Family Caregivers' Experiences during the COVID-19 Pandemic: Qualitative Study.

Background: The COVID-19 pandemic imposed lockdown measures that affected caregiving. Understanding caregivers' context provides reveals their adaptive strategies to continue caring in this situation of uncertainty and isolation. Objective: To better understand the caregiving experiences of caregivers looking after dependent individuals living in the community during the pandemic. Design: Qualitative research, phenomenological approach. Setting: Primary healthcare centers in Madrid region (Spain). Participants: 21 family caregivers. Methods: Purposive and theoretical sampling was used to recruit caregivers across nurses from primary healthcare centers. Participants were interviewed using a semi-structured interview guide to explore the caring experience. Interview transcripts were evaluated using thematic analysis. Results: The findings were categorized into two themes: "Caregivers during lockdown-providing care in a time of adversity" and "Caregiving toward normality". The sub-themes identified were the re-structuring of before-care services and the introduction of new care approaches, managing the dependent person's health problems, looking after oneself, and dealing with adversity. To adapt to the new normal, strategies were put in place designed to recover confidence and trust, reincorporate assistance, and reconnect with others. Conclusions: Care intensified during the pandemic. Caregivers took on the task without assistance, focusing on preventing contagion and protecting themselves to be able to continue giving care.

Nursing Diagnoses of Individuals with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Research Protocol for a Qualitative Synthesis.

Although previously developed qualitative studies have explored the experience of illness of individuals with myalgic encephalomyelitis/chronic fatigue syndrome, these findings have not been undertaken for the purpose of enabling the identification of nursing care needs in such patients. This study aims to identify NANDA-I nursing diagnoses of adults with myalgic encephalomyelitis/chronic fatigue syndrome based on a qualitative literature review of their experience of illness. The protocol includes: searches in the electronic databases Medline, Embase, CINAHL, PsycINFO, SCI-EXPANDED, SSCI, SciELO, LILACS, and Cuiden; and manual searches in specialised journals and the references of the included studies. The authors will systematically search qualitative research studies published in databases from 1994 to 2021. Searches are limited to studies in Spanish and English. All stages of the review process will be carried out independently by two reviewers. Any disagreements shall be resolved through joint discussions, involving a third reviewer if necessary. The findings will be synthesised into a thematic analysis informed by the Domains and Classes of the NANDA-I Classification of Nursing Diagnoses, which will then serve to identify nursing diagnoses. This review will enable nursing professionals to identify the care needs of individuals with myalgic encephalomyelitis/chronic fatigue syndrome by taking into consideration their experience of illness in its entirety.

[Uncovering infertility: the experience of women undergoing assisted reproductive technologies.] / Descubrir la infertilidad: la experiencia de mujeres sometidas a técnicas de reproducción asistida.

OBJECTIVE: Infertility is a huge reproductive health problem in developed countries. The aim was to understand the infertility experience of women who have undergone assisted reproduction technologies. METHODS: Qualitative study using Grounded Theory. Through intentional sampling and theoretical sampling, 20 women who had undergone Assisted Reproduction Technologies in public hospitals and specialized private clinics in Spain were selected. Data were collected using semi-structured interviews and were analysed using the principles of Grounded Theory: initial coding and focused coding, memo writing, theoretical sampling and constant comparative method. RESULTS: "Uncovering infertility: unveiling the unknown" is the core category that explains the process which women go through. Four subcategories emerged and describe the temporal process from seeking pregnancy to reception and coping with the infertility diagnosis: "Seeking for a vital desire: being mothers/fathers", "Suspecting infertility: the absence of the natural", "In search of a diagnosis: knowing and understanding the problem" and "The impact of diagnosis: a vital grief". CONCLUSIONS: Uncovering infertility is a process that has an impact on the different areas of women's lives. This process produces different emotions and feelings such as guilt, frustration, sadness or anger. This process could be easier if women have the support of their partner, their social environment and if they share their problem with women who have the same situation.

OBJETIVO: La infertilidad es uno de los grandes problemas de salud reproductiva en los países desarrollados. El objetivo de este estudio fue comprender la experiencia vivida de la infertilidad por mujeres que se han sometido a técnicas de reproducción asistida. METODOS: Estudio cualitativo de Teoría Fundamentada. Mediante muestreo intencional y muestreo teórico se seleccionaron 20 mujeres que habían sido sometidas a técnicas de reproducción asistida tanto en hospitales públicos como en clínicas privadas especializadas en España. La técnica de recogida de los datos fue la entrevista semiestructurada. El análisis siguió los procedimientos de la Teoría Fundamentada: codificación inicial y focalizada, escritura de memos analíticos, muestreo teórico y método de comparación constante. RESULTADOS: "Descubrir la infertilidad: desvelar lo desconocido" es la categoría principal que explica el proceso que viven las mujeres. Emergieron cuatro subcategorías que describen el proceso temporal desde el inicio de la búsqueda de embarazo hasta la recepción y afrontamiento del diagnóstico de infertilidad: "Buscar un deseo vital: ser madres/padres", "Sospechar la infertilidad: la ausencia de lo natural", "En busca de un diagnóstico: conocer y comprender el problema" y "El impacto del diagnóstico: un duelo vital". CONCLUSIONES: Descubrir la infertilidad es un proceso que afecta a los distintos ámbitos de la vida de las mujeres y en el que aparecen emociones y sentimientos como culpa, frustración, tristeza o rabia. Este proceso puede estar facilitado cuando se tiene el apoyo de su pareja, el entorno y se comparte el problema con mujeres que tienen su misma situación.

