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Background: Two billion peripheral intravenous catheters (PIVC) are inserted into inpatients worldwide year. Almost 1 in 2 PIVC failed for various reasons before completion of intravenous therapy. We aimed to determine the efficacy and costs of a multimodal intervention to reduce PIVC failure rates among inpatients. Methods: We conducted a cluster-randomised controlled trial at seven public hospitals in Spain. Clusters were randomly assigned (1:1) to the multimodal intervention or control arms, stratified by setting type and hospital. We concealed randomisation to allocation, without masking patients and professionals to the intervention arm. The primary outcomes were all-cause PIVC failure (due to phlebitis, extravasation, or obstruction) or infections before completion of scheduled intravenous therapy, at 12 months. All analyses were by intention-to-treat. We registered this trial with the ISRCTN Registry, number ISRCTN10438530. Findings: Between Jan 1, 2019, and March 1, 2020, we randomly assigned 22 eligible clusters to receive the multimodal intervention (n=11 clusters; 2196 patients; 2235 PIVCs, and 131 nurses) or usual practice in control group (n=11; 2282 patients, 2330 PIVCs, and 138 nurses). The intervention arm reduced PIVC failure rates compared to the control group (37·10 [SD 1·32] vs 46·49 [SD 2·59]; mean difference -9·39 [95% CI -11·22 to -7·57; p

The COVID-19 pandemic is worsening loneliness for many older people through the\ud challenges it poses in engaging with their social worlds. Digital technology has been offered\ud as a potential aid, however, many popular digital tools have not been designed to address the\ud needs of older adults during times of limited contact. We propose that the Social Identity\ud Model of Identity Change (SIMIC) could be a foundation for digital loneliness interventions.\ud While SIMIC is a well-established approach for maintaining wellbeing during life transitions,\ud it has not been rigorously applied to digital interventions. There are known challenges to\ud integrating psychological theory in the design of digital technology to enable efficacy,\ud technology acceptance, and continued use. The interdisciplinary field of Human Computer\ud Interaction has a history of drawing on models originating from psychology to improve the\ud design of digital technology and to design technologies in an appropriate manner. Drawing on\ud key lessons from this literature, we consolidate research and design guidelines for\ud multidisciplinary research applying psychological theory such as SIMIC to digital social\ud interventions for loneliness.

Objective The physical and psychological benefits of exercise during pregnancy are well established. However, the impact of exercise on pain during labour and the use of epidural analgesia has been less explored. The main aim of this study was to analyse the effectiveness and safety of moderate aerobic water exercise by pregnant women on the subsequent use of epidural analgesia during labour, induction of labour, mode of delivery, and pain perception. Design A multi-centre, parallel, randomised, evaluator blinded, controlled trial in a primary care setting. Setting Primary care centres in a health district of a tertiary obstetric metropolitan hospital in Mallorca, Spain. Participants Pregnant women (14 to 20 weeks’ gestation) who had low risk of complications. Methods Three hundred and twenty pregnant women were randomly assigned to two groups: women who practiced moderate aquatic aerobic exercise with usual antenatal care, and those who received usual prenatal care alone. The gynaecologist, anaesthesiologist and midwife who assisted the women during labour were blinded to group allocations. Principal outcome: use of epidural analgesia during labour. Other outcomes: use of epidural analgesia before 6 cm cervical dilation, labour pain, type of delivery, time of active labour, episiotomy or perineal tear, and induction of labour. Results The exercise program did not affect the use of epidural analgesia (OR = 0.79, 95% CI = 0.44 to 1.40), vaginal delivery (OR = 1.35, 95% CI = 0.73 to 2.41), or caesarean section (OR = 0.94, 95% CI = 0.47 to 1.89). However, women in the exercise group reported less pain during labour (mean difference: –0.6, 95% CI = –1.11 to –0.09). The two groups (moderate aquatic aerobic exercise versus usual antenatal care) showed no significant differences in maternal or newborn adverse events. Conclusion Aquatic aerobic exercise during pregnancy had no effect on the use of epidural analgesia during labour, whereas pain perception was lower after aquatic exercise compared to usual care in pregnancy. The intervention was safe for pregnant women and their newborns.

