Telehealth Virtual Simulation Across the Family Nurse Practitioner Curriculum.

ABSTRACT: The American Association of Colleges of Nursing recognizes telehealth education as an essential aspect of nurse practitioner (NP) education because it increases accessibility to health care. Studies reported in the literature have focused on NP telehealth simulation, but findings for the inclusion of simulation in multiple courses throughout the curriculum are scarce. This pre- and post-survey design study aimed to evaluate family nurse practitioner students' perceptions of knowledge, confidence, and attitudes regarding telehealth before and after engaging in telehealth virtual simulations in six courses. Simulations were rated highly and telehealth knowledge increased in three of the six courses.

Standardized Patients Versus Mannequins in Mental Health Simulation.

BACKGROUND: Mental health nursing simulation using various modalities can be useful in increasing student confidence, satisfaction, knowledge, and communication skills. Studies comparing the benefits of mental health nursing simulation using standardized patients versus mannequins are scarce. AIMS: The purpose of this study was to explore differences in knowledge, clinical learning, clinical reasoning, communication, confidence, and learner satisfaction when conducting mental health nursing simulation with standardized patients compared to mannequins. METHODS: A convenience sample of 178 senior level baccalaureate nursing students enrolled in the mental health nursing course participated in this study. Of the total sample, 41.6% (n = 74) participated in high-fidelity mannequin simulation and 58.4% (n = 104) in standardized patient simulation. Measures included a knowledge assessment, Satisfaction with Simulation Experience Scale (SSE), and a simulation evaluation survey. RESULTS: While knowledge levels increased regardless of simulation modality, clinical reasoning, clinical learning, communication, realism, and overall rating of the simulation experience were significantly higher among participants in standardized patient simulation compared to mannequins. CONCLUSIONS: Mental health simulations can be a useful learning tool for engaging in mental health scenarios in a safe simulated learning environment. While both mannequins and standardized patient modalities are helpful in increasing mental health nursing knowledge, standardized patient simulation has a greater impact on several other aspects including clinical reasoning and communication. Future multisite studies with larger samples are needed, including a wider variety of mental health scenarios.

Foundations of Nursing: Comparing Face-to-Face Versus Blended Learning.

ABSTRACT: Research focusing on blended learning for foundations of nursing courses is limited. The purpose of this study was to compare course performance outcomes when teaching foundations using blended learning compared to face-to-face instruction and to evaluate learner satisfaction and perceptions of effectiveness regarding blended learning. No significant differences were found in exam or final course grades between the two modalities. Most participants perceived blended learning as effective in meeting the course objectives and rated the course as either excellent, very good, or good. Blended learning was a useful strategy for teaching foundations of nursing.

N­glycosylation and receptor tyrosine kinase signaling affect claudin­3 levels in colorectal cancer cells.

Changes in protein levels in different components of the apical junctional complex occur in colorectal cancer (CRC). Claudin­3 is one of the main constituents of tight junctions, and its overexpression can increase the paracellular flux of macromolecules, as well as the malignant potential of CRC cells. The aim of this study was to investigate the molecular mechanisms involved in the regulation of claudin­3 and its prognostic value in CRC. In silico evaluation in each of the CRC consensus molecular subtypes (CMSs) revealed that high expression levels of CLDN3 (gene encoding claudin­3) in CMS2 and CMS3 worsened the patients' long­term survival, whereas a decrease in claudin­3 levels concomitant with a reduction in phosphorylation levels of epidermal growth factor receptor (EGFR) and insulin­like growth factor 1 receptor (IGF1R) could be achieved by inhibiting N­glycan biosynthesis in CRC cells. We also observed that specific inactivation of these receptor tyrosine kinases (RTKs) led to a decrease in claudin­3 levels, and this regulation seems to be mediated by phospholipase C (PLC) and signal transducer and activator of transcription 3 (STAT3) in CRC cells. RTKs are modulated by their N­linked glycans, and inhibition of N­glycan biosynthesis decreased the claudin­3 levels; therefore, we evaluated the correlation between N­glycogenes and CLDN3 expression levels in each of the CRC molecular subtypes. The CMS1 (MSI immune) subtype concomitantly exhibited low expression levels of CLDN3 and N­glycogenes (MGAT5, ST6GAL1, and B3GNT8), whereas CMS2 (canonical) exhibited high gene expression levels of CLDN3 and N­glycogenes (ST6GAL1 and B3GNT8). A robust positive correlation was also observed between CLDN3 and B3GNT8 expression levels in all CMSs. These results support the hypothesis of a mechanism integrating RTK signaling and N­glycosylation for the regulation of claudin­3 levels in CRC, and they suggest that CLDN3 expression can be used to predict the prognosis of patients identified as CMS2 or CMS3.

