Study of the fingerprints of a Spanish sample for the determination of the hand and finger.

The individuality and permanence of fingerprints make of them a very useful feature in the identification of individuals. There are now automated computer programmes that allow a quick comparison between a fingermark and a database. However, in order to assess the strength of evidence in fingerprint identification, complementary information on the frequencies of the different morphological features of the dermopapillary ridges is required. This idea is used in this work as a starting point to evaluate the frequencies of the parameters used in the determination of the hand and finger in a large sample of 2600 fingerprints taken from 134 male and 127 female Spanish population. Based on these fingerprints, the frequencies of different categories of the following parameters were obtained: type of pattern, slope of the apex ridge, subtype of two-delta pattern, ridge tracing, major angle, major ridge count, bisector, rotation of the central ridge, assimilation to loops and slant. Moreover, the results have shown that these characters are useful for the determination of the hand in whorls (two-delta pattern) and loops (one-delta pattern), but not for the determination of the finger. The most useful and classificatory parameter when determining the hand of origin of a two-delta fingerprint is the slope of the apex ridge, and for the one-delta pattern, knowing the location of the delta allows the correct estimation of the hand of a fingerprint in more than 93% of the cases. The data presented in this paper are novel and can be used by latent print examiners to improve the statistical basis of their decisions in reaching conclusions.

La gestión del liderazgo enfermero y la cultura de seguridad del paciente en las organizaciones sanitarias / Nursing leadership management and patient safety culture in healthcare organizations

Objetivo: actualizar el análisis de la relación del liderazgo enfermero con la seguridad del paciente diferenciando entre los distintos tipos de liderazgo. Método: revisión narrativa realizada entre marzo y diciembre de 2021. Se consultaron las bases de datos PubMed, IBECS y CINAHL, utilizando los términos: Leadership, Patient Safety, Risk Management y Nursing, Supervisory, entre otros. Se incluyeron artículos de los últimos cinco años publicados en español o inglés. La selección se llevó a cabo entre tres investigadoras. Resultados: se encontraron 294 registros de los que 13 fueron incluidos finalmente en la revisión. Tres tipos de liderazgo (auténtico, transformacional y ético) tuvieron asociación con la disminución de eventos adversos. El liderazgo auténtico se mostró como predictor del aumento del clima de seguridad. El liderazgo ético se asoció con mayor notificación de errores. Se identificaron aspectos importantes de la persona que lidera para mejorar la seguridad: en la retroalimentación no asigna culpas, es capaz de transmitir los mensajes de forma adecuada, establece un clima de confianza y una comunicación continuada con el personal, es accesible, motivadora, tiene inteligencia emocional, promueve el trabajo en equipo. Conclusiones: distintos tipos de liderazgo se asocian a beneficios en la seguridad del paciente. Que las supervisoras desarrollen un liderazgo eficaz y basado en las relaciones positivas favorece una adecuada cultura de seguridad lo que ha de tenerse en cuenta a la hora de promoverla.(AU)

Objective: to update the analysis of the relationship between nursing leadership and patient safety, differentiating between types of leadership. Method: a narrative review conducted between March and December 2021. The PubMed, IBECS and CINAHL databases were consulted, using the terms Leadership, Patient Safety, Risk Management and Nursing, Supervisory, among others. Articles from the past five years published in Spanish or English were included. Three female researchers were in charge of selection. Results: there were 294 records retrieved, 13 of which were finally included in the review. Three types of leadership (authentic, transformational and ethical) were associated with a reduction in adverse events. Authentic leadership appeared as a predictor for an increase in safety environment. The ethical leadership was associated with a higher report of errors. Important aspects of the leader person were identified in order to improve safety: not assigning blame during feedback, being able to convey messages adequately, establishing a trust environment and continuous communication with staff, being accessible and motivating, having emotional intelligence, and promoting teamwork. Conclusions: different types of leadership are associated with benefits in patient safety. Supervisors developing an effective leadership based on positive relationships will encourage an adequate safety culture, which must be taken into account at the time of promotion.(AU)

Systemic inflammation and sympathetic activation in gestational diabetes mellitus with obstructive sleep apnea.

BACKGROUND: Although some evidence suggests an association between obstructive sleep apnea (OSA) and gestational diabetes mellitus (GDM), its consequences still remain largely unknown. We sought to determine whether OSA is associated with higher inflammation and sympathetic levels in GDM, and to relate them with insulin resistance and perinatal outcomes. METHODS: OSA was identified by polysomnography and defined as an apnea-hypopnea index of ≥ 5 h-1. Plasma cytokines (TNF-α, IL-1ß, IL-6, IL-8, IL-10), metanephrine, and normetanephrine were determined by immunoassays. RESULTS: We included 17 patients with GDM and OSA and 34 without OSA. Women with GDM and OSA had higher normetanephrine concentrations [81 IQR (59-134) vs. 68 (51-81) pg/mL]. No differences in the inflammatory profile were found, while IL-1ß was higher in patients with mean nocturnal oxyhemoglobin saturation ≤ 94%. We found positive correlations between increased sympathetic activation and IL-1ß, with obstructive apneas, while time in REM showed an inverse relationship with IL-1ß and metanephrine. Furthermore, IL-10 was inversely related with time in sleep stages 1-2, and with the arousal index, and it was positively related with time in slow-wave sleep. Significant correlations were also found between IL-1ß and insulin resistance. There were no significant differences in neonatal characteristics; however, we found inverse relationships between IL-10 and birth weight (BW), and percentile of BW. CONCLUSIONS: OSA increased sympathetic activity, and IL-1ß concentration was higher in patients with GDM with lower nocturnal oxygenation, all of which were related with obstructive events, and time in REM. Moreover, IL-1ß was related with insulin resistance, and IL-10 inversely correlated with neonatal BW.

