Analysis of the Cardiorespiratory Pattern of Patients Undergoing Weaning Using Artificial Intelligence.

The optimal extubating moment is still a challenge in clinical practice. Respiratory pattern variability analysis in patients assisted through mechanical ventilation to identify this optimal moment could contribute to this process. This work proposes the analysis of this variability using several time series obtained from the respiratory flow and electrocardiogram signals, applying techniques based on artificial intelligence. 154 patients undergoing the extubating process were classified in three groups: successful group, patients who failed during weaning process, and patients who after extubating failed before 48 hours and need to reintubated. Power Spectral Density and time-frequency domain analysis were applied, computing Discrete Wavelet Transform. A new Q index was proposed to determine the most relevant parameters and the best decomposition level to discriminate between groups. Forward selection and bidirectional techniques were implemented to reduce dimensionality. Linear Discriminant Analysis and Neural Networks methods were implemented to classify these patients. The best results in terms of accuracy were, 84.61 ± 3.1% for successful versus failure groups, 86.90 ± 1.0% for successful versus reintubated groups, and 91.62 ± 4.9% comparing the failure and reintubated groups. Parameters related to Q index and Neural Networks classification presented the best performance in the classification of these patients.

Design of a Classifier to Determine the Optimal Moment of Weaning of Patients undergoing to the T-tube Test.

Weaning from mechanical ventilation in the intensive care unit is a complex and relevant clinical problem. Prolonged mechanical ventilation leads to a variety of medical complications that increase hospital stay and costs, in addition to contributing the morbidity and mortality, affecting long-term quality of life. This work presents a methodology to establish the optimal moment of extubation of a patient connected to a mechanical ventilator, submitted to the T-Tube test. 133 patients are analyzed, classified into two groups: successful group (94 patients) and failed group (39 patients). The behaviour of the respiratory function is characterized through the mean, standard deviation, kurtosis, skewness, interquartile range and coefficient of interval of the respiratory flow time series. To classify these patients, neural networks (NN) and support vector machines (SVM) classifier are used, considering time intervals of the 450s, 600s and 900s. According to the results, the best classification is obtained using the SVM. Clinical Relevance-The paper determines the optimal moment for weaning a patient connected to a mechanical ventilator using machine learning techniques.

Multiple Sources of Introduction of North American Arabidopsis thaliana from across Eurasia.

Large-scale movement of organisms across their habitable range, or migration, is an important evolutionary process that can shape genetic diversity and influence the adaptive spread of alleles. Although human migrations have been studied in great detail with modern and ancient genomes, recent anthropogenic influence on reducing the biogeographical constraints on the migration of nonnative species has presented opportunities in several study systems to ask the questions about how repeated introductions shape genetic diversity in the introduced range. We present an extensive overview of population structure of North American Arabidopsis thaliana by studying a set of 500 whole-genome sequenced and over 2,800 RAD-seq genotyped individuals in the context of global diversity represented by Afro-Eurasian genomes. We use methods based on haplotype and rare-allele sharing as well as phylogenetic modeling to identify likely sources of introductions of extant N. American A. thaliana from the native range in Africa and Eurasia. We find evidence of admixture among the introduced lineages having increased haplotype diversity and reduced mutational load. We also detect signals of selection in immune-system-related genes that may impart qualitative disease resistance to pathogens of bacterial and oomycete origin. We conclude that multiple introductions to a nonnative range can rapidly enhance the adaptive potential of a colonizing species by increasing haplotypic diversity through admixture. Our results lay the foundation for further investigations into the functional significance of admixture.

La satisfacción laboral de los profesionales como pieza clave en la calidad asistencial / Job Satisfaction of Professionals as a Key Element in Quality of Care

OBJETIVO: determinar el nivel de satisfacción laboral del personal dependiente de la Dirección de Enfermería del Complejo Asistencial Universitario de Burgos (CAUB). MÉTODO: se diseñó un estudio descriptivo transversal. La muestra de estudio (n= 1.844) se conformó con los profesionales activos, dependientes de la Dirección de Enfermería del CAUB en la fecha de estudio, excluyendo a los liberados sindicales o a los que estaban de vacaciones. Se usó el cuestionario Font Roja validado en el ámbito hospitalario, incluyendo variables sociodemográficas y laborales, y una pregunta sobre satisfacción global (de 0 a 10). Se realizó análisis univariante y bivariante. La relación entre las distintas variables se evaluó mediante pruebas estadísticas. RESULTADOS: se recogieron 1.089 encuestas. La edad media fue de 46 años (DE: 10,677). El 96% (n= 904) de los encuestados era mujer. El 59% (n= 563) de las encuestas analizadas fue respondida por enfermeras. El 93% (n= 889) llevaba ejerciendo la profesión más de cinco años. Un 53% (n= 506) de la muestra del estudio llevaba más de cinco años trabajando en la misma unidad. La puntuación media de la satisfacción global autopercibida fue de 6,74 (DE: 1,925). Las variables edad, tiempo desde la finalización de los estudios, tiempo de ejercicio de profesión, categoría profesional y área de trabajo mostraron relaciones estadísticamente significativas (p< 0,05) con la percepción de satisfacción global. Por dimensiones, la satisfacción es baja para la mayoría de los profesionales en casi todas excepto en contenido de su trabajo relación interprofesional. CONCLUSIONES: los profesionales se declaran satisfechos en su situación laboral global autopercibida. Las dimensiones mejor valoradas son las que se refieren a la relación interprofesional con superiores y al contenido del trabajo. Por su parte, la presión de trabajo, monotonía laboral y promoción/expectativas fueron los aspectos con los que los profesionales se sienten menos satisfechos