Nurses' perceptions and demands regarding COVID-19 care delivery in critical care units and hospital emergency services.

BACKGROUND: The COVID-19 pandemic is a public health challenge that puts health systems in a highly vulnerable situation. Nurses in critical care units (CCUs) and hospital emergency services (HESs) have provided care to patients with COVID-19 under pressure and uncertainty. OBJECTIVE: To identify needs related to safety, organisation, decision-making, communication and psycho-socio-emotional needs perceived by critical care and emergency nurses in the region of Madrid, Spain, during the acute phase of the epidemic crisis. METHODS: This is a cross-sectional study (the first phase of a mixed methods study) with critical care and emergency nurses from 26 public hospitals in Madrid using an online questionnaire. RESULTS: The response rate was 557, with 37.5% reporting working with the fear of becoming infected and its consequences, 28.2% reported elevated workloads, high patient-nurse ratios and shifts that did not allow them to disconnect or rest, while taking on more responsibilities when managing patients with COVID-19 (23.9%). They also reported deficiencies in communication with middle management (21.2%), inability to provide psycho-social care to patients and families and being emotionally exhausted (53.5%), with difficulty in venting emotions (44.9%). CONCLUSIONS: Critical care and emegency nurses may be categorised as a vulnerable population. It is thus necessary to delve deeper into further aspects of their experiences of the pandemic.

Micellar Nanocarriers from Dendritic Macromolecules Containing Fluorescent Coumarin Moieties.

The design of efficient drug-delivery vehicles remains a big challenge in materials science. Herein, we describe a novel class of amphiphilic hybrid dendrimers that consist of a poly(amidoamine) (PAMAM) dendritic core functionalized with bisMPA dendrons bearing cholesterol and coumarin moieties. Their self-assembly behavior both in bulk and in water was investigated. All dendrimers exhibited smectic A or hexagonal columnar liquid crystal organizations, depending on the generation of the dendrimer. In water, these dendrimers self-assembled to form stable spherical micelles that could encapsulate Nile Red, a hydrophobic model compound. The cell viability in vitro of the micelles was studied in HeLa cell line, and proved to be non-toxic up to 72 h of incubation. Therefore, these spherical micelles allow the encapsulation of hydrophobic molecules, and at the same time provided fluorescent traceability due to the presence of coumarin units in their chemical structure, demonstrating the potential of these dendrimers as nanocarriers for drug-delivery applications.

Coumarin-Containing Pillar[5]arenes as Multifunctional Liquid Crystal Macrocycles.

Liquid crystal macrocycles (LCMs) combine the unique properties of liquid crystals with those associated with macrocyclic compounds-shape persistence and the capability of hosting small molecules. Herein, we investigate the grafting of coumarin-containing promesogenic moieties to pillar[5]arene as a strategy to obtain multifunctional LCMs. Pillar[5]arenes containing 10 and 30 coumarin units are glassy materials with nematic mesomorphism. Moreover, the coumarin moieties afford the pillar[5]arene derivatives with enhanced film-forming and photoresponsive properties. Photodimerization of the coumarin moieties results in cross-linked polymer networks, which can be used as alignment layers. Therefore, liquid-crystal coumarin-containing pillar[5]arenes represent a significant addition to the family of LCMs and may become useful for the development of engineered, hierarchical structures and materials.

General anesthesia safety in progressive leukodystrophies: A retrospective study of patients with Krabbe disease and metachromatic leukodystrophy.