Evaluación comparativa, mediante ensayos biomecánicos, de dispositivos de ostomía de dos piezas / Comparative evaluation through biomechanical tests of two-piece ostomy systems

OBJETIVO: comparar las propiedades mecánicas de los dispositivos de ostomía de dos piezas más empleados en España (Coloplast -o Fabricante I- y Fabricante II), mediante la realización de ensayos mecánicos. MÉTODO: los ensayos se realizaron en el Instituto de Biomecánica de Valencia (IBV), empleándose una máquina universal de ensayos MTS INSIGHT/468, con unas condiciones ambientales controladas de temperatura (22-24 ºC) y de humedad (39-41%). El tamaño de la muestra para cada uno de los ensayos fue de 10 unidades para cada tipo de sistema. Se llevaron a cabo tres pruebas: 1) Ensayo de resistencia a la degradación del adhesivo en solución salina; 2) Ensayo de resistencia al estallido del canal de vaciado de las bolsas abiertas; 3) Ensayo de resistencia a la separación entre el disco y la bolsa. RESULTADOS: en el ensayo de resistencia a la degradación del adhesivo en solución salina, los dos adhesivos, sometidos a periodos de degradación de 6 y 12 horas en solución salina a 37 ºC, presentaron diferencias significativas a favor del Fabricante I (Coloplast) para los dos periodos. En el ensayo de resistencia al estallido del canal de vaciado de las bolsas abiertas, con las bolsas llenas de agua, cerradas y pegadas sobre una plancha lisa, después de aplicar cargas de compresión hasta el estallido del canal, los dos sistemas no mostraron diferencias significativas. En el ensayo de resistencia a la separación entre el disco y la bolsa, ensamblada cada bolsa a su disco correspondiente y aplicadas cargas de tracción hasta la separación, también hubo diferencias significativas a favor del Fabricante I (Coloplast). CONCLUSIÓN: se puede afirmar que ambos sistemas son seguros, pero el sistema Coloplast presenta mayor durabilidad ante la degradación por el efluente y mayor coeficiente de seguridad frente a la separación entre la bolsa y el disco

OBJECTIVE: to compare the mechanical characteristics of the two-piece ostomy systems most widely used in Spain: (Coloplast or Manufacturer I and Manufacturer II), through mechanical tests. METHOD: tests were conducted in the Instituto de Biomecánica de Valencia (IBV), using a MTS INSIGHT/468 universal test machine, under environmental conditions of controlled temperature (22-24 ºC) and humidity (39-41%). The sample size for each test was 10 units per each type of system. Three tests were conducted: 1) Resistance test to degradation of the adhesive in saline solution; 2) Resistance test to burst of the outlet in open pouches; 3) Resistance test for the separation between the disc and the pouch. RESULTS: in the test of resistance to degradation of the adhesive in saline solution, both adhesives were submitted to 6 and 12-hour degradation periods in saline solution at 37 ºC, and significant differences were presented in favour of Manufacturer 1 (Coloplast) for both time periods. In the resistance test for the burst of the outlet in open pouches, the pouches were filled with water, closed and stuck on a flat plate; after applying compression charges until the outlet burst, both systems did not show any significant differences. In the resistance test for the separation between disc and pouch, each pouch was assembled with its disc, and traction charges were applied until their separation; there were significant differences in favour of Manufacturer I (Coloplast). CONCLUSION: it can be stated that both systems are safe, but the Coloplast system shows higher durability in terms of degradation by effluent, and a higher safety coefficient regarding the separation between pouch and disc

