Palliative care knowledge test for nurses and physicians: validation and cross-cultural adaptation.

BACKGROUND: Palliative care knowledge is essential in primary healthcare due to the increasing number of patients who require attention in the final stage of their life. Health professionals (physicians and nurses) need to acquire specific knowledge and abilities to provide high-quality palliative care. The development of education programmes in palliative care is necessary. The Palliative Care Knowledge Test (PCKT) is a questionnaire that evaluates the basic knowledge about palliative care, but it has not been adapted into Spanish, and its effectiveness and utility for Spanish culture have not been analysed. OBJECTIVE: The aim of this study was to report the translation into Spanish and a psychometric analysis of the PCKT. METHODS: The questionnaire survey was validated with a group of 561 physicians and nurses. The PCKT Spanish Version (PCKT-SV) was obtained from a process, including translation, back translation and revision by experts and a pilot study. The content validity and reliability of the questionnaire were analysed. RESULTS: The results showed internal consistency and reliability indexes similar to those obtained by the original version of PCKT. CONCLUSION: The PCKT-SV is a useful instrument for measuring Spanish-speaking physician and nurse knowledge of palliative care, and it is suitable to evaluate the effectiveness of training activities in palliative care.

Haloarchaea as Cell Factories to Produce Bioplastics.

Plastic pollution is a worldwide concern causing the death of animals (mainly aquatic fauna) and environmental deterioration. Plastic recycling is, in most cases, difficult or even impossible. For this reason, new research lines are emerging to identify highly biodegradable bioplastics or plastic formulations that are more environmentally friendly than current ones. In this context, microbes, capable of synthesizing bioplastics, were revealed to be good models to design strategies in which microorganisms can be used as cell factories. Recently, special interest has been paid to haloarchaea due to the capability of some species to produce significant concentrations of polyhydroxyalkanoate (PHA), polyhydroxybutyrate (PHB), and polyhydroxyvalerate (PHV) when growing under a specific nutritional status. The growth of those microorganisms at the pilot or industrial scale offers several advantages compared to that of other microbes that are bioplastic producers. This review summarizes the state of the art of bioplastic production and the most recent findings regarding the production of bioplastics by halophilic microorganisms with special emphasis on haloarchaea. Some protocols to produce/analyze bioplastics are highlighted here to shed light on the potential use of haloarchaea at the industrial scale to produce valuable products, thus minimizing environmental pollution by plastics made from petroleum.

Prevención de úlceras iatrogénicas por inmovilización terapéutica en niños con férula. Ensayo clínico / Prevention of iatrogenic ulcers produced by therapeutic immobilization with a lower limb splint in children. Clinical trial

INTRODUCCIÓN: La inmovilización con férula de yeso en miembro inferior es un procedimiento frecuente para niños en los servicios de urgencias, el cual no está exento de riesgos relacionados con la inmovilidad y presión, sobre estos factores los enfermeros tienen que adoptar cuidados preventivos. OBJETIVO: Comprobar la eficacia del parche-talonera polimérico en la prevención de úlceras iatrogénicas en niños inmovilizados con férula de yeso en miembro inferior. MATERIAL Y MÉTODO: Ensayo clínico aleatorio preventivo sobre pacientes pediátricos de 0 a 14 años que precisen inmovilización con férula de yeso en miembro inferior. Se realizó muestreo consecutivo no probabilístico simple ciego. Análisis estadístico descriptivo de las variables y test de la X 2 con las variables aplicación del parche y aparición de úlceras. RESULTADOS: Se obtuvo una muestra de n=74 pacientes. Se objetivó úlcera en 21.7% de pacientes, piel íntegra (48.2%) y eritema que palidece 30.1%. Se aplicó el test de la X2 para las variables aplicación de parche polimérico y aparición de úlcera, obteniendo X 2=0.135 con p = 0.713, y por tanto, no existe significación estadística entre estas dos variables. CONCLUSIONES: No existe relación directa entre la prevención de úlceras por presión en niños inmovilizados con férula de yeso y la aplicación de parche protector polimérico. Es fundamental que los enfermeros/as ofrezcan una educación sanitaria de calidad en los cuidados y mantenimiento de la férula para evitar complicaciones