BACKGROUND: Krabbe disease and metachromatic leukodystrophy are leukodystrophies characterized by neurologic degeneration and early death. Patients often require general anesthesia for diagnostic and therapeutic interventions. METHODS: A retrospective review of medical records was conducted for patients with Krabbe disease and metachromatic leukodystrophy receiving general anesthesia at a large children's hospital between 2012 and 2017. Patient complications and American Society of Anesthesiologists Physical Status were recorded for all procedures. The Neurodevelopment in Rare Disorders classification system was created to categorize the severity of the patient's disease progression based on clinical markers. Descriptive and inferential statistics were used to compare: (a) complication rate of affected patients vs the general hospital population; (b) the accuracy of the novel Neurodevelopment in Rare Disorders classification system vs American Society of Anesthesiologists Physical Status regarding the assessment of complication risk; (c) complication rate in patients with hematopoietic stem cell transplantation vs those without transplantation; (d) complication rate in immunosuppressed patients vs nonimmunosuppressed patients; and (e) complication rate of the three most commonly performed procedures. RESULTS: A total of 96 patients underwent 287 procedures. Of these, 11 cases had complications, yielding a rate of 3.8%. This is significantly higher than the overall complication rate at our institution of 0.246%. Statistical analysis showed better correlation between the Neurodevelopment in Rare Disorders classification system and complication rate than American Society of Anesthesiologists Physical Status and complication rate. The system also showed better accuracy in differentiating low-risk and high-risk patients. No statistically significant difference in complication rate was found for patients with transplantation vs those without transplantation or for immunosuppressed vs nonimmunosuppressed patients. Of the three most common procedures, central catheter placement/removal exhibited the highest complication rate. CONCLUSIONS: Although the complication rate for patients with Krabbe disease and metachromatic leukodystrophy is higher than the general population, most complications were mild and self-limiting. These results suggest that, in experienced hands, general anesthesia is well tolerated in most children. Findings show that the Neurodevelopment in Rare Disorders classification system is a better indicator for assessing complication risk in patients with Krabbe and metachromatic leukodystrophy than American Society of Anesthesiologists Physical Status.

Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment: a qualitative pilot study.

BACKGROUND: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. METHODS: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. RESULTS: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. CONCLUSIONS: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. TRIAL REGISTRATION: ClinicalTrials.gov , NCT02757781 . Registered on 25 April 2016.

Factores que determinan la evaluación del trabajo fin de grado. Un análisis multinivel / Factors that determine the evaluation of the final year project. An analysis multilevel

OBJETIVOS: Analizar el desarrollo y la evaluación de los resultados de la implementación del trabajo fin de grado (TFG) en el grado de enfermería (2010-2014) de la Universidad Autónoma de Madrid, así como explorar los factores que influyen en la evaluación global del TFG (EGT) y en las puntuaciones de las competencias alcanzadas en la memoria y la defensa. MÉTODO: Estudio descriptivo transversal en 146 estudiantes de 4.° de grado en enfermería de la Universidad Autónoma de Madrid. Variables: sexo, convocatoria, modalidad TFG, tipología TFG, temática TFG, seminarios, proceso de tutorización, competencias específicas en la memoria la defensa y en la EGT (de 0-10). Análisis: regresión lineal múltiple multinivel de efectos mixtos (variable aleatoria: tutor). RESULTADOS: Ciento treinta y ocho estudiantes defendieron su TFG. En un 19,6% la temática fue «salud mental». Un 54,3% fueron revisiones narrativas. La puntuación media en la memoria, la defensa y EGT: 8,69, 8,25 y 8,69 respectivamente. En los modelos de regresión lineal múltiple multinivel, la variable que permaneció (p≤0,05) tanto para la memoria y la defensa fue el proceso de tutorización. Para la EGT permanecieron en el modelo la convocatoria (menor calificación en la extraordinaria [coeficiente B: -0,791; p = 0,000]) y la modalidad (mayor calificación si el TFG era realizado por 2/3 estudiantes (coeficiente B: 0,282; p = 0,053). CONCLUSIONES: Las calificaciones medias en TFG reflejan un adecuado nivel competencial, contribuyendo a una mejor puntuación tanto en la memoria como en la defensa el proceso de tutorización. La modalidad conjunta para realizar el TFG, así como su presentación en convocatoria ordinaria, elevaron la calificación de la EGT

OBJECTIVES: To analyze the development and evaluation of the results from implementation of the End-of-Degree Proyect (EDP) in the Nursing Degree (2010-2014) of Universidad Autónoma de Madrid, as well as to explore factors that influence Global Assessment of EDP (GAE) and competency scores achieved in the Final Report and Defense. METHOD: Cross-sectional study on 146 students of 4th Grade in Nursing of the Universidad Autónoma de Madrid. Variables: Sex, exam convocation, EDP modality, EDP typology, EDP subject, seminars, tutoring, specific competences in Final Report, Defense and GAE (0-10). Data analysis: Multilevel linear regression models (random variable: tutor). RESULTS: 138 students defended their EDP. The subject was "Mental Health" in 19,6% of the cases. 54.3% of EDP were narrative reviews. Average score in Final Report and Defense and GAE: 8.69, 8.25 and 8.69 respectively. In multilevel multiple linear regression models, the variable that remained (p≤0,05) for both Final Report and Defense was tutoring. Exam Convocation (less qualification in the extraordinary one (coefficient B: -0,791; p 0.000)) and modality (higher score if EDP was performed by two/three students (coefficient B: 0.282; p = 0.053) remained in model to GAE. CONCLUSIONS: The average qualifications in EDP reflect an adequate level of competence; tutoring contributes to a better score in both Final Report and Defense. The joint modality to realize EDP, as well as its presentation in ordinary exam convocation, elevated the qualification of the GAE

