolor a las 24 h e intenso disminuyó en los 3hospitales de forma general desde T0 o T1 a T3; sin embargo, no se obtuvieron diferencias estadísticamente significativas concluyentes. CONCLUSIONES: La evolución de la implantación de las recomendaciones de proceso ha mejorado desde el inicio, al igual que los resultados sobre los pacientes, consiguiendo una disminución de la prevalencia y la intensidad del dolor, aunque no se obtuvieron datos concluyentes; todo esto conlleva una mejor práctica enfermera con mayores registros, continuidad asistencial y mejora de la gestión del dolor en los pacientes

AIM: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients

Implementation results of the assessment and management of pain guideline within Best Practice Spotlight Organisations (BPSO®). / Resultados de la implantación de la Guía de valoración y manejo del dolor en Centros Comprometidos con la Excelencia en Cuidados (CCEC®) en España.

AIM: to analyse the progress of implementing the process recommendations of the RNAO Assessment and Management of Pain guideline and health outcomes. METHOD: An observational, longitudinal, retrospective study conducted in 3tertiary-level hospitals in Spain. All patients discharged over the last 5 days of each month from the units selected in the implementation process were included. We evaluated structural data, mean hospital stay, implementation strategy and degree of implementation of the process recommendations of the RNAO guideline over the first 3 years of implementation, and outcomes. A descriptive analysis was performed by calculating means and absolute and relative frequencies in periods: baseline (T0), annual, over the 3first years of implementation (T1, T2 and T3 respectively), and inferential. RESULTS: 8128 patients were included in the study. Hypotheses were contrasted between the different periods. The initial pain assessment in the first 24h following admission or post-surgery increased after the baseline period in all the hospitals, especially those that did not meet the guidelines from the outset. It continued to rise progressively up to 3 years following implementation (reaching 94.6% in hospital 2). By contrast, implementation of the care plan did not exceed 37.5% and 38.5% in hospitals 1 and 3 respectively. With regard to the outcome indicators, the prevalence of pain at 24hours and intense pain generally decreased in the 3hospitals from T0 or T1 to T3, however no conclusive statistically significant differences were obtained. CONCLUSIONS: Implementation of the process recommendations improved from the outset, as did patient outcomes. A decrease in the prevalence and intensity of pain was achieved, although no conclusive data were obtained; all of which leads to better nursing practice with more recording, continuity of care and improved pain management for patients.

Application and evaluation of the best practice guideline: Breastfeeding. / Aplicación y evaluación de la Guía de buenas prácticas: lactancia materna.

OBJECTIVE: To analyse the progress of care in the promotion of breastfeeding and describe breastfeeding results following the implementation of the RNAO guideline in various types of national health centres. METHOD: Quantitative descriptive longitudinal study of the results of implementing the recommendations of the RNAO-Breastfeeding guideline in 9 national health centres following the implementation methodology of the programme of the Best Practice Spotlight Organization®. Process and result variables are collected at hospital level and in primary care by registering on the CAREVID platform. The weighted mean was calculated as a summary statistic. RESULTS: The implementation of the recommendations of the Breastfeeding guideline was associated with a relative increase in: skin-to-skin contact 57,7% (p < 0,000), exclusive breastfeeding in the 1st intake 47,8% (p < 0,000), exclusive breastfeeding on hospital discharge 18,4% (p < 0,000) and prenatal education 63,95% (p < 0,00). CONCLUSION: The implementation of the RNAO-Breastfeeding guideline in different national health centres has increased the application of the recommendations based on scientific evidence, generalising appropriate breastfeeding care (such as prenatal education, application of skin-to-skin contact and exclusive breastfeeding in the first intake) and is consequently significantly approaching the international recommendations on breastfeeding.

Significados del viaje turístico en jóvenes millenials. Caso de estudio: Texcoco, México / Meaning of travel for millennial young people in Mexico. Case study: Texcoco, Mexico / Significados de viagem turística para os jovens millenials do México. Estudo de caso: Texcoco, México

Resumen (analítico): Desde un paradigma interpretativo, realizamos un estudio sobre las creencias y valores que orientan los viajes turísticos de los y las gentes jóvenes millenials para establecer su tipificación turística. Con este objetivo, adelantamos una investigación cualitativa con jóvenes estudiantes de la Universidad Autónoma del Estado de México, en la región de Texcoco de la zona metropolitana de la ciudad de México. Sustentamos el planteamiento teórico en Schütz y Lalive, considerando el ethos como categoría base. Las técnicas que utilizamos fueron la entrevista -aplicada a 29 jóvenes de manera interactiva-, y el análisis del discurso, desagregado en las dimensiones temporal, social y espacial. Los hallazgos nos permitieron configurar dos ethos: el tradicional y el liberador, cuya diferenciación radica en los anclajes socioculturales que tiene la gente joven a partir de sus creencias y valores.

Abstract (analytical): Using an interpretative approach, this research involved the study of the beliefs, values and models that shape the experience of travelling for millennial young people in Mexico was carried out to classify what types of tourists are visiting Texcoco. A qualitative study was carried out by a group of young university students from the Universidad Autónoma del Estado de México, in the Texcoco region of the metropolitan area of Mexico City. The theoretical approach is based on the work of Schütz and Lalive, taking ethos as a base category. The methodological technique used was the interview, applying a discourse analysis to the meta-texts obtained in their temporal, social and spatial dimensions. The findings facilitated the configuration of two ethos: the traditional and the liberator, with the differentiation lying in the sociocultural anchors that young people have from their beliefs and values.

Resumo (analítico): Desde um paradigma interpretativo, um estudo foi realizado sobre as crenças e valores que orientam as viagens turísticas dos jovens millenials para estabelecer sua tipificação turística. Com esse objetivo, a pesquisa qualitativa foi realizada com jovens estudantes da Universidade Autônoma do Estado do México, na Texcoco, na região metropolitana da Cidade do México. A abordagem teórica é baseada em Schütz e Lalive, considerando o ethos como uma categoria de base. As técnicas utilizadas foram a entrevista, aplicada a 29 jovens de forma interativa e a análise do discurso, desagregada nas dimensões temporal, social e espacial. As descobertas permitem configurar dois ethos: o tradicional e o libertador, cuja diferenciação reside nas âncoras socioculturais que os jovens têm de suas crenças e valores.