Evaluación comparativa mediante ensayos biomecánicos de anillos moldeables de ostomía / Comparative assessment through biomechanical trials between moldable rings for ostomy

OBJETIVO: determinar la resistencia a la degradación en solución salina de diversos anillos moldeables para ostomía, así como comprobar si existen diferencias estadísticamente significativas entre la resistencia a la degradación de los anillos moldeables de Coloplast (Col-2 y Col-4,2) con respecto a dos anillos moldeables comerciales de otros fabricantes (Fab1 y Fab2). MÉTODOS: el material objeto de ensayo consiste en cuatro modelos de anillos moldeables: Col-2 de 2 mm de espesor, Col-4,2 de 4,2 mm de espesor, Fab1 y Fab2 de espesor 4 mm. El tamaño de la muestra de ensayo fue de 10 unidades por tipo de sistema. Los ensayos fueron realizados en el laboratorio de ensayos del Instituto de Biomecánica de Valencia, utilizando una máquina universal de ensayos INSTRON8874/511, con unas condiciones ambientales de temperatura (23 ºC) y de humedad (56%). RESULTADOS: el análisis estadístico de los resultados revela diferencias estadísticamente significativas (p< 0,001) entre las muestras pertenecientes a Coloplast (Col-2= 1,84 N y Col-4,2 = 1,97 N) con las muestras de los fabricantes 1 y 2 (Fab1= 0,90 N y Fab2= 0,92 N). No se observan diferencias estadísticamente significativas entre las dos muestras de Coloplast (p= 0,706) ni entre las dos muestras de los otros dos fabricantes (p= 0,917). CONCLUSIÓN: las dos muestras de Coloplast presentan valores de fuerza de penetración significativamente mayores (dos veces superiores) que las muestras de los otros dos fabricantes y, por tanto, una mayor resistencia a la degradación a las seis horas de estar sumergida en un suero salino. Sin embargo, no se observan diferencias estadísticamente significativas en la resistencia a la degradación entre las dos muestras de Coloplast a pesar de ser anillos de diferente grosor. Este efecto se debe a que las mediciones se han realizado con penetraciones de 1 mm

OBJECTIVE: to determine the resistance to degradation in saline solution for different moldable rings for ostomy, as well to confirm if there are any statistically differences between the resistance to degradation in Coloplast moldable rings (Col-2 and Col-4.2) vs. two moldable rings marketed by other manufacturers (Fab1 and Fab2). METHODS: the material object of the trial consisted in four models of moldable rings: Col-2 with 2 mm thickness, Col-4.2 with 4.2 mm thickness, and Fab1 & Fab2 4 mm thickness. The trial sample size was 10 units per type of system. The trials were conducted at the testing laboratory of the Biomechanical Institute, Valencia, using a universal testing machine INSTRON8874/511, under environmental conditions of temperature (23 ºC) and humidity (56%). RESULTS: the statistical analysis of results revealed statistically significant differences (p< 0.001) between the Coloplast samples (Col-2= 1.84 N and Col-4.2 = 1.97 N) and the samples from manufacturers 1 and 2 (Fab1= 0.90 N and Fab2= 0.92 N). No statistically significant differences were observed between the two Coloplast samples (p= 0.706) or between the two samples from the other two manufacturers (p= 0.917). CONCLUSION: the two Coloplast samples presented significantly higher penetration strength values (twice higher) than the samples from the other two manufacturers; and therefore, higher resistance to degradation at six hours of being immersed in saline. However, no statistically significant differences were observed in terms of resistance to degradation between both Coloplast samples, regardless of the different thickness of the rings. This effect was due to measurements being conducted with 1mm penetrations

High-Fidelity Mannequin Simulation versus Virtual Simulation for Recognition of Critical Events by Student Registered Nurse Anesthetists.