Sobrepeso y obesidad: eficacia de las intervenciones en adultos / Overweight and obesity: effectiveness of interventions in adults

Objetivo: Identificar las intervenciones más efectivas en adultos con sobrepeso y obesidad. Método: Revisión narrativa mediante búsqueda bibliográfica en bases de datos PubMed, Cochrane, Instituto Joanna Briggs, EMBASE, Cuiden y Cinahl con lenguaje libre y controlado (términos MeSH) utilizando los operadores booleanos AND y OR. La búsqueda se limitó a artículos publicados entre 2007-2015. Se seleccionaron 18 en función de los criterios de inclusión y exclusión establecidos. Resultados: Se identificaron distintos tipos de intervenciones basadas en la modificación de los estilos de vida, fundamentalmente dieta, actividad física y la esfera del comportamiento, encontrándose grandes diferencias en cuanto a contenidos específicos, grado de intensidad de las intervenciones, tiempo de seguimiento y elementos evaluados. En la mayoría de los estudios se consiguen pérdidas de peso estadísticamente significativas pero limitadas en cuanto a peso y número de personas. Las intervenciones que utilizan Internet no tienen un efecto uniforme en la pérdida de peso. En el mantenimiento logran niveles similares al de cara a cara. Conclusiones: La combinación de dieta, ejercicio y terapia cognitivo-conductual es la forma más eficaz de intervención en el sobrepeso y la obesidad. No existen datos suficientes para señalar la intervención grupal o individual como más efectivas. La intervención online permite una mayor accesibilidad y menor coste (AU)

Objective: To identify the most effective interventions in overweight and obese adults. Method: A narrative review through a search of the literature in databases PubMed, Cochrane, Joanna Briggs Institute, EMBASE, Cuiden y Cinahl with free and controlled language (MeSH terms) using Boolean operators AND and NOT. The research was limited to articles published between 2007 and 2015. Eighteen articles were selected based on the established inclusion and exclusion criteria. Results: Different types of interventions were identified based on the modification of lifestyles, mainly diet, physical activity and behavior. Major differences were found in specific content, degree of intensity of interventions, time tracking and elements evaluated. Most of studies found statistically significant weight loss but this was limited in terms of weight and number of people. Web-based interventions have no uniform effect on weight loss but achieve similar levels to face-to-face interventions in maintaining weight loss. Conclusions: The combination of personalised diet, exercise and cognitive behavioural therapy is the most effective form of intervention in overweight and obesity. There is insufficient data to indicate whether group or individual interventions are more effective. Online intervention allows greater accessibility and lower cost (AU)

Overweight and obesity: effectiveness of interventions in adults. / Sobrepeso y obesidad: eficacia de las intervenciones en adultos.

OBJECTIVE: To identify the most effective interventions in overweight and obese adults. METHOD: A narrative review through a search of the literature in databases PubMed, Cochrane, Joanna Briggs Institute, EMBASE, Cuiden y Cinahl with free and controlled language (MeSH terms) using Boolean operators AND and NOT. The research was limited to articles published between 2007 and 2015. Eighteen articles were selected based on the established inclusion and exclusion criteria. RESULTS: Different types of interventions were identified based on the modification of lifestyles, mainly diet, physical activity and behavior. Major differences were found in specific content, degree of intensity of interventions, time tracking and elements evaluated. Most of studies found statistically significant weight loss but this was limited in terms of weight and number of people. Web-based interventions have no uniform effect on weight loss but achieve similar levels to face-to-face interventions in maintaining weight loss. CONCLUSIONS: The combination of personalised diet, exercise and cognitive behavioural therapy is the most effective form of intervention in overweight and obesity. There is insufficient data to indicate whether group or individual interventions are more effective. Online intervention allows greater accessibility and lower cost.

Proton conductive ionic liquid crystalline poly(ethyleneimine) polymers functionalized with oxadiazole.

Two novel series of ionic liquid crystal polymers that display proton conductive properties are presented here. These materials are based on linear (l-PEI) or branched (b-PEI) poly(ethyleneimine) functionalized with unsymmetrical oxadiazole carboxylic acids derived from 1,3,4-oxadiazole (1,3,4-OXA m ) or 1,2,4-oxadiazole (1,2,4-OXA m ). The subscript "m" indicates the length of the spacer between the rigid moiety and the carboxyl group, namely m = 4 and 10. The occurrence of proton transfer from the carboxylic acid to the amine groups was confirmed by FTIR and NMR measurements. The liquid crystalline properties were investigated by differential scanning calorimetry (DSC), polarizing optical microscopy (POM), and X-ray diffraction (XRD). All ionic complexes displayed enantiotropic smectic A mesophases and in the case of the l-PEI derivatives a nematic phase was also observed at high temperatures. All investigated derivatives presented good proton conductivity values as determined by electrochemical impedance spectroscopy (EIS). Therefore, these ionic LC hyperbranched polymers represent an effective approach for the preparation of proton-transporting polymeric materials with potential applications in electrochemical devices.