Stem-end-rot (SER), caused by Lasiodiplodia theobromae or Diaporthe citri, is an important postharvest disease in humid and warm citrus growing areas, such as the Northwestern region of Argentina. The commercial control of SER has been accomplished by applications of the systemic fungicide carbendazim (CARB). However, alternative chemicals for this fungicide are needed due to increasing restrictive regulations in overseas markets. The aim of this work was to evaluate the effectiveness of conventional and reduced-risk postharvest fungicides to control SER. In vitro tests show that L. theobromae was more resistant to fungicides than D. citri. In trials using artificially inoculated lemons, SER caused by D. citri (Phomopsis SER) was controlled by the fungicides evaluated. The conventional fungicides imazalil and thiabendazole (TBZ) were the most effective chemicals to control SER caused by L. theobromae (Diplodia SER), while other fungicides, as fludioxanil, azoxystrobin, pyrimetanil and propiconazole, were not effective. The best control of Diplodia SER was obtained by immersion for 60 s in 2000 mg/L of TBZ at pH 5 and 20 °C. In this condition, TBZ-residue loading on lemons was 3.0 mg-L−1, which did not exceed the allowed maximum residue levels. TBZ applied in lemon commercial treatments is the best option to reduce SER caused by both pathogens. At this time, this is the unique suitable alternative to replace CARB treatment in Argentinean packinghouses. Fil: Cerioni, Luciana. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; Argentina Fil: Bennasar, Paula Bettina. SA San Miguel; Argentina Fil: Lazarte, Daniela. SA San Miguel; Argentina Fil: Sepulveda, Milena. SA San Miguel; Argentina Fil: Smilanick, Joseph L.. No especifica; Fil: Ramallo, Jaqueline. SA San Miguel; Argentina Fil: Rapisarda, Viviana Andrea. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Tucumán. Instituto Superior de Investigaciones Biológicas. Universidad Nacional de Tucumán. Instituto Superior de Investigaciones Biológicas; Argentina

Resumen La investigacion enfermera en Espana no puede ser entendida sin el analisis de la evolucion de la profesion en los ultimos 40 anos. El contexto social, politico y economico ha determinado el devenir de la investigacion en cuidados y es necesario un analisis de la situacion actual de cara a los retos inmediatos que la profesion enfermera tiene ante si. Ofrecer una perspectiva global de la investigacion en cuidados en Espana, como marco de reflexion y discusion acerca de posibles estrategias a corto y medio plazo que orienten la planificacion y toma de decisiones a los distintos agentes implicados en la investigacion enfermera en Espana. Estudio multimetodo que ha combinado analisis documental, con metodos bibliometricos. Se han identificado algunas politicas aisladas de fomento de la investigacion en cuidados, un crecimiento importante de la formacion doctoral (49 programas de doctorado) y 89 grupos de investigacion enfermera (1,92 grupos por millon de habitantes) responsables de una produccion cientifica que situa a Espana en el septimo lugar en el ranking mundial de produccion cientifica en el area de Enfermeria. El incremento en el gasto publico en I +D+ I y el crecimiento en impacto bibliometrico se asocian a una mayor densidad de grupos de investigacion enfermeros. La investigacion enfermera en Espana es sensible a las politicas y recursos de fomento de la investigacion, aunque no hay una estrategia consolidada y uniforme que supere las barreras actuales. Aun se desconoce el impacto del desarrollo academico de la Enfermeria espanola en la produccion cientifica.

Objective The aim of this study is to evaluate the effectiveness of 2 different therapies, pressure release (PR) and kinesiotaping (KT) for myofascial pain syndrome in the sternocleidomastoid muscle. Methods Experimental, randomized, controlled, single-blind study. KT was applied for group C, PR to treat group B and placebo to treat group A. The used variables were: Algometry, Numerical Pain Scale (NPS), Questionnaire of Quality of Life SF-12, and Goniometry of cervical complex. Participants were assisted in public hospitals of the Balearic Health Service (Spain), from March 2012 to March 2013. The study includes a sample of 75 patients with cervical myofascial pain syndrome of the sternocleidomastoid muscle. Each patient received three appointments. Each appointment lasted 20 minutes approximately. Results Questionnaire SF-12 shows that the improvement of the quality of life with KT was 10.32 points ( P P P P P Conclusions KT and PR are two therapeutic techniques which help to reduce pain, show increased levels in Goniometry (cervical movements) and contribute to improve quality of life. It seems that KT could be more effective than PR.