OBJECTIVE: to determine the level of job satisfaction among the staff under the Nursing Management of the Complejo Asistencial Universitario de Burgos (CAUB). METHOD: a cross-sectional descriptive study was designed. The study sample (n= 1,844) was formed with those active professionals under the authority of the Nursing Management of the CAUB at the time of the study, excluding full-time union representatives or those on holidays. The Font Roja questionnaire validated in the hospital setting was used, including sociodemographical and occupational variables, and one question on overall satisfaction (on a scale from 0 to 10). Univariate and bivariate analyses were conducted, and the relationship between different variables was evaluated through statistical tests. RESULTS: in total, 1,098 surveys were collected; the mean age was 46-year-old (SD: 10.677), and 96% (n= 904) of the survey participants were female. Of the surveys analyzed, 59% (n= 563) were answered by nurses; 93% (n= 889) of them had been in practice for over five years, and 53% (n= 506) of the study sample had been working in the same hospital unit for over five years. The mean score for self-perceived overall satisfaction was 6.74 (SD: 1.925). The following variables: age, time since completing their education, time of professional practice, professional job category and area of work, showed a statistically significant relationship (p< 0.05) with the perception of overall satisfaction. By dimensions, the level of satisfaction was low for the majority of professionals in almost all of them, except in job content and interprofessional relationship. CONCLUSIONS: professionals stated that they were satisfied in terms of their self-perceived overall working situation. The best valued dimensions were those regarding interprofessional relationship with superiors and job content; on the other hand, work pressure, monotony of tasks and promotion/expectations were the aspects with which professionals were less satisfied

Measurement uncertainty of ß-lactam antibiotics results: estimation and clinical impact on therapeutic drug monitoring.

Background Despite that measurement uncertainty data should facilitate an appropriate interpretation of measured values, there are actually few reported by clinical laboratories. We aimed to estimate the measurement uncertainty of some ß-lactam antibiotics (ß-LA), and to evaluate the impact of reporting the measurement uncertainty on clinicians' decisions while guiding antibiotic therapy. Methods Measurement uncertainty of ß-LA (aztreonam [ATM], cefepime [FEP], ceftazidime [CAZ], and piperacillin [PIP]) values, obtained by an UHPLC-MS/MS based-method, was estimated using the top-down approach called the single laboratory validation approach (EUROLAB guidelines). Main uncertainty sources considered were related to calibrators' assigned values, the intermediate precision, and the bias. As part of an institutional program, patients with osteoarticular infections are treated with ß-LA in continuous infusion and monitored to assure values at least 4 times over the minimal inhibitory concentration (4×MIC). We retrospectively evaluated the impact of two scenarios of laboratory reports on clinicians' expected decisions while monitoring the treatment: reports containing only the ß-LA values, or including the ß-LA coverage intervals (ß-LA values and their expanded measurement uncertainties). Results The relative expanded uncertainties for ATM, FEP, CAZ and PIP were lower than 26.7%, 26.4%, 28.8%, and 25.5%, respectively. Reporting the measurement uncertainty, we identified that clinicians may modify their decision especially in cases where 4×MIC values were within the ß-LA coverage intervals. Conclusions This study provides a simple method to estimate the measurement uncertainty of ß-LA values that can be easily applied in clinical laboratories. Further studies should confirm the potential impact of reporting measurement uncertainty on clinicians' decision-making while guiding antibiotic therapy.

Diffusion-weighted magnetic resonance imaging in peritoneal carcinomatosis from suspected ovarian cancer: Diagnostic performance in correlation with surgical findings.

PURPOSE: Ovarian cancer (OC) is the commonest cause of death by gynaecological cancer in developed countries. Peritoneal carcinomatosis (PC) complete debulking without residual disease of >1 cm is the best prognostic predictor in advanced OC. PC is assessed with Computed tomography (CT). CT accuracy and cytoreduction success predictive ability are limited. PET/CT is not an imaging standard for PC. PC shows high signal foci in Diffusion-weighted magnetic resonance imaging (DWI MRI). We assessed the diagnostic performance (DP) and tumour burden correlation of Whole body DWI with background suppression MRI (WB-DWIBS/MRI) in PC of suspected OC using the Peritoneal Cancer Index (PCI), referring to cytoreduction surgery as the standard reference. METHOD: Fifty patients with suspicion of disseminated OC underwent cytoreduction and WB-DWIBS/MRI. The PCI scores tumour burden (0-3) in 13 anatomical regions (global range of 0-39). Two radiologists (Rad1/Rad2) assessed the PCI preoperatively and with surgical findings. We evaluated regional and global DP, the interobserver agreement (Cohen´s kappa coefficient), statistical differences (McNemar test) and tumour burden (Pearson's test). RESULTS: 72% (36/50) were epithelial OC and 78% (39/50) achieved complete cytoreduction. Global-PCI correlation was 0.762 (Rad1) with DP: Sensitivity 0.84, specificity 0.89, accuracy 0.89, and kappa 0.41. Average global-PCI was 7. The pelvis and right hypochondrium showed the highest positive rate and DP, while the intestinal regions presented the lowest. Previous studies reported higher sensitivity than CT or PET/CT, although only a few used the PCI. CONCLUSIONS: WB-DWIBS/MRI is reliable to depict, quantify and to predict complete cytoreductive surgery in OC PC.

Tackling the Diagnosis: Solid Pseudopapillary Tumor of the Pancreas in a Young Man.