Early recognition of intraoperative critical events is essential in optimizing the health outcomes of surgical patients. Use of simulation in nurse anesthesia education allows students to practice recognizing changes in the patient's condition in a safe learning environment. Second- and third-year student registered nurse anesthetists were randomly assigned to 2 groups to explore differences in recognizing intraoperative myocardial infarction (MI) using highfidelity mannequin simulation vs virtual simulation. One group participated in a virtual simulation first, followed by a high-fidelity mannequin simulation. The other group participated in a high-fidelity mannequin simulation first, then virtual simulation. Second-year students recognized an intraoperative MI faster when using high-fidelity mannequin simulation than when using virtual simulation. However, there was no significant difference among third-year students in the time it took to recognize a critical event when using high-fidelity mannequin simulation vs virtual simulation. These findings indicate that both simulation modalities are useful in evaluating student registered nurse anesthetists' timely recognition of intraoperative critical events such as MI. However, for students with less didactic and clinical practicum experience in the program, such as second-year students, the use of high-fidelity mannequin simulation for recognizing an intraoperative MI may be more beneficial than virtual simulation.

Circulating Neutrophil Extracellular Traps Are Elevated in Patients With Deep Infiltrating Endometriosis.

Neutrophil extracellular traps (NETs) have been described to be related to the pathogenesis of inflammatory and autoimmune conditions. Endometriosis is currently considered a chronic inflammatory condition. Therefore, we performed a preliminary case-control study to compare the circulating plasma NET levels in patients with surgically confirmed endometriosis (E group, n = 82) and those of patients without surgical findings of endometriosis (C group, n = 35). Venous blood samples were obtained at the time of surgery. Circulating plasma NET levels were assessed as histone-DNA complexes (ie, nucleosomes) by a quantitative sandwich enzyme-linked immunosorbent assay. The results were expressed in arbitrary units. Circulating plasma NET levels were significantly higher in the E group compared with the C group (median [25th; 75th percentiles]): E group: 0.734 [0.484; 1.363]; C group: 0.541 [0.411; 0.653]; P = .005). The subanalysis of E group patients with deep infiltrating endometriosis (DIE group) or without DIE (non-DIE group) showed that plasma NET levels were higher in the DIE group ( P = .02). No differences were observed in NET levels among patients with and without severe pelvic pain or in patients with and without infertility, regardless of the presence of endometriotic lesions. Therefore, our study shows significantly higher NET levels in patients with endometriosis, which seem to be attributed to increased levels in the subgroup of patients with DIE, suggesting that the presence of elevated circulating plasma NET levels may reflect an inflammatory status in this gynecological condition. Further research is warranted to confirm our findings and to assess the exact role of NETs in the pathophysiological mechanisms of endometriosis.

Biomechanical study of pelvic discontinuity in failed total hip arthroplasty. Lessons learnt from the treatment of pelvic fractures.

Pelvic discontinuity is a rare but serious problem in orthopedic surgery. Acetabular reconstruction in case of severe bone loss after failed total hip arthroplasty is technically difficult, especially in segmental loss type III (anterior or posterior) or pelvic discontinuity (type IV). Acetabular reinforcement devices are frequently used as load-sharing devices to allow allograft incorporation and in order to serve as support of acetabular implants. This study tries to show, by means of biomechanic work, the efficiency of reinforced plate in anterior column in a segmental pelvic loss, illustrated with a clinical case, which shows the socket stability of hip prosthesis.

Anti-proliferative and pro-apoptotic effects induced by simultaneous inactivation of HER1 and HER2 through endogenous polyclonal antibodies.