INTRODUCTION: Immobilization with plaster cast in lower limb is a frequent procedure for children in the emergency services, which is not without risks related to immobility and pressure, on these factors nurses have to adopt preventive care. OBJECTIVE: To verify the efficacy of the polymeric heel patch in the prevention of iatrogenic ulcers in children immobilized with a plaster splint in the lower limb. MATERIAL AND METHOD: Preventive randomized clinical trial on pediatric patients aged 0 to 14 years who require immobilization with a lower limb cast cast. Simple blind non-probabilistic consecutive sampling was performed. Descriptive statistical analysis of the variables and X2 test with the application variables of the patch and the appearance of ulcers. RESULTS: A total sample of n = 74 patients was obtained. Ulcer was observed in 21.7% of patients, whole skin (48.2%) and erythema that pales 30.1%. The X2 test was applied for the application of polymer patch and ulcer appearance variables, obtaining X2 = 0.135 with p = 0.713, and therefore, there is no statistical significance between these two variables. CONCLUSIONS: There is no direct relationship between the prevention of pressure ulcers in children immobilized with plaster splint and the application of polymeric protective patch. It is very important that nurses offer a quality health education in the care and maintenance of the splint to avoid complications

La historia clínica domiciliaria de cuidados paliativos: una propuesta para la atención integral de los pacientes terminales / Home palliative care medical history: A proposal for the integral care of terminal patients

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[Validity of smoking measurements during pregnancy: specificity, sensitivity and cut-off points]. / Validez de distintas medidas de consumo de tabaco durante el embarazo: especificidad, sensibilidad y puntos de corte dónde y cuándo.

BACKGROUND: Non-disclosure by pregnant women smokers of their smoking habit questions the validity of self-declarations. The purpose of this research is to determine the rate of Non disclosure and to establish the validity of exhaled CO as a method of biochemical validation. METHOD: Data obtained in a Randomised Clinical Trial in 12 Health Centres in Malaga. 454 pregnant women smokers, of whom 104 declared that they had stopped smoking at the start. Measurement of the habit: self-declaration, carbon monoxide (CO) and cotinine in the urine in those subjects who declared that they no longer smoked. The ROC curve was obtained for the CO, calculating the area under the curve and the sensitivity and specificity for different cut-off points. Using the CO as the gold standard, the validity of the self-declarations was determined in terms of sensitivity and specificity. RESULTS: Cotinine/self-declaration comparison: rate of Non disclosure 15.4% (IC 95% 9.3-24.1). Cotinine/CO comparison: Area under the ROC curve of 0.838 (IC 95% 0.740-0.935). For a cut-off point of 9, recommended in the relevant bibliography, we achieved 100% specificity with 12.5% sensitivity. CO/self-declaration comparison (cut-off point 9): False negations 0.8%, prevalence of spontaneous abandonment of smoking habit 58.1%. CONCLUSIONS: A percentage of Non disclosure similar to other studies and the validity of CO as a method for the identification of women smokers are confirmed. At cut-off point 9, the validity of CO and self-declaration would be similar, with the prevalence of spontaneous abandonment increasing up to unreal figures. At the present time, the evidence is not sufficient in order to recommend 9 as the CO cut-off point. The results suggest that this should be lower. More extensive research is necessary in pregnant women who state that they do not smoke, using an appropriate methodology.

Un estudio cualitativo para conocer las características que definen y mejoran la formación en comunicación asistencial e interprofesional / A study with focus groups to understand the characteristics that define and improve training in health care and inter-professional communication