Solid pseudopapillary tumor (SPT) of the pancreas is an extremely rare pancreatic tumor. It usually goes undetectable for a prolonged period of time given its lack of clinical symptoms. But when detected, it has a malignancy potential of 15%. Here we present a case of SPT diagnosed incidentally in a 17-year-old man during a routine evaluation for an abdominal trauma.

Opinions of nurses regarding conscientious objection.

BACKGROUND: In the last decades, there have been important developments in the scientific and technological areas of healthcare. On certain occasions this provokes conflict between the patients' rights and the values of healthcare professionals which brings about, within this clinical relationship, the problem of conscientious objection. AIMS: To learn the opinions that the Nurses of the Madrid Autonomous Community have regarding conscientious objection. RESEARCH DESIGN: Cross-cutting descriptive study. PARTICIPANTS AND RESEARCH CONTEXT: The nurses of 9 hospitals and 12 Health Centers in the Madrid Autonomous Community. The study was done by means of an auto completed anonymous questionnaire. The variables studied were social-demographical and their opinions about conscientious objections. ETHICAL CONSIDERATIONS: The study was approved by the Ethical Community of Clinical Research of the University Hospital Príncipe de Asturias. Participants were assured of maximum confidentiality and anonymity. FINDINGS: A total of 421 nurses answered the questionnaire. In total, 55.6% of the nurses confirmed they were religious believers, and 64.3% declared having poor knowledge regarding conscientious objection. The matters that caused the greatest objections were voluntary abortions, genetic embryo selection, refusal of blood transfusions, and therapy refusal. DISCUSSION: Different authors state that the most significant cases of conscientious objections for health professionals are those regarding carrying out or assisting in abortions, euthanasia, the practice of assisted reproduction and, finally, the prescription and dispensing of the morning-after pill. In our study, the most significant cases in which the nurses would declare conscientious objections would be the refusal to accept treatment, the selection of embryos after genetic diagnosis preimplantation, the patient's refusal to receive blood transfusions due to religious reasons and pregnant women's request for voluntary abortions within the first 14 weeks. CONCLUSION: Nurses' religious beliefs influence their opinions regarding conscientious objection. The nurses who declare themselves as religious believers object in a higher percentage than those without religious beliefs.

"Edublog Enfermería" en España y México / Nursing Edublog in Spain and Mexico

OBJETIVO: conocer el impacto en las redes sociales tras implementar un proyecto de innovación docente, que consistió en la adaptación de un blog, "Edublog Enfermería", como herramienta de apoyo de las clases presenciales de dos universidades de España y México, y la difusión de contenidos docentes sobre salud sexual y reproductiva a través de las redes sociales Twitter y Facebook. MÉTODO: estudio descriptivo. Se crearon perfiles en redes sociales enlazados e insertados en el blog. Se invitó a utilizar estas herramientas a los 117 alumnos matriculados en la asignatura de Enfermería en Salud Sexual y Reproductiva de segundo curso de Grado en Enfermería de la Universidad de Valladolid durante un semestre académico (2016-2017). Se midió de forma descriptiva el uso de Facebook y Twitter después del semestre. RESULTADOS: se trabajó en red desde las dos universidades y se generó un intenso flujo de comunicación en gente joven. Twitter logró 1.001 seguidores, 4.267 tweets y 564 "Me gusta". Facebook 2.139 seguidores y un alcance semanal entre 15.000 y 25.000 personas e interacciones por semana de 1.200 a 1500. CONCLUSIONES: aprender a través de estas herramientas gratuitas, fáciles de usar, utilizadas de forma cotidiana, permiten la inmersión de los alumnos en el mundo profesional y de los profesionales en una continua actualización de su disciplina. La rapidez de la difusión de la comunicación que genera, la interacción y poder usarlas desde cualquier lugar y en cualquier momento hace que estas herramientas sean idóneas para el aprendizaje de Enfermería

OBJECTIVE: to understand the impact on social networks of implementing an educational innovation project, consisting in the adaptation of the blog called "Nursing Edublog" as a support tool for face-to-face classes in two Universities from Spain and Mexico, and the communication of educational contents on sexual and reproductive health through the social networks Twitter and Facebook. METHOD: a descriptive study. Profiles were created in social networks, linked and inserted in the blog. The 117 students registered in the course Sexual and Reproductive Health Nursing in the second term of the Nursing Degree at the Universidad de Valladolid were invited to use these tools during an academic semester (2016-2017). There was a descriptive measurement of the use of Facebook and Twitter after the semester. RESULTS: there was on-line work from both universities, and an intense communication flow was generated among young people. Twitter achieved 1,001 followers, 4,267 tweets and 564 Likes. Facebook achieved 2,139 followers, and reached between 15,000 and 25,000 persons per week and 1,200 to 1,500 interactions per week. CONCLUSIONS: learning through these free tools, easy to use and used daily, allow the immersion of students in the professional world, and a continuous update in their discipline for professionals. The fast spread of communication generated, the interaction, and the ability to use them from any place and at any time, make these tools adequate for education on Nursing

Evaluación del Informe de Cuidados de Enfermería en un hospital universitario / Assessment of nursing care reports in a university hospital