The human epidermal growth factor receptor (HER1) and its partner HER2 are extensively described oncogenes and validated targets for cancer therapy. However, the effectiveness of monospecific therapies targeting these receptors is hampered by resistance emergence, which is frequently associated with the upregulation of other members of HER family. Combined therapies using monoclonal antibodies or tyrosine kinase inhibitors have been suggested as a promising strategy to circumvent this resistance mechanism. We propose an alternative approach based on simultaneous inactivation of HER1 and HER2 by multi-epitope blockade with specific polyclonal antibodies induced by vaccination. Elicited antibodies impaired both receptors activation and induced their degradation, which caused the inhibition of down-signaling cascades. This effect was translated into cell cycle arrest and apoptosis induction of human tumor cells. Elicited antibodies were able to reduce the viability of a panel of human tumor lines with differential expression levels of HER1 and HER2. The most significant effects were obtained in the tumor lines with lower expression levels of both receptors. These new insights would contribute to the rational design of HER receptors targeting multivalent vaccines, as an encouraging approach for the treatment of cancer patients.

Cost-effectiveness of strategies to increase screening coverage for cervical cancer in Spain: the CRIVERVA study.

BACKGROUND: The aim of the study is to carry out a cost-effectiveness analysis of three different interventions to promote the uptake of screening for cervical cancer in general practice in the county of Valles Occidental, Barcelona, Spain. METHODS: Women aged from 30 to 70 years (n = 15,965) were asked to attend a general practice to be screened. They were randomly allocated to one of four groups: no intervention group (NIG); one group where women received an invitation letter to participate in the screening (IG1); one group where women received an invitation letter and informative leaflet (IG2); and one group where women received an invitation letter, an informative leaflet and a phone call reminder (IG3). Clinical effectiveness was measured as the percentage increase in screening coverage. A cost-effectiveness analysis was performed from the perspective of the public health system with a time horizon of three to five years - the duration of the randomised controlled clinical trial. In addition, a deterministic sensitivity analysis was performed. Results are presented according to different age groups. RESULTS: The incremental cost-effectiveness ratio (ICER) for the most cost-effective intervention, IG1, compared with opportunistic screening was € 2.78 per 1% increase in the screening coverage. The age interval with the worst results in terms of efficiency was women aged < 40 years. CONCLUSIONS: In a population like Catalonia, with around 2 million women aged 30 to 70 years and assuming that 40% of these women were not attending general practice to be screened for cervical cancer, the implementation of an intervention to increase screening coverage which consists of sending a letter would cost on average less than € 490 for every 1000 women. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01373723 .

A N-glicosilação do EGFR afeta a sinalização intracelular e a estabilidade das Junções Tight em células de câncer colorretal / [ EGFR N-glycosylation affects intracellular signaling and stability of Tight Junctions in Colorectal Cancer Cells]