Objetivo: Identificar características, dificultades y necesidades de formación en comunicación asistencial e interprofesional de los profesionales sanitarios y descubrir mecanismos de mejora y perfil docente deseable para la implantación de una línea estratégica de formación. Material y método: Estudio cualitativo, descriptivo e interpretativo desarrollado entre septiembre de 2006 y julio de 2007 a iniciativa de la Dirección General de Asistencia Sanitaria del Servicio Murciano de Salud y la Dirección General de Calidad Asistencial, Formación e Investigación Sanitaria de la Consejería de Sanidad de Murcia, España. Participaron 11 médicos, 5 enfermeros, 1 psicólogo y 1 periodista de atención primaria y especializada y la Consejería de Sanidad de Murcia. Se utilizaron dos grupos focales con muestreo por saturación estructural, registro de los discursos en soporte audiovisual, transcripción literal y análisis de contenido. Resultados: Es preciso potenciar cambios de actitud y adquirir herramientas para la adecuada atención de situaciones cotidianas. También es necesario replantear temas y enfoques, definir el perfil de los docentes y desarrollar mecanismos de colaboración y motivación. La formación en comunicación asistencial e interprofesional es fundamental aunque escasa, autodidacta, poco estructurada y generalista. Presenta dificultades relacionadas con la asistencia, la difusión y el reconocimiento. Conclusiones: Una línea estratégica de formación en comunicación debe fundamentarse en una perspectiva humana. Su integración debe ser asumida por la institución y ser universal a partir de los intereses y las necesidades sentidas y expresadas por los profesionales y los ciudadanos

Objective: To identify the characteristics, needs and difficulties of training of health professionals in health care and inter-professional communication and discover mechanisms for improvement and a desirable educational profile for implementing a training strategy.Material and method: Qualitative, descriptive and interpretive study carried out between September 2006 and July 2007 at the initiative of the Dirección General de Asistencia Sanitaria-Servicio Murciano de Salud (SMS) and the Dirección General de Calidad Asistencial,Formación e Investigación Sanitaria-Consejería de Sanidad of Murcia, Spain. Participants included 11 doctors, 5 nurses, 1 psychologist and 1 primary and specialised care journalist and the Consejería de Sanidad of Murcia. 2 focus groups were used withsampling by structural saturation, recording of speeches on audiovisual support, verbatim transcript and content analysis.Results: We must encourage attitude changes and acquire the tools for proper care in everyday situations. It is also necessary to rethink subject matter and approaches, define the profile of teachers and develop collaboration and motivation mechanisms. Training in health care communication and inter-professional communication iscrucial but it is limited, self-taught, poorly structured and generalistic. It has difficulties associated with attendance, outreach and recognition.Conclusions: A strategic plan for training communication must be based on a human perspective. Its integration must be undertaken by the institution, and universal with the interests and needs felt and expressed by professionals and citizens

Validez de distintas medidas de consumo de tabaco durante el embarazo: especificidad, sensibilidad y puntos de corte dónde y cuándo / Validity of smoking measurements during pregnancy: scpecificity sensitivity and cut-off points

Fundamentos: La ocultación del hábito tabáquico en mujeres embarazadas fumadoras cuestiona la validez de la autodeclaración. Los objetivos de esta investigación son determinar el índice de ocultación y establecer la validez del CO en aire espirado como método de validación bioquímica. Método: Datos obtenidos de un Ensayo Clínico Aleatorizado en 12 Centros de Salud de Málaga. 454 mujeres embarazadas fumadoras de las cuales manifestaron abandonar 104 al inicio. Medición del habito: autodeclaración, monóxido de carbono (CO) y cotinina en orina en las que declararon no fumar. Para el CO se obtuvo la curva ROC calculándose el área bajo la curva y la sensibilidad y especificidad para diferentes puntos de corte. Empleando el CO como patrón oro se determinó la validez de la autodeclaración, en términos de la sensibilidad y la especificidad. Resultados: Comparación cotinina/autodeclaración: tasa de ocultación 15,4% (IC 95% 9,3-24,1). Comparación cotinina/CO: Área bajo la curva ROC de 0,838 (IC 95% 0,740-0,935). Para punto de corte de 9, recomendado en la bibliografía, logramos especificidad 100% con sensibilidad 12,5%. Comparación CO/autodeclaración (punto de corte 9): Falsos negativos 0.8%, prevalencia abandono espontáneo 58,1%. Conclusiones: Se confirma un porcentaje de ocultación similar a otros estudios y la validez del CO como método para la identificación de mujeres fumadoras. En punto de corte 9, la validez de CO y autodeclaración serían similares, aumentando hasta cifras irreales la prevalencia del abandono espontáneo En la actualidad no hay pruebas suficientes para recomendar el 9 como punto de corte de CO. Los resultados sugieren que este debería ser inferior. Son necesarias investigaciones más amplias en mujeres gestantes que se declaren no fumadoras con una metodología adecuada (AU)