OBJETIVO: valorar la calidad de los Informes de Cuidados de Enfermería (ICE) realizados en las unidades de hospitalización de un complejo hospitalario universitario y determinar su mejoría en 2016 respecto a 2015. MÉTODO: se llevó a cabo un estudio descriptico longitudinal retrospectivo, con dos cortes en periodos similares, mayo de 2015 y mayo de 2016, en el Complejo Asistencial Universitario de Burgos. Para la recogida de datos se utilizó el programa de gestión de cuidados GACELA Care. Se analizó la calidad de los ICE en función a criterios estandarizados y consensuados por el equipo. Se realizó un análisis descriptivo de la calidad de los ICE. Para valorar los cambios entre 2015 y 2016 en su calidad global y de sus variables, se utilizó la prueba de Chi cuadrado o el test exacto de Fisher. RESULTADOS: se analizaron 666 informes. Los ICE efectuados aumentaron en el 2016 de 316 (79%) a 350 (85%). Los informes con calidad muy buena ascendieron del 1% (n= 4) al 17% (n= 60), disminuyendo los de calidad mala, del 53% (n= 169) al 42% (n= 146) con p< 0,00. Globalmente, las varibles de Observaciones (resumen) y Observaciones (dipositivos/continuidad de cuidados) mejoraron significativamente en 2016 respecto a 2015. La variable de Valoración activa alcanzó el 75% de cumplimentación, mientras que en el 13% de los ICE no se incluyeron recomendaciones al alta que precisaba el paciente CONCLUSIONES: la cumplimentación del ICE es bastante elevada, mejorando de un año a otro, aunque solo en el 25% de ellos se realiza con una calidad buena o muy buena. Sería recomendable planificar una intervención con el objeto de mejorar la calidad en la cumplimentación de estos informes

OBJECTIVE: to assess the quality of Nursing Care Reports (NCR) completed in the hospitalization units of a university hospital, and to determine their improvement in 2016 vs. 2015. METHOD: a retrospective longitudinal descriptive study was conducted, with two cut-off dates in similar periods: May, 2015 and May, 2016, in the Complejo Asistencia Universitario de Burgos. The care management program GACELA-Care was used for data collection. The quality of NCRs was analyzed based on standard criteria that were agreed upon by consensus of the team. There was a descriptive analysis of NCR quality. Chi-Square Test or Fisher's Exact Test was used in order to assess the changes between 2015 and 2016 in terms of overall quality and variables. RESULTS: there was an analysis of 666 reports. There was an increase in the number of NCRs conducted: from 316 (79%) to 350 (85%) in 2016. The reports with very good quality increased from 1% (n= 4) to 17% (n= 60), and there was a reduction in the number of reports with poor quality, from 53% (n= 169) to 42% (n= 146) with p< 0.00. Overall, the variables Observations (summary) and Observations (devices, continuity of care) improved significantly in 2016 vs. 2015. The Active Assessment variable reached 75% compliance, while 13% of NCRs did not include recommendations needed by the patient at discharge. CONCLUSIONS: NCR compliance is quite high, and improving from one year to another, though only 25% of these reports presented Good or Very Good quality. It would be advisable to plan an intervention with the aim to improve the quality in the completion of these reports

Influencia de determinantes de género en la anticoncepción de estudiantes de Enfermería y Obstetricia mexicanas / Influence of gender determinants on anticonception among Mexican Nursing and Obstetrics students / Influência de determinantes de gênero na anticoncepção de estudantes de Enfermagem e Obstetrícia Mexicanas

Objetivo: Analizar la influencia de los determinantes de género en la anticoncepción de estudiantes de Enfermería y Obstetricia de la Universidad Nacional Autónoma de México (UNAM). Método: Estudio observacional analítico con enfoque cuantitativo. Se administró el cuestionario COGANT, anónimo, voluntario y autocumplimentado de forma digital. Muestreo no probabilístico, incidental. Se incluyó a todas las estudiantes mujeres que aceptaron participar en el estudio de forma voluntaria, matriculadas en la asignatura de Obstetricia I de la Escuela Nacional de Enfermería y Obstetricia de la UNAM (n = 121). Análisis descriptivo de la media, desviación típica, rango y mediana de la puntuación total. Análisis factorial y test de normalidad de K-S. Se analizaron las puntuaciones obtenidas en cada ítem mediante porcentajes utilizando SPSS v. 23. Resultados: La puntuación media del cuestionario fue 58.68, DT 8.39, rango 43-87. En este estudio se comprobó que el eje central de la relación de pareja ya no es la maternidad. No se encontró gran influencia de los condicionantes de género en la salud reproductiva de las alumnas, predominó la autonomía y una actitud más igualitaria. Sin embargo, persisten algunos estereotipos de género, como la actitud pasiva o sumisa de las mujeres y un rol de género inseguro. Conclusiones: Desde las universidades los estudiantes de Enfermería deben capacitarse en salud sexual y reproductiva con perspectiva de género para que, al involucrarse después como profesionales de enfermería en la educación sexual integral de adolescentes, promuevan la igualdad de género y normas sociales equitativas e influyan sobre la conducta sexual más segura, ya que aplaza el inicio de las relaciones sexuales y aumenta el uso de los preservativos.

Objective: To analyze the influence which gender determinants have on Nursing and Obstetrics students of the National Autonomous University of Mexico. Method: This is an analytic observational study with a quantitative focus. The COGANT questionnaire was digitally offered to be voluntarily and anonymously completed. Sampling was non-probabilistic and incidental. The sample was constituted by n = 121 women students from the Obstetrics I course who voluntarily decided to participate. A descriptive analysis which included mean, typical deviation, range, and median calculation from the total scores was carried out. A factorial analysis and a K-S normality test were performed. SPSS v. 23 was used. Results: The median score in the questionnaire was 58.68, TD =8.39, range =43 to 87. The findings suggested that maternity is no longer the main core of the couple relationship. Gender conditions were not found to be highly influential on the students' reproductive health. An autonomous and equalitarian attitude prevailed among; nevertheless, some gender stereotypes such as passive or submissive attitude and an uncertain gender role still prevailed among some students. Conclusions: Within universities, nursing students should train and strengthen their sexual and reproductive health under a gender perspective so that they can also project, and promote, gender equalitarian social norms which can foster safe health behaviors including the use of preservatives and an older age of sexual relations initiation.