Introdução: O câncer colorretal (CCR) constitui um importante problema de saúde pública no Brasil e no mundo. Durante a progressão de tumores epiteliais, como o CCR, é frequentemente observada uma desestabilização do complexo juncional apical, composto pelas junções tight (JT) e junções aderentes (JA). O aumento dos níveis de expressão das claudinas, principais proteínas transmembranas constituintes das JT, induz a perda da sua função de barreira e aumenta o potencial maligno das células do CCR. Embora cada vez mais estudos estejam focados em compreender melhor os aspectos moleculares que regulam a estabilidade das TJ, o papel desempenhado por N-glicanos neste processo continua sendo pouco explorado. Objetivo: Assim, o objetivo do presente estudo foi investigar o papel dos N-glicanos na regulação da estabilidade das JT em CCR. Materiais e Métodos: Utilizando a linhagem celular HCT-116 (carcinoma colorretal humano), foi avaliado o efeito do tratamento com dois inibidores de biossíntese de N-glicanos, swainsonina (SW) e tunicamicina (Tun), sobre a estabilidade das JT mediante: citometria de fluxo, Western blot, microscopia eletrônica de transmissão, co-imunoprecipitação e imunofluorescência. A expressão de ácido siálico na superfície celular também foi inibida utilizando análogo fluorinado de ácido siálico (Sia-F). Além disso, foram avaliados o grau de N-glicosilação do Receptor do Fator de Crescimento Epidérmico (EGFR) e os níveis de expressão de claudina-3 (cld-3) em tecidos de pacientes com CCR (n = 21) por imunohistoquímica e Western blot (Protocolo-CEP nº: 84/04). Para este estudo foram consultadas bases de dados internacionais (NCBI e TCGA) a fim de identificar os sítios de N-glicosilação (Asn-XSer/Thr) do EGFR e relatos de mutações nestes sítios em CCR. Utilizando um algoritmo classificador de subtipos de CCR foi avaliada também a expressão de glicogenes e de cld-3 em quatro subtipos moleculares de CCR. Ministério da Saúde Instituto Nacional de Câncer Coordenação de Pós-graduação Resultados: Primeiramente, foi avaliado o efeito de SW e Tun na expressão proteica de vários constituintes das TJ. Foi observado que apenas o tratamento com Tun diminuiu os níveis de expressão de cld-3. A Tun também promoveu, concomitantemente, diminuição dos níveis de fosforilação de proteínas na faixa de peso molecular da cld-3 (22kDa) e reorganização da sua localização celular do citoplasma à membrana. Os resultados mostraram que, após o tratamento com Tun, as células HCT-116 desenvolveram contatos celulares mais estabelecidos. Além disso, a deglicosilação do EGFR promoveu redução dos seus níveis de expressão na membrana celular e também diminuiu tanto os seus níveis de ativação quanto a fosforilação das proteínas downstream ERK e AKT. Foi observado que o tratamento com Sia-F diminuiu tanto a ativação de EGFR quanto os níveis de expressão de cld-3. Os resultados mostraram também que tumores de pacientes com CCR, que expressavam maiores níveis proteicos de cld-3 do que os respectivos tecidos normais adjacentes, exibiram também um maior grau de N-glicosilação do EGFR. Finalmente, não foram encontrados relatos de mutações em sítios de N-glicosilação do EGFR em CCR, porém, foram encontradas diferenças na expressão de glicogenes e de cld-3 entre os quatro subtipos moleculares de CCR. Conclusão: Conjuntamente, os resultados demonstram que a N-glicosilação do EGFR desempenha um papel na regulação da cld-3, contribuindo para uma melhor compreensão da biologia do CCR. Estes achados também sugerem um potencial significado clínico de alterações no padrão de N-glicosilação do EGFR.

Barriers to Clinical Research Participation Among African Americans.

UNLABELLED: Clinical research requires representation of racially and ethnically diverse participants to accurately represent the general population. Overall life expectancy of African Americans is shorter than that of the general U.S. POPULATION: Compared with the other ethnic groups in the United States, African Americans have higher rates of hypertension, stroke, obesity, and diabetes, and higher rates of mortality related to stroke and cancer. Although many health disparities exist among African Americans, they are well underrepresented in clinical research. This article provides an overview of barriers that may influence participation in clinical research among African Americans. Issues of trust, experimentation, communication, and logistics are the most commonly identified barriers. The barriers and facilitators identified in this review may be useful in the development and implementation of recruitment and research strategies that are culturally sensitive and that may enhance trust and willingness to participate among African Americans.

Síndrome de Stevens-Johnson: presentación de una paciente / Stevens-Johnson syndrome: presentation of a patient

El síndrome de Stevens-Johnson constituye una emergencia dermatológica. Es una enfermedad de la piel que amenaza la vida en la que la muerte celular hace que la epidermis se separe de la dermis; tiene tasas altas de mortalidad y es de condición rara, con una incidencia de alrededor de 2.6 a 6.1 casos por millón de personas por año. Se presenta una paciente que ingresó en el hospital y que tuvo una evolución favorable(AU)

Software educativo sobre atención prenatal para la formación de estudiantes de la carrera de Medicina / Educational software on prenatal attention for the formation of the Medicine career students