Background: Non disclosure by pregnant women smokers of their smoking habit questions the validity of self-declarations. The purpose of this research is to determine the rate of Non disclosure and to establish the validity of exhaled CO as a method of biochemical validation. Method: Data obtained in a Randomised Clinical Trial in 12 Health Centres in Malaga. 454 pregnant women smokers, of whom 104 declared that they had stopped smoking at the start. Measurement of the habit: self-declaration, carbon monoxide (CO) and cotinine in the urine in those subjects who declared that they no longer smoked. The ROC curve was obtained for the CO, calculating the area under the curve and the sensitivity and specificity for different cut-off points. Using the CO as the gold standard, the validity of the self-declarations was determined in terms of sensitivity and specificity. Results: Cotinine/self-declaration comparison: rate of Non disclosure 15.4% (IC 95% 9.3-24.1). Cotinine/CO comparison: Area under the ROC curve of 0.838 (IC 95% 0.740-0.935). For a cut-off point of 9, recommended in the relevant bibliography, we achieved 100% specificity with 12.5% sensitivity. CO/self-declaration comparison (cut-off point 9): False negations 0.8%, prevalence of spontaneous abandonment of smoking habit 58.1%. Conclusions: A percentage of Non disclosure similar to other studies and the validity of CO as a method for the identification of women smokers are confirmed. At cut-off point 9, the validity of CO and self-declaration would be similar, with the prevalence of spontaneous abandonment increasing up to unreal figures. At the present time, the evidence is not sufficient in order to recommend 9 as the CO cut-off point. The results suggest that this should be lower. More extensive research is necessary in pregnant women who state that they do not smoke, using an appropriate methodology (AU)

[Evaluation of the validity of AD/HD diagnoses in referrals from paediatrics to the child psychiatry clinic]. / Validez del diagnóstico clínico de trastorno por déficit de atención con hiperactividad en las derivaciones de pediatría a la consulta de psiquiatría infantil.

OBJECTIVES: To evaluate the validity of clinical diagnoses of attention deficit/hyperactivity disorder (AD/HD). DESIGN: Descriptive, cross-sectional study. SETTING: Mental Health Care area 6, Murcia, Spain. PARTICIPANTS: The sample consists of those patients referred consecutively to the child psychiatry clinic between July and September 2005. MAIN MEASUREMENTS: The presumptive diagnosis of AD/HD in the paediatric department referral was compared with the definitive one in psychiatry (gold standard). Sensitivity, specificity and predictive values and probability quotients were calculated. RESULTS: Seventy-five patients were included; 12% were lost. Sixty-six cases were studied, 15 with AD/HD and 51 with other diagnoses (23 with differential diagnoses from AD/HD). Sensitivity was 86.7% (95% CI, 69.5-100); specificity, 54.9% (95% CI, 41.3-68.6); positive predictive value, 36.1% (95% CI, 20.4-51.8); and negative predictive value, 93.3% (95% CI, 84.4-100). CONCLUSIONS: Validity of diagnosis was moderate with high sensitivity, low specificity and a low positive predictive value, the latter calculated for low AD/HD prevalence. The clinical picture of AD/HD tends to be oversized. The presumptive diagnosis in primary care behaved as a screening test. The clinical diagnosis in primary care should be complemented with other diagnostic tests that provide greater specificity.