HighlightsAn epidemiologic system analysis of cardiovascular risk is presented through a Bayesian network model.The Bayesian network model can serve as a generic tool for application oriented activities: explanation, prediction, monitoring and prevention.Due to cardiovascular disease is multifactorial, the application of this kind of model is of special interest, both from theoretical and practical point of view.The induced Bayesian network was used to make inferences taking into account three reasoning patterns: causal reasoning, evidential reasoning, and intercausal reasoning. An extensive, in-depth study of cardiovascular risk factors (CVRF) seems to be of crucial importance in the research of cardiovascular disease (CVD) in order to prevent (or reduce) the chance of developing or dying from CVD. The main focus of data analysis is on the use of models able to discover and understand the relationships between different CVRF. In this paper a report on applying Bayesian network (BN) modeling to discover the relationships among thirteen relevant epidemiological features of heart age domain in order to analyze cardiovascular lost years (CVLY), cardiovascular risk score (CVRS), and metabolic syndrome (MetS) is presented. Furthermore, the induced BN was used to make inference taking into account three reasoning patterns: causal reasoning, evidential reasoning, and intercausal reasoning. Application of BN tools has led to discovery of several direct and indirect relationships between different CVRF. The BN analysis showed several interesting results, among them: CVLY was highly influenced by smoking being the group of men the one with highest risk in CVLY; MetS was highly influence by physical activity (PA) being again the group of men the one with highest risk in MetS, and smoking did not show any influence. BNs produce an intuitive, transparent, graphical representation of the relationships between different CVRF. The ability of BNs to predict new scenarios when hypothetical information is introduced makes BN modeling an Artificial Intelligence (AI) tool of special interest in epidemiological studies. As CVD is multifactorial the use of BNs seems to be an adequate modeling tool.

Objective Obesity, metabolic syndrome (MetS) and low adherence to Mediterranean diet are frequent in major depression patients and have been separately related with prognosis. The aim of this study is to analyse their predictive power on major depression outcome, at 6 and 12 months. Methods 273 Major depressive patients completed the Beck Depression Inventory for depressive symptoms and the 14-item Mediterranean diet adherence score. MetS was diagnosed according to the International Diabetes Federation (IDF). Results At the baseline Mediterranean diet adherence was inversely associated with depressive symptoms ( p =0.007). Depression response was more likely in those patients with normal weight ( p =0.006) and not MetS ( p =0.013) but it was not associated with Mediterranean diet adherence ( p =0.625). Those patients with MetS and obesity were less likely to improve symptoms of depression than patients with obesity but not MetS. Conclusions Obesity and MetS, but not low adherence to the Mediterranean diet at baseline, predicted a poor outcome of depression at 12 months. Our study suggests that MetS is the key factor that impacts negatively in depression prognosis, rather than obesity or diet. If this finding is confirmed, clinicians should be aware about MetS diagnosis and treatment in overweight depressed patients, especially if outcome is not being satisfactory enough.

There has been an alarming worldwide increase of obese people in recent years. Currently, there is no consensus on whether patients that are scheduled to undergo bariatric surgery should lose weight before the intervention. The objective of this research is to analyse the influence of pre-surgery loss of weight in the nutritional parameters of patients.Fifty patients that were scheduled to undergo bariatric surgery followed a very low caloric diet during 4 weeks prior to the surgery. The nutritional parameters were analysed at 3 specific moments: before starting the diet, at the moment of surgery (when the diet was concluded) and one month after the surgery.Average values for hemoglobin, albumina and lymphocytes were kept within the range of normal values at all moments, even though the decrease of those parameters was statistically significant throughout the study (P.05). By following the very low caloric diet, less than 9.5% of the sample suffered anaemia.Loss of weight prior to surgery does not have a significant influence in the nutritional parameters of the patient. These results would support the indication of losing weight for patients that are considered candidates for bariatric surgery.

Resumen Introduccion El numero de personas obesas ha aumentado de forma alarmante en todo el mundo. Actualmente no existe un consenso acerca de si los pacientes que van a ser sometidos a una cirugia bariatrica deben o no perder peso antes de la misma. El objeto de la presente investigacion es analizar la influencia de la perdida de peso preoperatoria en los parametros nutricionales de los pacientes. Metodos Se sometio a 50 pacientes que iban a ser intervenidos de una cirugia bariatrica a una dieta de muy bajo contenido calorico durante las 4 semanas previas a la intervencion. Se analizaron los parametros nutricionales en 3 momentos especificos: antes de empezar la dieta, en el momento de la intervencion (al finalizar la dieta) y un mes despues. Resultados La media de hemoglobina, albumina y linfocitos se mantuvo dentro del rango de la normalidad en todo momento a pesar de que los descensos de dichos parametros fueron estadisticamente significativos a lo largo del estudio (p Conclusiones La perdida de peso preoperatoria no influye de manera significativa en los parametros nutricionales analizados. Estos resultados apoyarian la indicacion de una perdida de peso preoperatoria en los pacientes candidatos a cirugia bariatrica.