Objetivo: Analisar a influência dos determinantes de género na anticoncepção de estudantes de Enfermagem e Obstetrícia da Universidade Nacional Autónoma de México (UNAM). Método: Estudo observacional analítico com enfoque quantitativo. Administrou-se o questionário COGANT, anónimo, voluntário e auto oferecido de forma digital. Amostragem não probabilística, incidental. Incluíram-se todas as estudantes mulheres que aceitaram participar no estudo de forma voluntaria, matriculadas na disciplina de Obstetrícia I da Escola Nacional de Enfermagem e Obstetrícia da UNAM, corresponderam a uma n = 121. Análise descritiva da média, desvio típico, faixa e media da pontuação total. Análise fatorial e teste de normalidade de K-S. Analisaram-se as pontuações obtidas em cada item mediante porcentagens utilizando SPSS v. 23. Resultados: A pontuação média do questionário foi 58.68, DT 8.39, faixa 43-87. Neste estudo comprovou-se que o eixo central da relação do casal já não é a maternidade. Não se encontrou grande influência das condicionantes de género na saúde reprodutiva das alunas, predominou a autonomia e uma atitude mais igualitária. Porém, persistem alguns estereótipos de género como a atitude passiva ou submissa das mulheres e um rolo de género inseguro. Conclusões: Desde as universidades os estudantes de Enfermagem devem capacitar-se na saúde sexual e reprodutiva com perspectiva de género, para que ao envolver-se depois como profissionais de enfermagem na educação sexual integral de adolescentes, promovam a igualdade de género e normas sociais equitativas e influenciem sobre uma conduta sexual mais segura, já que adia o início das relações sexuais e aumenta o uso dos preservativos.

Elastografía tipo ARFI: modificación tras tratamiento antiviral en el trasplante hepático con recidiva por VHC / ARFI elastography: changes after direct-acting antiviral treatment in transplanted livers with relapse of hepatitis C virus infection

Objetivo. Evaluar la modificación de los valores en la elastografía hepática tipo ARFI tras el tratamiento antiviral en pacientes con trasplante hepático e infección por el virus de la hepatitis C (VHC) con recidiva durante el postrasplante. Material y métodos. Se han estudiado 15 pacientes receptores de trasplante hepático con infección por el VHC y recidiva sobre el injerto durante el primer año tras el trasplante que fueron tratados con antivirales de acción directa. A todos ellos se les realizó ecografía basal, Doppler y elastografía hepática tipo ARFI en los 3 meses anteriores al inicio del tratamiento y durante los 3 meses posteriores a su finalización. En la misma semana de la elastografía se realizó analítica con perfil hepático y determinación de la carga viral (ARN-VHC) en sangre periférica mediante técnica de reacción en cadena de la polimerasa. Se ha estudiado el cambio en las velocidades de cizallamiento de la elastografía antes y después del tratamiento. El análisis estadístico se ha efectuado mediante el test de Wilcoxon para datos apareados. Resultados. Todos los pacientes alcanzaron una respuesta viral mantenida a los 3 meses de finalizar el tratamiento. Se han encontrado diferencias estadísticamente significativas en las velocidades de la elastografía, con disminución de estas tras finalizar el tratamiento (la mediana de los valores de la onda de cizallamiento previos al tratamiento fue de 1,97m/s, y tras finalizarlo fue de 1,58m/s; p=0,001). Conclusión. La velocidad de la onda de cizallamiento disminuye de manera significativa tras el tratamiento antiviral en los pacientes receptores de trasplante hepático con recidiva de la infección por VHC (AU)

Objective. To evaluate the changes in the values obtained in acoustic radiation force impulse (ARFI) elastography of the liver after antiviral treatment in patients with liver transplants and hepatitis C virus (HVC) infection recurring after transplantation. Material and methods. We studied 15 patients infected with HVC who had received liver transplants where an HVC infection recurring in the graft within one year after the transplant was treated with direct-acting antivirals. All patients underwent ultrasonography including Doppler and ARFI elastography in the three months before starting treatment with direct-acting antivirals (baseline study) and again in the three months after finishing the treatment. In the same week when the elastography study was done, liver function tests were done and the viral load (HCV RNA) was determined in peripheral blood with the polymerase chain reaction method. We used the Wilcoxon test for paired samples to compare the changes in the shear wave velocities before and after treatment. Results. All patients achieved a virologic response that was sustained at 3 months after the end of treatment. On elastography, median shear wave velocities decreased after treatment (1.97m/s before treatment vs. 1.58m/s after treatment; p=0.001). Conclusion. The shear wave velocity decreased significantly after antiviral treatment in patients who had relapsed HVC infection after liver transplantation (AU)

ARFI elastography: changes after direct-acting antiviral treatment in transplanted livers with relapse of hepatitis C virus infection. / Elastografía tipo ARFI: modificación tras tratamiento antiviral en el trasplante hepático con recidiva por VHC.