Validez del diagnóstico clínico de trastorno por déficit de atención con hiperactividad en las derivaciones de pediatría a la consulta de psiquiatría infantil / Evaluation of the validity of AD/HD diagnoses in referrals from paediatrics to the child psychiatry clinic

Objetivos. Evaluar la validez del diagnóstico clínico de trastorno por déficit de atención con hiperactividad (TDAH). Diseño. Estudio descriptivo, transversal. Emplazamiento. Área VI de Salud Mental de Murcia. Participantes. Pacientes derivados de forma consecutiva a la consulta de psiquiatría infantil entre los meses de julio y septiembre de 2005. Mediciones principales. Se compararon los diagnósticos de sospecha en la derivación del pediatra con los definitivos realizados en psiquiatría (patrón oro). Se estimaron la sensibilidad, la especificidad, los valores predictivos y cocientes de probabilidad. Resultados. De 75 pacientes, se estudió a 66 (12% de pérdidas), 15 con TDAH y 51 con otros diagnósticos (23 con los diagnósticos diferenciales de TDAH). La sensibilidad fue del 86,7% (intervalo de confianza [IC] del 95%, 69,5-100), la especificidad del 54,9% (IC del 95%, 41,3-68,6), el valor predictivo positivo del 36,1% (IC del 95%, 20,4-51,8) y el valor predictivo negativo del 93,3% (IC del 95%, 84,4-100). Conclusiones. Se ha obtenido una validez diagnóstica moderada con una sensibilidad alta, una especificidad baja y un valor predictivo positivo bajo estimado para una prevalencia de TDAH baja. Existe una tendencia a sobrediagnosticar el cuadro. El diagnóstico de sospecha en atención primaria se comportó como una prueba de cribado. El diagnóstico clínico en atención primaria debería completarse con otras pruebas diagnósticas que nos aporten mayor especificidad

Objectives. To evaluate the validity of clinical diagnoses of attention deficit/hyperactivity disorder (AD/HD). Design. Descriptive, cross-sectional study. Setting. Mental Health Care area 6, Murcia, Spain. Participants. The sample consists of those patients referred consecutively to the child psychiatry clinic between July and September 2005. Main measurements. The presumptive diagnosis of AD/HD in the paediatric department referral was compared with the definitive one in psychiatry (gold standard). Sensitivity, specificity and predictive values and probability quotients were calculated. Results. Seventy-five patients were included; 12% were lost. Sixty-six cases were studied, 15 with AD/HD and 51 with other diagnoses (23 with differential diagnoses from AD/HD). Sensitivity was 86.7% (95% CI, 69.5-100); specificity, 54.9% (95% CI, 41.3-68.6); positive predictive value, 36.1% (95% CI, 20.4-51.8); and negative predictive value, 93.3% (95% CI, 84.4-100). Conclusions. Validity of diagnosis was moderate with high sensitivity, low specificity and a low positive predictive value, the latter calculated for low AD/HD prevalence. The clinical picture of AD/HD tends to be oversized. The presumptive diagnosis in primary care behaved as a screening test. The clinical diagnosis in primary care should be complemented with other diagnostic tests that provide greater specificity

[Not Available]. / Un estudio cualitativo para conocer las características que definen y mejoran la formación en comunicación asistencial e interprofesional.

OBJECTIVE: To identify the characteristics, needs and difficulties of training of health professionals in health care and inter-professional communication and discover mechanisms for improvement and a desirable educational profile for implementing a training strategy. MATERIAL AND METHOD: Qualitative, descriptive and interpretive study carried out between September 2006 and July 2007 at the initiative of the Dirección General de Asistencia Sanitaria-Servicio Murciano de Salud (SMS) and the Dirección General de Calidad Asistencial, Formación e Investigación Sanitaria-Consejería de Sanidad of Murcia, Spain. Participants included 11 doctors, 5 nurses, 1 psychologist and 1 primary and specialised care journalist and the Consejería de Sanidad of Murcia. 2 focus groups were used with sampling by structural saturation, recording of speeches on audiovisual support, verbatim transcript and content analysis. RESULTS: We must encourage attitude changes and acquire the tools for proper care in everyday situations. It is also necessary to rethink subject matter and approaches, define the profile of teachers and develop collaboration and motivation mechanisms. Training in health care communication and inter-professional communication is crucial but it is limited, self-taught, poorly structured and generalistic. It has difficulties associated with attendance, outreach and recognition. CONCLUSIONS: A strategic plan for training communication must be based on a human perspective. Its integration must be undertaken by the institution, and universal with the interests and needs felt and expressed by professionals and citizens.