[Design of a nursing assessment instrument during pregnancy monitoring in Primary Health care and the validation of its content]. / Diseño de un instrumento de valoración enfermera para el seguimiento de embarazo en Atención Primaria de salud y la validación de su contenido.

OBJECTIVE: This research aims to develop a nursing assessment tool, based on Gordon's Health Functional Patterns, through a content validation by a committee of experts, applying a Delphi technique. DESIGN: An assessment instrument with 53 items has been designed. SITE: It is carried out within the framework of a doctoral thesis, for its implementation by midwives of Primary Health Care. PARTICIPANTS: The committee was made up of 16 professionals with a hide clinical, teaching and research experience who all participated in the entire validation process. INTERVENTION: It has been assessed as a whole and in each of the items through four rounds of consultations, establishing a positive assessment of more than 60% to accept each item, as well as incorporating the suggestions provided by the committee. The final version had to reach a unanimous consensus. MAIN MEASUREMENTS: All items were accepted with a score higher than 60%. RESULTS: There were no contradictions between the inputs provided by the experts, so all of them were integrated into the final version that has a 100% approval by the committee. CONCLUSION: After this process, a new assessment tool is presented to be applied by primary care midwives in the pregnancy monitoring. The questionnaire has been piloted with 50 pregnant women, determining the most prevalent nursing diagnoses, establishing the workload for the midwife of her implementation of individualized care plans to improve some health indicators of pregnant women.

Intravesical Condyloma Acuminata Progressing to Squamous Cell Carcinoma of the Bladder: An Unusual Presentation.

Squamous cell carcinoma (SCC) of the bladder resulting from condyloma acuminata (CA) is uncommon. Most cases of SCC are asymptomatic until an advanced stage making the diagnosis difficult. Most patients present with urinary symptoms. We present the case of a 31-year-old African American male who presented to the emergency department with right lower extremity deep vein thrombosis. His past medical history was significant for recurrent bladder and urethral CA with high-grade dysplasia. A computed tomography (CT) gave the incidental findings of pelvic and bladder masses. The masses were studied and came back concerning for malignancy. The patient will undergo surgical removal soon. This manuscript illustrates an unusual presentation of CA progressing to SCC, including the diagnostic approach and treatment. We hope to increase awareness of the clinical presentation and regular follow-up in patients with risk factors.

La actitud expectante en la otitis media aguda ¿reduce los costes? / Does watchful waiting reduce costs in acute otitis media?

Conclusiones de los autores del estudio: el empleo apropiado de la actitud expectante para el manejo de la otitis media aguda podría simultáneamente mejorar los resultados de salud y ahorrar costes a la sociedad. En contraposición, los autores interpretan que esta actitud podría suponer un aumento de las visitas, requiriendo educación adicional de los padres y del personal sanitario. Comentario de los revisores: este análisis de coste-efectividad demuestra que la actitud expectante basada en las pautas de la Academia Americana de Pediatría para el manejo de la otitis media se asocia con menores costes totales y evita la pérdida de años de vida ajustados por discapacidad. Sería necesario realizar estudios de costes en Atención Primaria y adaptados a nuestro medio, donde se puede asegurar un seguimiento más exhaustivo de los pacientes obteniendo incluso costes menores

Author's conclusions: the appropriate use of watchful waiting for the management of acute otitis media could simultaneously improve health outcomes and save costs for society. In contrast, the authors interpret that this attitude could imply an increase in visits, requiring additional education from parents and health personnel. Reviewer's commentary: this cost-effectiveness analysis demonstrates that watchful waiting management for acute otitis media in patients meeting criteria of the AAP guidelines, stratifying by age and severity symptoms, is associated with lower total costs and also avoids the loss of years of life due to disability. It would be necessary to conduct cost studies in Primary Care, adapted to our environment where it can be ensured a more exhaustive monitoring of patients and the costs could be even lower

Efficient detection of wound-bed and peripheral skin with statistical colour models.

A pressure ulcer is a clinical pathology of localised damage to the skin and underlying tissue caused by pressure, shear or friction. Reliable diagnosis supported by precise wound evaluation is crucial in order to success on treatment decisions. This paper presents a computer-vision approach to wound-area detection based on statistical colour models. Starting with a training set consisting of 113 real wound images, colour histogram models are created for four different tissue types. Back-projections of colour pixels on those histogram models are used, from a Bayesian perspective, to get an estimate of the posterior probability of a pixel to belong to any of those tissue classes. Performance measures obtained from contingency tables based on a gold standard of segmented images supplied by experts have been used for model selection. The resulting fitted model has been validated on a training set consisting of 322 wound images manually segmented and labelled by expert clinicians. The final fitted segmentation model shows robustness and gives high mean performance rates [(AUC: .9426 (SD .0563); accuracy: .8777 (SD .0799); F-score: 0.7389 (SD .1550); Cohen's kappa: .6585 (SD .1787)] when segmenting significant wound areas that include healing tissues.