Fundamento: la metodología para la atención prenatal consiste en un conjunto de consultas y cuidados previos al parto; esta ha experimentado modificaciones de acuerdo con los conocimientos actuales y el desarrollo del sistema de salud cubano. Objetivo: diseñar un software educativo sobre atención prenatal para los estudiantes de Medicina. Métodos: se realizó un estudio descriptivo, con enfoque cualitativo durante el curso 2012-2013 en el Hospital Gineco-Obstétrico de Villa Clara. Se emplearon métodos teóricos: análisis-síntesis, inducción-deducción e histórico-lógico para los referentes teóricos sobre el tema, revisión bibliográfica y evolución de los conceptos; y relacionados con las tecnologías de la información y la comunicación; empíricos: análisis documental del programa, orientaciones metodológicas y textos básicos; y la encuesta a estudiantes y profesores para determinar los conocimientos sobre la mencionada metodología, y fundamentar la necesidad de un software educativo como medio de enseñanza y matemáticos para los valores absolutos y relativos. Resultados: existen carencias sobre la metodología para el control prenatal, en cuanto a los exámenes complementarios del embarazo, en temáticas como Isoinmunización y Embarazo, parámetros relacionados con la glicemia y prueba de tolerancia a la glucosa; los docentes declaran que el tiempo asignado para el tema es suficiente, aunque reconocen la necesidad de un nuevo enfoque a los contenidos, y del diseño de un software educativo. Conclusiones: el producto elaborado es novedoso, ha sido diseñado de acuerdo con herramientas que propician la interacción, posee un correcto enfoque pedagógico y científico-metodológico por lo que fue valorado como adecuado por los especialistas consultados.

Background: the methodology for the prenatal attention consists on a group of consultations and previous cares to the childbirth; it has experienced modifications according to the current knowledge and the development of the Cuban health system. Objective: to design an educational software on prenatal attention for the students of Medicine. Methods: it was carried out a study, with a qualitative approach during the academic year 2012-2013 in Villa Clara Gynecological-obstetric Hospital. Theoretical methods were used: analysis-synthesis, induction-deduction and historical-logical for the theoretical foundations on the topic, bibliographic review and evolution of the concepts; and those related with the information and communication technologies; empiric: documental analysis of the program, methodological orientations and basic texts; and the survey to students and professors to determine the knowledge on the mentioned methodology, and to base the necessity of an educational software as a teaching aid and mathematics for the absolute and relative values. Results: lacks exist on the methodology for the prenatal control, in regard to diagnostic procedures for pregnancy, in topics like Iso-inmunization and Pregnancy, parameters related with glycemic control and glucose tolerance test; professors declare that the time assigned for the topic is enough, although they recognize the necessity to apply a new approach to the contents, and the design of an educational software. Conclusions: the elaborated product is novel, it has been designed according to the tools that propitiate ample interaction, and it possesses a correct pedagogic and scientific-methodological approach. The consulted specialists valued it as adequate.

Acculturation, Health Literacy, and Illness Perceptions of Hypertension among Hispanic Adults.

PURPOSE: Hypertension treatment rates are disproportionately lower among Hispanics compared to non-Hispanic Whites and non-Hispanic Blacks. The purpose of this study was to examine the relationship among acculturation, health literacy, and illness perceptions of hypertension among Hispanics. DESIGN: A cross-sectional correlational design was used, including 144 Hispanic adults with a self-reported diagnosis of hypertension. METHOD: The instruments used included the Short Acculturation Scale for Hispanics, the Newest Vital Sign instrument to measure health literacy, and the Brief Illness Perception Questionnaire. RESULTS: Significant relationships were found among acculturation, health literacy, and several illness perceptions (consequences, control, symptoms, and emotions). CONCLUSION: Acculturation and health literacy play an important role in illness perceptions of hypertension among Hispanics. IMPLICATIONS: Findings could be helpful in the development of tailored health promotion interventions to improve hypertension management among Hispanic adults.