Not Only Columns: High Hole Mobility in a Discotic Nematic Mesophase Formed by Metal-Containing Porphyrin-Core Dendrimers.

We report a new family of multifunctional liquid-crystalline porphyrin-core dendrimers that have coumarin functional groups around the porphyrin core. Porphyrin metalation strongly affects the photophysical properties, and therefore ZnII and CuII derivatives have also been prepared. All the synthesized dendrimers form a nematic discotic mesophase. Their high tendency for homeotropic alignment makes these dendrimers excellent candidates for device applications, owing to their easy processability, spontaneous alignment between electrodes, and self-healing of defects because of their dynamic nature. The charge mobility values of these materials are the highest ever reported for a nematic discotic phase. Moreover, these values are similar to the highest values reported for ordered columnar mesophases, and this shows that a supramolecular organization in columns is not necessary to achieve high charge mobility.

Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study.

OBJECTIVE: to identify the students' perception about the quality of clinical placements and asses the influence of the different tutoring processes in clinical learning. METHODS: analytical cross-sectional study on second and third year nursing students (n=122) about clinical learning in primary health care. The Clinical Placement Evaluation Tool and a synthetic index of attitudes and skills were computed to give scores to the clinical learning (scale 0-10). Univariate, bivariate and multivariate (multiple linear regression) analyses were performed. RESULTS: the response rate was 91.8%. The most commonly identified tutoring process was "preceptor-professor" (45.2%). The clinical placement was assessed as "optimal" by 55.1%, relationship with team-preceptor was considered good by 80.4% of the cases and the average grade for clinical learning was 7.89. The multiple linear regression model with more explanatory capacity included the variables "Academic year" (beta coefficient = 1.042 for third-year students), "Primary Health Care Area (PHC)" (beta coefficient = 0.308 for Area B) and "Clinical placement perception" (beta coefficient = - 0.204 for a suboptimal perception). CONCLUSIONS: timeframe within the academic program, location and clinical placement perception were associated with students' clinical learning. Students' perceptions of setting quality were positive and a good team-preceptor relationship is a matter of relevance. OBJETIVO: identificar a percepção dos estudantes de enfermagem sobre a qualidade das Práticas Clínicas em Atenção Primária à Saúde e avaliar a influência dos diferentes processos de tutoria na aprendizagem clínica. MÉTODOS: um estudo analítico transversal realizado com alunos do segundo e do terceiro ano de enfermagem (n = 122) na aprendizagem clínica nos serviços de Atenção Primária à Saúde. A Ferramenta de Avaliação de Práticas Clínicas (Clinical Placement Evaluation Tool) e um índice sintético de atitudes e habilidades (escala de 0 a 10) foram calculados para marcar a aprendizagem clínica. Foram realizadas análises univariadas, bivariadas e multivariadas (regressão linear múltipla). RESULTADOS: a taxa de resposta foi de 91,8%. O processo de tutoria mais indicado foi o de "preceptor-professor" (45,2%). As Práticas Clínicas foram avaliadas como "ótimas" por 55,1%, o relacionamento com a equipe-preceptor foi considerado bom por 80,4% dos casos e a classificação média para a aprendizagem clínica foi de 7,89. O modelo de regressão linear múltipla, com mais capacidade explicativa incluiu as variáveis "ano acadêmico" (coeficiente de beta = 1.042 para alunos do terceiro ano), "área de cuidados de saúde primários" (coeficiente de beta = 0,308 para a Área B) e "percepção de práticas clínicas" (beta coeficiente = - 0,204 para uma percepção menos que ótima). CONCLUSÕES: O momento dentro do programa acadêmico, a localização e percepção das Práticas Clínicas foram associados com a aprendizagem clínica dos alunos. A percepção dos alunos sobre a qualidade do lugar das Práticas Clínicas foi positiva e um bom relacionamento da equipe-preceptor é uma questão de relevância. OBJETIVO: identificar la percepción del alumnado de enfermería sobre la calidad de las Prácticas Clínicas y evaluar la influencia de los diferentes procesos de tutoría en el aprendizaje clínico. MÉTODOS: estudio analítico transversal realizado con estudiantes de segundo y tercer año de enfermería (n = 122) en el aprendizaje clínico en los servicios de atención primaria de salud. La Herramienta de Evaluación de Prácticas Clínicas (Clinical Placement Evaluation Tool) y un índice sintético de las actitudes y habilidades (escala de 0 a 10) se calcularon para puntuar el aprendizaje clínico. Se realizaron análisis univariados, bivariados, multivariados (regresión lineal múltiple). RESULTADOS: la tasa de respuesta fue del 91,8%. El proceso de tutoría más comúnmente identificado fue "preceptor-profesor" (45,2%). Las Prácticas Clínicas se evaluaron como "óptimas" en un 55,1%, la relación equipo-preceptor fue considerada buena por el 80,4% de los casos y la calificación media para el aprendizaje clínico fue de 7.89. El modelo de regresión lineal múltiple con mayor capacidad explicativa incluyó las variables "año académico" (coeficiente beta = 1.042 para los estudiantes de tercer año), "Área de Atención Primaria de la Salud" (coeficiente beta = 0,308 para el Área B) y la "percepción de las Prácticas Clínicas" (coeficiente beta = - 0,204 para una percepción subóptima). CONCLUSIONES: el momento dentro del programa académico, la ubicación y la percepción de las Prácticas Clínicac se asociaron con el aprendizaje clínico de los estudiantes. La percepción de los estudiantes de la calidad del lugar de las Prácticas Clínicas fue positiva y la buena relación equipo-preceptor es una cuestión de relevancia.