A web-based e-learning application for wound diagnosis and treatment.

Pressure ulcers (PrU) are considered as one of the most challenging problems that Nursing professionals have to deal with in their daily practice. Nowadays, the education on PrUs is mainly based on traditional lecturing, seminars and face-to-face instruction, sometimes with the support of photographs of wounds being used as teaching material. This traditional educational methodology suffers from some important limitations, which could affect the efficacy of the learning process. This current study has been designed to introduce information and communication technologies (ICT) in the education on PrU for undergraduate students, with the main objective of evaluating the advantages an disadvantages of using ICT, by comparing the learning results obtained from using an e-learning tool with those from a traditional teaching methodology. In order to meet this major objective, a web-based learning system named ePULab has been designed and developed as an adaptive e-learning tool for the autonomous acquisition of knowledge on PrU evaluation. This innovative system has been validated by means of a randomized controlled trial that compares its learning efficacy with that from a control group receiving a traditional face-to-face instruction. Students using ePULab gave significantly better (p<0.01) learning acquisition scores (from pre-test mean 8.27 (SD 1.39) to post-test mean 15.83 (SD 2.52)) than those following traditional lecture-style classes (from pre-test mean 8.23 (SD 1.23) to post-test mean 11.6 (SD 2.52)). In this article, the ePULab software is described in detail and the results from that experimental educational validation study are also presented and analyzed.

Effectiveness of an e-learning tool for education on pressure ulcer evaluation.

AIMS AND OBJECTIVES: To evaluate the effectiveness of information and communication technologies in the undergraduate students' pressure ulcer training as a learning tool, compared with traditional teaching methods. BACKGROUND: Pressure ulcers constitute one of the great challenges faced by nursing professionals. Currently, pressure ulcer training is based on traditional on-campus teaching, involving lecture-style classes with frequent use of photographs of the wounds. This traditional training has some important weaknesses that can put the efficacy of the training at risk. DESIGN: A randomised controlled trial was developed including undergraduate nursing students. METHODS: The intervention group used an adaptive self-learning e-learning tool developed by the research team (ePULab) for pressure ulcer assessment and treatment. The control group received a traditional on-campus class on the same topic. Pretest and post-test questionnaires were designed to assess the students' ability in pressure ulcer diagnosis and treatment. RESULTS: The educational intervention based on the use of the ePULab tool produced significantly better learning acquisition results than those obtained by traditional lecture-style classes: the total score improved in the control group from 8·23 (SD 1·23)-11·6 (SD 2·52) after the lecture, whereas in the intervention group, the knowledge score changed from 8·27 (SD 1·39)-15·83 (SD 2·52) (p = 0·01) with the use of ePULab. CONCLUSIONS: The results show a higher effectiveness of the devised e-learning approach for education on management of pressure ulcers. RELEVANCE TO CLINICAL PRACTICE: Our results reveal the suitability of the ePULab e-learning tool as an effective instrument for training on assessment of and treatment for pressure ulcers and its potential impact on clinical decision-making.

Binary tissue classification on wound images with neural networks and bayesian classifiers.

A pressure ulcer is a clinical pathology of localized damage to the skin and underlying tissue caused by pressure, shear, or friction. Diagnosis, treatment, and care of pressure ulcers are costly for health services. Accurate wound evaluation is a critical task for optimizing the efficacy of treatment and care. Clinicians usually evaluate each pressure ulcer by visual inspection of the damaged tissues, which is an imprecise manner of assessing the wound state. Current computer vision approaches do not offer a global solution to this particular problem. In this paper, a hybrid approach based on neural networks and Bayesian classifiers is used in the design of a computational system for automatic tissue identification in wound images. A mean shift procedure and a region-growing strategy are implemented for effective region segmentation. Color and texture features are extracted from these segmented regions. A set of k multilayer perceptrons is trained with inputs consisting of color and texture patterns, and outputs consisting of categorical tissue classes which are determined by clinical experts. This training procedure is driven by a k-fold cross-validation method. Finally, a Bayesian committee machine is formed by training a Bayesian classifier to combine the classifications of the k neural networks. Specific heuristics based on the wound topology are designed to significantly improve the results of the classification. We obtain high efficiency rates from a binary cascade approach for tissue identification. Results are compared with other similar machine-learning approaches, including multiclass Bayesian committee machine classifiers and support vector machines. The different techniques analyzed in this paper show high global classification accuracy rates. Our binary cascade approach gives high global performance rates (average sensitivity =78.7% , specificity =94.7% , and accuracy =91.5% ) and shows the highest average sensitivity score ( =86.3%) when detecting necrotic tissue in the wound.