The effectiveness of continuous positive airway pressure (CPAP) therapy greatly depends on consistent use. However, data regarding adherence in non-sleepy obstructive sleep apnea (OSA) patients are scarce. The aim of this study was to assess long-term adherence and predictors of CPAP compliance in a large sample of non-sleepy OSA patients.We conducted a prospective, multicenter study comprising 357 non-sleepy patients (Epworth Sleepiness Scale score11) with moderate-to-severe OSA (apnea-hypopnea index [AHI] of ≥20) who began CPAP therapy between May 2004 and May 2006; follow-up ended in May 2009. Non-compliance was scored as CPAP dropout or average cumulative CPAP use of4 hours per night. Multivariate Cox regression analysis was performed to identify independent predictors of poor CPAP adherence.Patients were followed up for a median of four years (interquartile range [IQR] = 3.0-4.4). At the end of the study period, 230 patients (64.4%) fulfilled the criteria for good CPAP compliance, whereas 127 patients (35.6%) were considered non-compliant. The median CPAP use was five hours per night (interquartile range = 2.18-6.25). Multivariate analysis showed that interactions between the AHI and the percentage of nighttime spent with an O2 saturation of90% (TC90) (p = 0.010) and between the AHI and hypertension at baseline (p = 0.029) predicted long-term compliance with CPAP.This study demonstrates that CPAP treatment is feasible in non-sleepy, moderate-to-severe OSA patients. Good CPAP adherence was predicted by greater OSA severity as measured by both the AHI and TC90 and by the presence of hypertension at baseline in patients with higher AHI levels.

Resumen Introduccion Existe falta de consenso internacional sobre la definicion exacta y las competencias asociadas a los roles de enfermeria de practica avanzada (EPA), caso que resulta mas acuciante en nuestro entorno nacional dada la corta trayectoria de la misma en nuestro pais. El objetivo del trabajo consistio en delinear el marco competencial para enfermeras de practica avanzada en nuestro contexto nacional mediante el proceso de consenso de expertos a traves del metodo Delphi. Metodo Basandonos en un proceso de revision bibliografica previo, se identifico un conglomerado de 17 dominios competenciales (clusters de competencias relacionadas). Este conjunto inicial fue revisado, refinado y validado por un conjunto de panelistas expertos en la materia (tanto clinicos como investigadores, gestores y docentes) a traves de sucesivas rondas en busca del adecuado consenso sobre cada una de las diferentes competencias propuestas. Resultados Los resultados permitieron establecer una solida base en forma de mapa de competencias que permitiera identificar aquellos conjuntos de competencias mas especificos para roles de practica avanzada, independientemente del contexto de regulacion y practica profesional, identificando dominios como investigacion y practica basada en la evidencia, liderazgo clinico y profesional o gestion de cuidados. Discusion Este conjunto de competencias relacionadas con roles de practica avanzada en nuestro entorno permite delinear los estandares competenciales propios de este nivel de practica enfermera, y servir de referencia tanto para el desarrollo normativo, la revision de roles o el planteamiento de perfiles formativos.

A possible synthetic approach to the bridged indole alkaloid pericine (subincanadine E), based on the combination of a ring-closing metathesis (RCM) and a Heck cyclization, is described. After having developed a convenient RCM-based route to tricyclic intermediates embodying the central nine-membered ring, the closure of the strained 1-azabicyclo[5.2.2]undecane framework of the alkaloid using a vinyl halide Heck coupling was pursued without success.