La experiencia del cuidado de las mujeres cuidadoras con procesos crónicos de salud de familiares dependientes / The experience of women care cargivers with chronic conditions of dependent relatives

Objetivo: Describir la experiencia del cuidado de las mujeres cuidadoras con procesos crónicos de salud que cuidan de un familiar dependiente. Diseño: Estudio cualitativo de teoría fundamentada constructivista. Emplazamiento: Estudio realizado en dos áreas de salud urbanas de la Comunidad de Madrid. Participantes: Treinta y nueve mujeres con enfermedad crónica que cuidan a familiares dependientes se seleccionaron por medio del muestreo con propósito. Método: Los datos se recolectaron por medio de 23 entrevistas semiestructuradas y 2 grupos focales entre abril de 2010 y diciembre de 2011. En el análisis de datos se utilizaron los procedimientos de la teoría fundamentada. Resultados: Sentir la vida mermada describe la experiencia subjetiva de las cuidadoras familiares con procesos crónicos de salud que cuidan a un familiar dependiente. Al contrastar su vida pasada con su vida actual se hacen conscientes de las pérdidas que han ido sufriendo a lo largo del tiempo. Se sienten menos fuertes, más tristes y menos libres, les preocupa cómo hacer frente a las demandas del cuidado familiar. La vida que ahora llevan les hace cuestionarse el sentido de sus propias vidas. Conclusiones: Este estudio muestra las pérdidas que constatan las mujeres cuidadoras con procesos crónicos de salud en su día a día que les lleva a perder el sentido de su propia vida. Conocer la experiencia de estas cuidadoras ayudará a los equipos de atención primaria a desarrollar intervenciones específicas de acuerdo con las necesidades específicas de las cuidadoras y proporcionar recursos que compensen las pérdidas que sienten y mejoren su calidad de vida (AU)

Objective: To describe the experience of women caregivers with chronic conditions who care for a dependent relative. Design: Qualitative study based on constructivist grounded theory. Location: Study conducted on two Health Areas urban of the Community of Madrid. Participants: Thirty nine women with a chronic condition who take care of dependent relatives were selected by means of purposive sampling. Method: Data were collected through 23 semi-structured interviews and 2 focus groups between April 2010 and December 2011. Grounded theory procedures were used in the data analysis. Results: To feel their life hampered describes the subjective experience of family caregivers with chronic conditions who take care of a dependent relative. When comparing their past life with the current life they become aware of the losses they have suffered over time. They feel less strong, sadder and less free; they worry about how to meet the demands of family care. The life they are leading makes them question the meaning of their own lives. Conclusions: This study shows the losses realized day by day by women caregivers with a chronic illness, which lead them to lose the meaning of their own lives. To know the experience of these women caregivers will help develop interventions and specific services that compensate for the losses they feel and help improve their quality of living (AU)

[The experience of women care cargivers with chronic conditions of dependent relatives]. / La experiencia del cuidado de las mujeres cuidadoras con procesos crónicos de salud de familiares dependientes.

OBJECTIVE: To describe the experience of women caregivers with chronic conditions who care for a dependent relative. DESIGN: Qualitative study based on constructivist grounded theory. LOCATION: Study conducted on two Health Areas urban of the Community of Madrid. PARTICIPANTS: Thirty nine women with a chronic condition who take care of dependent relatives were selected by means of purposive sampling. METHOD: Data were collected through 23 semi-structured interviews and 2 focus groups between April 2010 and December 2011. Grounded theory procedures were used in the data analysis. RESULTS: To feel their life hampered describes the subjective experience of family caregivers with chronic conditions who take care of a dependent relative. When comparing their past life with the current life they become aware of the losses they have suffered over time. They feel less strong, sadder and less free; they worry about how to meet the demands of family care. The life they are leading makes them question the meaning of their own lives. CONCLUSIONS: This study shows the losses realized day by day by women caregivers with a chronic illness, which lead them to lose the meaning of their own lives. To know the experience of these women caregivers will help develop interventions and specific services that compensate for the losses they feel and help improve their quality of living.