OBJECTIVE: To evaluate the changes in the values obtained in acoustic radiation force impulse (ARFI) elastography of the liver after antiviral treatment in patients with liver transplants and hepatitis C virus (HVC) infection recurring after transplantation. MATERIAL AND METHODS: We studied 15 patients infected with HVC who had received liver transplants where an HVC infection recurring in the graft within one year after the transplant was treated with direct-acting antivirals. All patients underwent ultrasonography including Doppler and ARFI elastography in the three months before starting treatment with direct-acting antivirals (baseline study) and again in the three months after finishing the treatment. In the same week when the elastography study was done, liver function tests were done and the viral load (HCV RNA) was determined in peripheral blood with the polymerase chain reaction method. We used the Wilcoxon test for paired samples to compare the changes in the shear wave velocities before and after treatment. RESULTS: All patients achieved a virologic response that was sustained at 3 months after the end of treatment. On elastography, median shear wave velocities decreased after treatment (1.97m/s before treatment vs. 1.58m/s after treatment; p=0.001). CONCLUSION: The shear wave velocity decreased significantly after antiviral treatment in patients who had relapsed HVC infection after liver transplantation.

Blog materno-infantil: una experiencia en la Atención Primaria española / Mother-and-Child Blog: an experience in Spanish Primary Care

OBJETIVO: analizar la utilidad, la satisfacción y los flujos de información generados en la red 2.0 por el blog materno-infantil implementado en un centro de Atención Primaria de la Comunidad de Castilla y León. MÉTODO: estudio descriptivo longitudinal prospectivo (etapa final del embarazo, a los 15 días y a los 3 meses de vida del recién nacido) en un centro de salud urbano y sobre la población de mujeres embarazadas que realizan seguimiento de su embarazo y revisiones pediátricas. Además de las variables sociodemográficas, se incluyeron la utilidad y grado de satisfacción del blog materno-infantil, y aquellas que permitían analizar el flujo de comunicación del blog. Se realizó análisis estadístico descriptivo (medidas de tendencia central y dispersión; frecuencias absolutas y relativas), análisis bivariante (Chi cuadrado) y análisis del flujo de comunicación del blog mediante la aplicación Google Analytics. RESULTADOS: el blog fue utilizado por un 46% de mujeres durante la gestación y un 67% en los primeros tres meses del postparto. Destacó el mayor uso en mujeres primigestas y en las mujeres con un nivel socioeconómico alto. El grado de satisfacción obtuvo una puntuación superior a 8 (escala de 1 a 10) en todos los aspectos analizados. CONCLUSIONES: esta nueva forma de comunicación y educación para la salud en red, entre ciudadanos y sanitarios, ha demostrado un elevado nivel de aceptación, resolver problemas de salud, generar tranquilidad y tener un elevado nivel de satisfacción en los usuarios

OBJECTIVE: to analyze the utility, satisfaction, and information flows generated in the Web 2.0 by the Mother-and-Child Blog implemented in a Primary Care Centre of the Castile and León Community. METHOD: a prospective longitudinal descriptive study (final stage of pregnancy, at 15 days and at 3 months into the newborn life) in an urban health centre, and with the population of pregnant women undergoing pregnancy follow-up and paediatric check-ups. As well as sociodemographical variables, the study included the utility and level of satisfaction of the Mother-and-Child Blog, and any variables allowing the analysis of the communication flow in said blog. A descriptive statistical analysis was conducted (central tendency and dispersion measures; absolute and relative frequencies), bivariate analysis (Square-chi Test), and analysis of the communication flow in the blog through the Google Analytics application. RESULTS: the blog was used by 46% of women during pregnancy, and 67% during the first three months of the postpartum period. The higher use by first-time mothers stood out, as well as by women with a high socioeconomic level. The degree of satisfaction reached a score above 8 (scale from 1 to 10) in all aspects analyzed. CONCLUSIONS: this new way of on-line communication and health education between citizens and healthcare professionals has shown a high level of acceptance, solved health problems, provided reassurance, and reached a high degree of satisfaction among its users

Perfil internauta de las gestantes / Web-user profile in pregnant women from two primary care centers

Objetivo: conocer el perfil internauta de las gestantes de dos centros de salud con el fin de desarrollar un blog materno-infantil con contenidos de alto interés. Material y métodos: estudio descriptivo longitudinal de gestantes con fecha probable de parto de entre el 1 de mayo de 2014 y el 31 de marzo de 2015, con seguimiento de su embarazo y revisiones pediátricas del bebé en dos centros de salud urbanos. Se analizaron variables sociodemográficas y datos sobre frecuencia de uso de Internet, modalidades y expectativas. Resultados: se analizaron 101 cuestionarios. Edad media de las embarazadas: 32,64 años. El 53,8% fueron primíparas, el 37,6% tenía ya un hijo y el 8,7% dos o más. El 2,2% sin estudios, el 10,8% estudios primarios, el 43% secundarios y el 44,1% universitarios. El teléfono fue el dispositivo más utilizado. El 79,6% utilizaban Internet a diario. El nivel de estudios y la edad de la madre influyeron en el uso de determinados dispositivos y en la frecuencia de acceso. Los motivos principales para usar Internet fueron el correo electrónico y la búsqueda de información sobre salud. Los temas más consultados fueron maternidad, alimentación y estilos de vida. Más de la mitad buscan información en Internet antes o después de la consulta. A la mayoría les gustaría que su matrona, enfermera o pediatra utilizara nuevos canales de información y comunicación. Conclusiones: se observa un elevado uso de Internet para consultar problemas de salud entre las gestantes, especialmente las que tienen estudios superiores y menos de 30 años. Las primigestas muestran elevado interés en recibir información. Está justificado desarrollar herramientas de formación y comunicación sanitaria, como los blogs sanitarios (AU)