ResumenObjetivoDescribir los factores de riesgo cardiovascular en población trabajadora de las Islas Baleares y analizar si las diferencias por clase social varían en función de la edad y el sexo.MétodosEstudio transversal con una muestra de trabajadores/as activos/as de 20-65 años de edad de las Islas Baleares, incluidos en el estudio durante su revisión laboral periódica del año 2011. Se recogieron las siguientes variables: ocupación, clase social, edad, sexo, talla, peso, tabaquismo, presión arterial, perfil lipídico y glucosa. Se calculó el riesgo cardiovascular según dos ecuaciones (Framingham y REGICOR).ResultadosSe observaron diferencias por clase social en la mayoría de los factores de riesgo cardiovascular. Estas diferencias presentaron un patrón diferencial por grupo de edad y sexo. Las diferencias por clase social para la obesidad en las mujeres aumentaron con la edad, mientras que en los hombres disminuyeron. La hipertensión arterial presentó más diferencias por clase social entre las mujeres que entre los hombres, y en ambos sexos estas diferencias aumentaron con la edad. El perfil lipídico en las mujeres mostró diferencias importantes por clase social, que se acentuaron con la edad, en especial en el caso de bajos valores de colesterol HDL.ConclusionesLas desigualdades por clase social en los factores riesgo cardiovascular fueron mayores entre las mujeres que entre los hombres. Algunos factores de riesgo cardiovascular, como el tabaquismo y la obesidad, presentan desigualdades importantes en etapas muy tempranas de la vida.AbstractObjectiveTo describe the cardiovascular risk factors in a working population in the Balearic Islands and to examine whether differences by social class vary according to age and gender.MethodsA cross-sectional study was carried out in a sample of active workers aged 20-65 years in the Balearic Islands. The participants were included in the study during their annual work health assessment in 2011. The following variables were collected: occupation, social class, age, gender, height, weight, smoking, blood pressure, lipid profile, and glucose levels. Cardiovascular risk was calculated using two different equations (Framingham and REGICOR).ResultsDifferences by social class were observed for most cardiovascular risk factors. The pattern of these differences differed depending on age group and gender. Differences in obesity by social class increased with age in women but decreased in men. More differences in hypertension by social class were found among women than among men, with differences increasing with age in both genders. Significant differences by social class were found among women in lipid profile, and these differences increased with age, mainly for low levels of high-density lipoprotein-cholesterol.ConclusionsInequalities in cardiovascular risk factors by social class were higher among women than among men. Some cardiovascular risk factors such as smoking and obesity showed significant inequalities from a very early age.

Systemic sclerosis (SS) in a multifactorial and systemic, chronic, autoimmune disease that affects the connective tissue. We present this clinical case given the low prevalence of diffuse SS with early and progressive cardiac compromise in a young patient, and treatment with cardiac transplantation.

Systemic sclerosis (SS) in a multifactorial and systemic, chronic, autoimmune disease that affects the connective tissue. We present this clinical case given the low prevalence of diffuse SS with early and progressive cardiac compromise in a young patient, and treatment with cardiac transplantation.

Resumen La amniocentesis es un procedimiento de diagnostico prenatal invasivo de segundo trimestre, descrito inicialmente en 1966 por Steele y Berg. Consiste en la introduccion de una aguja espinal a traves de la pared abdominal, la pared uterina y la cavidad amniotica bajo guia ecografica continua, de forma que se pueda aspirar una muestra del liquido amniotico que envuelve el feto y que contiene celulas de origen fetal. La amniocentesis se realiza a partir de las 16 semanas de gestacion y en el liquido amniotico se pueden realizar estudios cromosomicos, bioquimicos, moleculares o microbiologicos. El procedimiento conlleva un riesgo de perdida fetal de aproximadamente el 0,5% cuando se realiza en el segundo trimestre, despues de la fusion de la membrana amniotica con el corion, ademas de un riesgo menor de otras complicaciones, como la perdida de liquido amniotico (0,3%), hemorragia placentaria, infeccion intraamniotica, hematoma de la pared abdominal o traumatismo fetal. A medida que la experiencia internacional se acumula, se van determinando los factores que pueden ayudar a mejorar aun mas la seguridad y la facilidad tecnica del procedimiento. Hemos descrito un nuevo metodo de aspiracion para realizar la amniocentesis que emplea un Vacutainer® (BD Vacutainer Systems, Plymouth, Reino Unido), para obtener un vacio continuo cuando la aguja ya esta insertada dentro de la cavidad amniotica, en contraste con la tecnica estandar de aspiracion mediante jeringa o «pistola» en que las presiones negativas son discontinuas. Sin embargo, la tecnica clasica con aspiracion con jeringa continua siendo valida y la mas utilizada. Basados en la experiencia de 30 anos y en el volumen de procedimientos realizados en nuestro centro (mas de 20.000 procedimientos invasivos realizados), junto con una revision de la bibliografia publicada hasta la fecha, hemos planteado una guia practica actualizada para la realizacion de la amniocentesis.