Factors associated to clinical learning in nursing students in primary health care: an analytical cross-sectional study / Fatores associados à aprendizagem clínica dos alunos de enfermagem nos cuidados de saúde primários: um estudo analítico transversal / Factores asociados al aprendizaje clínico de los estudiantes de enfermería en la atención primaria de salud: un estudio transversal analítico

ABSTRACT Objective: to identify the students' perception about the quality of clinical placements and asses the influence of the different tutoring processes in clinical learning. Methods: analytical cross-sectional study on second and third year nursing students (n=122) about clinical learning in primary health care. The Clinical Placement Evaluation Tool and a synthetic index of attitudes and skills were computed to give scores to the clinical learning (scale 0-10). Univariate, bivariate and multivariate (multiple linear regression) analyses were performed. Results: the response rate was 91.8%. The most commonly identified tutoring process was "preceptor-professor" (45.2%). The clinical placement was assessed as "optimal" by 55.1%, relationship with team-preceptor was considered good by 80.4% of the cases and the average grade for clinical learning was 7.89. The multiple linear regression model with more explanatory capacity included the variables "Academic year" (beta coefficient = 1.042 for third-year students), "Primary Health Care Area (PHC)" (beta coefficient = 0.308 for Area B) and "Clinical placement perception" (beta coefficient = - 0.204 for a suboptimal perception). Conclusions: timeframe within the academic program, location and clinical placement perception were associated with students' clinical learning. Students' perceptions of setting quality were positive and a good team-preceptor relationship is a matter of relevance.

RESUMO Objetivo: identificar a percepção dos estudantes de enfermagem sobre a qualidade das Práticas Clínicas em Atenção Primária à Saúde e avaliar a influência dos diferentes processos de tutoria na aprendizagem clínica. Métodos: um estudo analítico transversal realizado com alunos do segundo e do terceiro ano de enfermagem (n = 122) na aprendizagem clínica nos serviços de Atenção Primária à Saúde. A Ferramenta de Avaliação de Práticas Clínicas (Clinical Placement Evaluation Tool) e um índice sintético de atitudes e habilidades (escala de 0 a 10) foram calculados para marcar a aprendizagem clínica. Foram realizadas análises univariadas, bivariadas e multivariadas (regressão linear múltipla). Resultados: a taxa de resposta foi de 91,8%. O processo de tutoria mais indicado foi o de "preceptor-professor" (45,2%). As Práticas Clínicas foram avaliadas como "ótimas" por 55,1%, o relacionamento com a equipe-preceptor foi considerado bom por 80,4% dos casos e a classificação média para a aprendizagem clínica foi de 7,89. O modelo de regressão linear múltipla, com mais capacidade explicativa incluiu as variáveis "ano acadêmico" (coeficiente de beta = 1.042 para alunos do terceiro ano), "área de cuidados de saúde primários" (coeficiente de beta = 0,308 para a Área B) e "percepção de práticas clínicas" (beta coeficiente = - 0,204 para uma percepção menos que ótima) Conclusões: O momento dentro do programa acadêmico, a localização e percepção das Práticas Clínicas foram associados com a aprendizagem clínica dos alunos. A percepção dos alunos sobre a qualidade do lugar das Práticas Clínicas foi positiva e um bom relacionamento da equipe-preceptor é uma questão de relevância.

RESUMEN Objetivo: identificar la percepción del alumnado de enfermería sobre la calidad de las Prácticas Clínicas y evaluar la influencia de los diferentes procesos de tutoría en el aprendizaje clínico. Métodos: estudio analítico transversal realizado con estudiantes de segundo y tercer año de enfermería (n = 122) en el aprendizaje clínico en los servicios de atención primaria de salud. La Herramienta de Evaluación de Prácticas Clínicas (Clinical Placement Evaluation Tool) y un índice sintético de las actitudes y habilidades (escala de 0 a 10) se calcularon para puntuar el aprendizaje clínico. Se realizaron análisis univariados, bivariados, multivariados (regresión lineal múltiple). Resultados: la tasa de respuesta fue del 91,8%. El proceso de tutoría más comúnmente identificado fue "preceptor-profesor" (45,2%). Las Prácticas Clínicas se evaluaron como "óptimas" en un 55,1%, la relación equipo-preceptor fue considerada buena por el 80,4% de los casos y la calificación media para el aprendizaje clínico fue de 7.89. El modelo de regresión lineal múltiple con mayor capacidad explicativa incluyó las variables "año académico" (coeficiente beta = 1.042 para los estudiantes de tercer año), "Área de Atención Primaria de la Salud" (coeficiente beta = 0,308 para el Área B) y la "percepción de las Prácticas Clínicas" (coeficiente beta = - 0,204 para una percepción subóptima). Conclusiones: el momento dentro del programa académico, la ubicación y la percepción de las Prácticas Clínicac se asociaron con el aprendizaje clínico de los estudiantes. La percepción de los estudiantes de la calidad del lugar de las Prácticas Clínicas fue positiva y la buena relación equipo-preceptor es una cuestión de relevancia.