Objectives: to assess the web-user profile in pregnant women from two primary care centers with the intention of developing high interest blog contents. Methods: descriptive study of 101 pregnant women who gave birth between May 2014 and March 2015 and attended routine post-partum and pediatric visits. Results: a total of 101 surveys were analyzed. The mean age was 32.64 years. In parity groups 53.8% were nulliparous, 37.6% second birth, 8.7% third birth or more. 13% had a low education level, 43% medium (secondary studies) and 44.1% high education level. Devices utilized were 88.2% smartphone, 82.6% personal computer, 65.6% tablet and 52.7% family computer. A 79.6% used the Internet every day. The level of education along with the age of the mother influences the use of certain devices and the frequency of internet access. Main uses were email and browsing health information. Most viewed topics were motherhood, food and lifestyle. More than half frequently looked for information before or after visiting the doctor or nurse. The majority of women are willing to communicate and receive information with/from the caregiver by new channels such as blogs, social media, etc. especially in primigravid women. Conclusions: pregnant women frequently use the Internet to consult about health problems, specially those with high level of education and aged under 30. Primigravid women are the most interested. This experiment supports further development of education and communication tools such as health-related blogs (AU)

La tecnología 2.0 al servicio de la salud materno-infantil / Technology 2.0 at the service of maternal and child health

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Ventajas e inconvenientes del aprendizaje basado en problemas percibidos por los estudiantes de Enfermería / Advantages and disadvantages of problem-based learning perceived by nursing students

Objetivo: Estudio exploratorio cualitativo fenomenológico con el objetivo de que los alumnos de Enfermería de la Universidad de Valladolid (España) reflexionen sobre las ventajas e inconvenientes tras utilizar metodología de aprendizaje basado en problemas durante un semestre académico. Sujetos y métodos: La muestra intencional estuvo formada por 47 grupos de entre cuatro y seis estudiantes con un total de 256 alumnos. Se recogieron datos a través de grupos focales cuyas opiniones fueron registradas por escrito realizando un análisis de contenido a través de la técnica de categorización. Resultados y conclusionea: Las ventajas percibidas son la elevada motivación, la mejora del trabajo en equipo, un aprendizaje más profundo y un cambio de papeles de los estudiantes, que fueron responsables de su propio aprendizaje, y de las profesoras, que fueron tutoras que les guiaron y orientaron. Entre los inconvenientes hay que señalar un rechazo inicial al cambio, la dificultad en la coordinación del grupo, una mayor carga de trabajo y un mayor tiempo para el aprendizaje

Aim: It is a phenomenological, qualitative and exploratory study with the aim of nursing students at the University of Valladolid (Spain) to reflect on the pros and cons after using problem based learning methodology during an academic semester. Subjects and methods: Intentional sampling methods were consisted of 47 groups of 4-6 students with a total of 256 students. Data was collected through focus groups whose opinions were recorded in writing by performing a content analysis through the technique of categorization. Results and conclusions: On the one hand, perceived advantages include: high motivation, improved teamwork, deeper learning and changing roles of students being responsible for their own learning and teachers, being mentors who guided and guided them. On the other hand, the disadvantages are: an initial rejection of change, difficulty in coordinating the group, increased workload and more time spent for learning

Evaluación por los estudiantes al tutor de enfermería en el contexto del aprendizaje basado en problemas / Student assessment on nursing mentor within the context of Problem Based Learning / Avaliação do orientador pelos estudantes de enfermagem no contexto de Aprendizagem Baseada em Problemas

IntroducciónLa universidad necesita incorporar metodologías docentes activas para adaptarse a las demandas de la sociedad del conocimiento en la que el alumno debe ser responsable de su propio aprendizaje. El rol del profesor como un tutor permite dar mayor protagonismo a los estudiantes en su proceso de aprendizaje.ObjetivoInvolucrar al alumnado de enfermería en la evaluación a sus tutoras después de utilizar metodología del aprendizaje basado en problemas y comprobar si existen diferencias en el proceso tutorial entre una tutora experta y una tutora novel.MétodosEstudio transversal, descriptivo, en una muestra de 128 estudiantes de 2.° curso de Enfermería de la Universidad de Valladolid (España) que contestaron a un cuestionario tipo Likert.ResultadosSe encontraron diferencias estadísticamente significativas (p < 0.01) en todos los ítems entre ambas tutoras. La evaluación fue muy satisfactoria.ConclusionesEvaluar al tutor permite una reflexión y retroalimentación entre los estudiantes y sus tutores, mejora la calidad docente y proporciona más autonomía a los estudiantes en su aprendizaje, implicándoles en la responsabilidad de ser honestos al evaluar las actividades de otros miembros del equipo, incluyendo las del tutor y las propias.

IntroductionThe University needs to incorporate active teaching methodologies to respond to the demands of knowledge societies in which the student must be responsible for their own learning. The role of the professor as a mentor allows students to be protagonists of their learning process.ObjectiveTo involve nursing students in the assessment of their mentors after using the methodology of Problem Based Learning, and to verify if there are differences in the mentoring process between an expert mentor and a novice one.MethodsTransversal and descriptive study with a sample of 128 students in their 2 nd Nursing course at the Valladolid University (Spain) who answered a Likert scaled questionnaire.ResultsStatistically significant differences (p < .01) were found in all items between both mentors. The assessment was very satisfactory.ConclusionsAssessing the tutor allows reflection and feedback of students and their mentors, encouraging them to be honest at evaluating the activities of other team members, including those of the tutor and their own.