A 51-Year-Old Woman With Hypoacusia and Increased Respiratory Effort in the Supine Position and OSA.

A 51-year-old woman with a personal history of vitiligo, normal thyroid hormone studies, a simple hysterectomy for multiple uterine myomas at age 35 years, and childhood adenotonsillectomy was seen for progressive hearing loss. She reported mild asthenia, cold intolerance, mild dysphagia with frequent choking while eating and drinking, and a progressive increase in inspiratory effort, especially in the supine position. Her partner described a progressively worsening history of snoring and witnessed apneic episodes, mostly in the supine position. Mild to moderate daytime sleepiness was also present.

A Bayesian cost-effectiveness analysis of a telemedicine-based strategy for the management of sleep apnoea: a multicentre randomised controlled trial.

BACKGROUND: Compliance with continuous positive airway pressure (CPAP) therapy is essential in patients with obstructive sleep apnoea (OSA), but adequate control is not always possible. This is clinically important because CPAP can reverse the morbidity and mortality associated with OSA. Telemedicine, with support provided via a web platform and video conferences, could represent a cost-effective alternative to standard care management. AIM: To assess the telemedicine impact on treatment compliance, cost-effectiveness and improvement in quality of life (QoL) when compared with traditional face-to-face follow-up. METHODS: A randomised controlled trial was performed to compare a telemedicine-based CPAP follow-up strategy with standard face-to-face management. Consecutive OSA patients requiring CPAP treatment, with sufficient internet skills and who agreed to participate, were enrolled. They were followed-up at 1, 3 and 6 months and answered surveys about sleep, CPAP side effects and lifestyle. We compared CPAP compliance, cost-effectiveness and QoL between the beginning and the end of the study. A Bayesian cost-effectiveness analysis with non-informative priors was performed. RESULTS: We randomised 139 patients. At 6 months, we found similar levels of CPAP compliance, and improved daytime sleepiness, QoL, side effects and degree of satisfaction in both groups. Despite requiring more visits, the telemedicine group was more cost-effective: costs were lower and differences in effectiveness were not relevant. CONCLUSIONS: A telemedicine-based strategy for the follow-up of CPAP treatment in patients with OSA was as effective as standard hospital-based care in terms of CPAP compliance and symptom improvement, with comparable side effects and satisfaction rates. The telemedicine-based strategy had lower total costs due to savings on transport and less lost productivity (indirect costs). TRIAL REGISTER NUMBER: NCT01716676.

Obstructive sleep apnea and systemic hypertension: longitudinal study in the general population: the Vitoria Sleep Cohort.

RATIONALE: Obstructive sleep apnea and systemic hypertension (SH) are highly prevalent. Although their association has been suggested in cross-sectional studies, conflicting evidence has emerged from longitudinal studies. OBJECTIVES: To assess the association between obstructive sleep apnea and SH in the middle-aged general population. METHODS: A total of 2,148 subjects were included in a longitudinal study of the Vitoria Sleep Cohort, a general population sample aged 30-70 years. We analyzed data on office blood pressure, anthropometric measures, health history, and home polygraphy. Out of 1,557 subjects who completed the 7.5-year follow-up, 377 were excluded for having SH at baseline. The odds ratios for the incidence of SH, according to the respiratory disturbance index (RDI) at baseline, were estimated in 1,180 subjects (526 men and 654 women) after adjustment for age; sex; body mass index; neck circumference; fitness level; and alcohol, tobacco, and coffee consumption. The RDI was divided into quartiles (0-2.9, 3-6.9, 7-13.9, and ≥ 14), using the first quartile as reference. MEASUREMENTS AND MAIN RESULTS: The crude odds ratio for incident hypertension increased with higher RDI category with a dose-response effect (P < 0.001), but was not statistically significant after adjustment for age (P = 0.051). Adjustments for sex (P = 0.342), body mass index (P = 0.803), neck circumference (P = 0.885), and fitness level and alcohol, tobacco, and coffee consumption (P = 0.708) further reduced the strength of the association between RDI and SH. No differences were observed between men and women. CONCLUSIONS: Our findings do not suggest an association between obstructive sleep apnea and the incidence of SH in the middle-aged general population. Long-term follow-up longitudinal studies are needed to better ascertain this association.