La reflexividad en la escritura de informes en la investigacion cualitativa / Reflexiveness in report writing for qualitative research

La reflexividad es un asunto fundamental en la investigación cualitativa, pues trabaja con la subjetividad de las personas desde la subjetividad del investigador. Permite a los investigadores reconocer su papel, la naturaleza situada de su investigación y valorar su impronta o huella en el resultado final de la misma. El proceso reflexivo está presente en todos los niveles de un estudio de investigación, desde la pregunta de investigación a la elaboración final del informe. Una postura reflexiva informa cómo el investigador lleva a cabo su investigación, las relaciones con los participantes en esta y cómo los representa en los informes. El presente artículo muestra cómo el proceso de la escritura de informes de los resultados de una investigación cualitativa promueve el uso de la reflexividad, ilustrándolo en el caso particular de un estudio de investigación; y cómo la escritura es un camino que ayuda a construir el self investigador

Reflexiveness is an essential matter in qualitative research, because it works with the subjectivity of persons from the subjectivity of the researcher. It allows researchers to acknowledge their role, the positioned nature of their research, and to assess their own impression or mark on the final research outcomes. The reflexive process is present in all levels of a research study, from the research question to the final report preparation. A reflexive position informs the way in which the researcher conducts the research, their relationship with participants, and how these are represented in reports. The present article shows how the process of writing the report about the outcomes of a qualitative research will encourage the use of reflexiveness, by illustrating it with the specific case of a research study; and how writing is a road which helps to build the researcher self

Bladder neck closure in children: long-term results and consequences.

AIM: Only few studies have gathered information on the long-term outcomes of children undergoing bladder neck closure (BNC). In the present study, we analyze the long-term results and consequences in this population. PATIENTS AND METHODS: The medical records of 20 patients (12 males and 8 females), who underwent BNC after several failed procedures to improve urinary incontinence were revised. Exstrophy complex was the underlying diagnose in all the cases: bladder exstrophy in 15 and cloacal exstrophy in 5. The median age of the patients at the time of surgery was 11.5 years (range 4-19 years). Previous surgeries were bladder neck reconstruction in 14 patients, bladder neck injection in 4 patients, and previous BNC in 1 patient. Overall 17 patients had concomitant bladder augmentation. The catheterizable stoma was made with appendix in 14, bowel in 3, and ureter in 3. The nine male patients aged>18 years at the time of this study received a questionnaire with specific questions on erections, orgasm, and details of ejaculation and were also asked to provide a semen sample. RESULTS: The median follow-up was 10 years (range 2-17 years) and median patient age was 21 years (range 13-32 years). Urinary continence was achieved initially in 16 patients (80%); 4 had a bladder neck fistula, 3 of them underwent surgical revision and achieved dryness. Long-term complications were: bladder stones (eight patients); stomal problems (four stenosis and three leaks); bladder perforation (two patients), and orchitis (one patient). All patients above the age of 18 years reported erections and orgasms although two had medium erectile dysfunction. The ejaculate volume was reported as normal in five, scarce in three, and absent in one, with slow ejection in seven. Only four supplied semen samples and only two showed normal values. CONCLUSIONS: BNC is an effective approach to incontinence when other procedures have failed. In the long term, the most frequent complications are those related with catheterizable stoma and stones. The high incidence report of a low fertility index and erectile dysfunction meant further study in a larger cohort.

Women's self-management of chronic illnesses in the context of caregiving: a grounded theory study.

AIMS AND OBJECTIVES: Uncover how women self-manage their own chronic illness while taking care of a dependent relative. BACKGROUND: International policies place special emphasis in promoting interventions addressed to control, prevent and care for people with chronic health conditions. Self-management is a crucial part of this care. Caregivers are more prone to have chronic illness than non-caregivers. They are confronted with dilemmas about taking care of themselves while taking care of their dependent relative and the rest of their families. Caregivers articulate strategies to enable them to focus their energy on caring. DESIGN: Qualitative study using constructivist grounded theory. METHODS: Thirty-nine women caregivers with a chronic illness participated in the study. Twenty-three semi-structured interviews and two focus groups were carried out between April 2010-December 2011. Data were analysed using grounded theory procedures. FINDINGS: Self-management helps women caregivers with a chronic illness to balance the demands of their own illness and those of the dependent relative. They self-manage their illness by self-regulating the treatment, by regulating their strength and by controlling their emotions. CONCLUSIONS: Women caregivers integrate effectively and creatively the management of their chronic illnesses within the complexities of family care. This renders their health needs invisible and reaffirms them as capable caregivers. RELEVANCE TO CLINICAL PRACTICE: Identifying self-management strategies of women caregivers allow health professionals to acknowledge and reinforce effective self-care measures and to deter those that are ineffective and lessen their quality of life.