IntroduçãoA universidade precisa incorporar metodologias docentes ativas para se adaptar às demandas da sociedade do conhecimento, na qual o aluno deve ser responsável de sua própria aprendizagem. O papel do professor como um orientador permite dar maior protagonismo aos estudantes no seu processo de aprendizagem.ObjetivoEnvolver o alunado de enfermagem na avaliação e as suas orientadoras depois da utilização da metodologia de aprendizagem baseada em problemas e comprovar a existência de diferenças no processo da orientação entre uma orientadora experiente e uma orientadora novel.MétodosEstudo transversal, descritivo, em uma amostra de 128 estudantes do 2.° curso de enfermagem da Universidade de Valladolid (Espanha), que responderam um questionário tipo Likert.ResultadosEncontraram-se diferenças estatisticamente significativas (p < 0,01) em todos os itens entre ambas as orientadoras. A avaliação foi muito satisfatória.ConclusõesAvaliar o orientador permite uma reflexão e retroalimentação entre os estudantes e os seus orientadores, melhora a qualidade docente e proporciona mais autonomia aos estudantes na sua aprendizagem, envolvendo-os na responsabilidade de ser honestos para avaliar as atividades dos outros membros da equipe, incluindo as do orientador e as próprias.

Hábitos sexuales en los adolescentes de 13 a 18 años / Sexual behavior in adolescents 13 to 18 years old

Introducción: la población adolescente es especialmente vulnerable a los riesgos relacionados con su conducta sexual, dado que se trata de un periodo de maduración en el que experimentar forma parte de esta etapa evolutiva. El embarazo en adolescentes y la maternidad temprana están asociados con el fracaso escolar, el deterioro de la salud física y mental, aislamiento social, pobreza y otros factores relacionados. Por otra parte, no usar métodos anticonceptivos de barrera aumenta el riesgo de infecciones de transmisión sexual (ITS), con serias consecuencias a corto y largo plazo en la salud biopsicosocial de los adolescentes. Objetivos: conocer las características sobre sexualidad de los adolescentes de la provincia de Valladolid. Métodos: estudio transversal descriptivo mediante encuesta anónima a una muestra de 2412 escolares de 13 a 18 años, en el curso académico 2011-2012. Resultados: el 81% de los alumnos consideran que tienen una información muy buena o buena sobre sexualidad. El 75% de los alumnos consideran que la información que tienen sobre infecciones de transmisión sexual es muy buena o buena. Han tenido relaciones con penetración el 30,4% de los alumnos. La edad de inicio de las relaciones sexuales completas se sitúa entre los 15 y 16 años (50,9%). La mayoría declaran que utilizan algún método anticonceptivo en sus relaciones (91,3%), pero todavía hay un 8,7% que refiere no utilizar ninguno. La mayoría utilizan como método anticonceptivo el preservativo (89,6%). Un 20,9% de los adolescentes que mantienen relaciones sexuales con penetración han utilizado en alguna ocasión la píldora del día después o anticoncepción de urgencia. El 3,6% declara haberse quedado embarazada o haber dejado embarazada a su pareja. Conclusiones: a pesar de considerarse suficientemente informados sobre sexualidad e ITS, los adolescentes presentan comportamientos de riesgo en sus actividades sexuales (AU)

Introduction: the adolescent population is particularly vulnerable to the risks related with their sexual behavior, because it is a period of maturation and experience which is part of this evolutionary stage. Teenage pregnancy and early motherhood are associated with school failure, impaired physical and mental health, social isolation, poverty and other related factors. Moreover the non-use of appropriate protective barriers increases the risk of sexually transmitted infections (STI), with serious consequences in the short and long term biopsychosocial adolescent health. Objectives: to determine the characteristics of adolescent sexuality in the province of Valladolid. Methods: cross-sectional study, using an anonymous survey to 2412 schoolchildren 13-18 years old in the academic year 2011-2012. Results: 81% of students feel they have very good or good information on sexuality. 75% of students believe that the information they have about STI is very good or good. 30.4% have had sexual intercourse. The age of first complete sexual intercourse is between 15 and 16 years (50.9%). Most of the adolescents use a contraceptive method in their relationships (91.3%), but there are still 8.7% referring not using any. Most of the students use the condom for contraceptive method (89.6%). 20.9% of teens who have had sex with penetration have used 'the morning-after pill' or emergency contraception at some time. 3.6% reported having being pregnant or having left his partner pregnant (AU)

Edublog Enfermería / Nursing edublog

Una de las principales innovaciones que se debe llevar a cabo para implementar la actual reforma de la universidad española se encuentra en el protagonismo de los estudiantes y las metodologías que promuevan el aprendizaje autónomo y, también, colaborativo. En este artículo se presenta el diseño y construcción de un blog educativo por el profesorado y el alumnado de la asignatura Enfermería en Salud Sexual y Reproductiva en 2º Grado en Enfermería de la Universidad de Valladolid (España), que tiene la finalidad de desarrollar estrategias didácticas novedosas para compartir ideas o como un instrumento de soporte para contenidos curriculares. Los weblogs, blogs o bitácoras son herramientas de gran utilidad en educación, son gratuitos y fáciles de usar. Complementan la enseñanza presencial, permiten el aprendizaje colaborativo, sirven como buscadores a través de enlaces específicos y promueven la interacción entre los profesores y los estudiantes con sus comentarios

One of the main innovations which must be conducted in order to implement the current reform in the Spanish University consists in the main role played by students and the methodologies which promote independent as well as cooperative learning. In this article, we present the design and building of an educational blog by the professors and students of the Nursing in Sexual and Reproductive Health subject in the 2nd Nursing Degree of the University of Valladolid (Spain), with the objective of developing innovative learning strategies to share ideas or as a supporting tool for educational contents. Weblogs, blogs or logs are very useful tools in education, they are free and easy to use. They complement face-to-face teaching, allow collaborative learning, are useful search engines through specific links, and they promote interaction between professors and students with their comments