Software educativo sobre atención prenatal para la formación de estudiantes de la carrera de Medicina / Educational software on prenatal attention for the formation of the Medicine career students

Fundamento: la metodología para la atención prenatal consiste en un conjunto de consultas y cuidados previos al parto; esta ha experimentado modificaciones de acuerdo con los conocimientos actuales y el desarrollo del sistema de salud cubano. Objetivo: diseñar un software educativo sobre atención prenatal para los estudiantes de Medicina. Métodos: se realizó un estudio descriptivo, con enfoque cualitativo durante el curso 2012-2013 en el Hospital Gineco-Obstétrico de Villa Clara. Se emplearon métodos teóricos: análisis-síntesis, inducción-deducción e histórico-lógico para los referentes teóricos sobre el tema, revisión bibliográfica y evolución de los conceptos; y relacionados con las tecnologías de la información y la comunicación; empíricos: análisis documental del programa, orientaciones metodológicas y textos básicos; y la encuesta a estudiantes y profesores para determinar los conocimientos sobre la mencionada metodología, y fundamentar la necesidad de un software educativo como medio de enseñanza y matemáticos para los valores absolutos y relativos. Resultados: existen carencias sobre la metodología para el control prenatal, en cuanto a los exámenes complementarios del embarazo, en temáticas como Isoinmunización y Embarazo, parámetros relacionados con la glicemia y prueba de tolerancia a la glucosa; los docentes declaran que el tiempo asignado para el tema es suficiente, aunque reconocen la necesidad de un nuevo enfoque a los contenidos, y del diseño de un software educativo. Conclusiones: el producto elaborado es novedoso, ha sido diseñado de acuerdo con herramientas que propician la interacción, posee un correcto enfoque pedagógico y científico-metodológico por lo que fue valorado como adecuado por los especialistas consultados(AU)

Enfermedad de Fox-Fordyce: presentación de una paciente / Fox-Fordyce disease: presentation of a patient

La enfermedad de Fox-Fordyce es un trastorno inflamatorio poco frecuente caracterizado por la aparición de pápulas pruriginosas con distribución folicular localizadas en las áreas dotadas de glándulas apocrinas. La etiopatogenia no se conoce con claridad; se involucra la obstrucción del conducto excretor apocrino como fenómeno precoz en el proceso. Se presenta una paciente de 25 años con la enfermedad de Fox-Fordyce confirmada histológicamente y con gran expresividad clínica vulvar(AU)

Cromomicosis: presentación de un paciente / Chromomycosis: presentation of a patient

La cromomicosis es una micosis subcutánea o profunda de curso crónico causada por un grupo de hongos dematiáceos que se caracteriza por la formación de nódulos cutáneos verrucosos y está localizada en zonas expuestas,fundamentalmente en los miembros inferiores y superiores. Se presenta un paciente masculino de 49 años de edad, piel blanca actínica, de profesión chofer de un camión de comunales, que desde el año 2010 presentaba una lesión en el dorso de la mano izquierda. Se le realizó un examen micológico con cultivo y se aisló la Phialophora verrucosa. Posteriormente la lesión se extendió a toda la mano, el antebrazo y la cara interna del brazo izquierdo. Fue ingresado en el Hospital Clínico Quirúrgico Arnaldo Milián Castro y se le aplicó un tratamiento antimicótico con anfotericín B endovenoso, previamente con ketoconazol y fluconazol, y finalmente tratamiento quirúrgico con exéresis y colgajos locales e injertos libres de piel; su evolución fue muy favorable y se encuentra en tratamiento de fisioterapia y rehabilitación(AU)

Self-management of hypertension in Hispanic adults.

Almost one third of the U.S. population has hypertension. Compared to non-Hispanic Whites, Hispanic individuals have significantly lower levels of hypertension awareness, treatment, and control. This article provides an integrative review of factors that may influence self-management of hypertension among Hispanic adults. A detailed literature search of articles published between 1985 and 2010 was performed. Twelve articles based on quantitative studies (n = 9) and qualitative studies (n = 3) were reviewed. Barriers and facilitators to self-management of hypertension were identified. The findings in this review may help health care professionals in recognizing factors that need to be considered in the development of self-management interventions for Hispanic patients with hypertension. Future research is needed to further explore facilitators to self-management, and to implement and evaluate intervention studies aimed at blood pressure management in Hispanics with hypertension.