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Clinical debriefing (CD) improves patient safety and builds team resilience.We describe the current use of CD by multiprofessional Spanish cardiology team members.A self-administered survey exploring 31 items was disseminated online in October 2020. A comparison was made between respondents that who experience in CD with inexperienced respondents. Inferential analysis was done using Pearson's χ 2 test.Out of 167 valid responses, 45.5% had been completed by cardiology nurses. One-third of the respondents had experience in CD. Most common situations preceding CD were those with negative outcomes (81.8%). Time constraint was the most commonly reported barrier (76.3%); however, it was significantly less than the expectation of inexperienced respondents (92%, P.01). Overall, only 28.2% reported self-confidence in their skills to lead a CD.There is a necessity in Spanish cardiology teams to receive training in CD and embed it in their daily practice.

RESUMEN En las últimas dos décadas han tenido lugar grandes avances en el campo de la cardiología intervencionista. Estos incluyen no solo nuevas técnicas y tratamientos, sino también cambios en la organización, como la atención continuada al infarto agudo de miocardio y la aparición de salas tuteladas. Todos estos avances hacen necesaria una actualización de los requisitos y del equipamiento necesarios en una unidad de hemodinámica y cardiología intervencionista. En este documento de consenso de la Asociación de Cardiología Intervencionista de la Sociedad Española de Cardiología, la Asociación de Cardiopatía Isquémica y Cuidados Agudos Cardiovasculares de la Sociedad Española de Cardiología, y la Asociación Española de Enfermería en Cardiología, se establecen las recomendaciones que deberían cumplir los centros hospitalarios donde esté instalada o se pretenda instalar una unidad de hemodinámica y cardiología intervencionista, los requisitos de dotación y cualificación de profesionales, las dotaciones tecnológicas y los materiales necesarios, y aspectos relacionados con las salas tuteladas y los programas de tratamiento de la cardiopatía estructural.

Over the last two decades, several key advances have been made in the field of interventional cardiology including new techniques and treatments, organizational changes such as the management of acute myocardial infarction, and the arrival of satellite catheterization laboratories. All these advances require the updating of the requirements and equipment that are needed in an interventional cardiology unit. This consensus document by the Interventional Cardiology Association of the Spanish Society of Cardiology, the Ischemic Heart Disease and Acute Cardiac Care Association of the Spanish Society of Cardiology and the Spanish Association of Nursing in Cardiology which describes the recommendations that should be followed by percutaneous coronary intervention capable hospitals or centers intend to build interventional cardiology units. It also describes the requirements for provision, qualification of professionals, technological and material resource allocation, and aspects related to supervised catheterization laboratories and structural heart disease programs.

The COVID-19 pandemic has resulted in many hospitalized patients and deaths worldwide. Coronavirus patients were isolated from their relatives and visits were banned to prevent contagion. This has brought about a significant change in deeply rooted care habits in Mediterranean and Latin American countries where the family normally accompanies vulnerable hospitalized patients. The aim of this qualitative study was to examine the hospitalization experience of COVID-19 patients and their family members. A phenomenological qualitative approach was used. Data collection included inductive, in-depth interviews with 11 COVID-19 hospitalized patients. The mean age of patients was 55.4 years and 45% were female. Nearly 50% required Intensive Care Unit (ICU) admission. Ten meaningful statements were identified and grouped in three themes: Positive and negative aspects of the care provided, the patient’s perspective, and perception of the experience of the disease. In conclusion, COVID-19 patients, aware of the severity of the pandemic, were very adaptable to the situation and had full confidence in health professionals. Patient isolation was perceived as necessary. Technology has helped to maintain communication between patients and relatives.

Background The coronavirus disease (COVID-19) pandemic has caused a worldwide health and social crisis directly impacting the healthcare system. Hospitals had to rearrange its structure to meet clinical needs. Spain has been experiencing a shortage of working nurses. Student nurses in their last year at university were employed to help the National Health System respond to the COVID-19 crisis. Aim The aim of this study was to explore and understand the experience of nursing students’ roles as healthcare aid in responding to the COVID-19 crisis. Methods A qualitative phenomenology design was used to explore undergraduate nursing students’ perceptions of their experiences as HAs during the COVID-19 outbreak. Open face-to-face interviews were conducted to nursing students (n=10) in May 2020. Data was analyzed using the hermeneutic interpretative approach. Results All participants were women aged between 21 and 25 years. Seven main themes emerged: learning, ambivalent emotions and adaptation were classified at a personal level; teamwork, patient communication, and unclear care processes were categorized under hospital structure; and coping mechanisms were part of external factors. Conclusions: Orientation, follow-up, and emotional support in crisis situations are key to unexperienced healthcare workers overcoming stressful emotions. Previous academic education and training may help novice future nurses feel more confident about their tasks and responsibilities as well as improve patient outcomes, resource management, and staff safety., Highlights • Nurses are key in response to COVID-19 healthcare crisis. • Spain needs to invest in nursing, to reach the average OCDE nurse-population rate. • Nursing students working as healthcare aids need continuous support and follow -up • Nursing students were very proud to actively contribute to the COVID-19 crisis.

Background The introduction of veno-arterial extracorporeal life support (v-a ECLS) widens the spectrum of patients that can be included in the heart transplant program, some examples are extended myocardial infarction, fulminant myocarditis or advanced cardiac insufficiency. In addition to this, the implementation of extracorporeal cardiopulmonary resuscitation (ECPR) extends even more the range of patients that can be benefitted of this therapy as a bridge to transplant. Purpose Our objective is to describe the incidence of v-a ECLS in those patients submitted to a heart transplant and to establish whether or not this technique increases the risk of mortality in this population. Methods Retrospective and descriptive statistical analysis of 82 consecutive patients submitted to heart transplant between 2015 and 2019 in a High Technology University Hospital. Demographic and clinical data, extracorporeal life support, extracorporeal cardiopulmonary resuscitation and assistance device type, together with survival at 30 days and one year were collected. Results 82 patients were transplanted during the study period distributed as follows: 47 (51.69%) were elective and 35 (48.1%) emergent being 25 (30.12%) of grade 1A and 10 (12.19%) of grade 1B. 52% had prior intra-aortic balloon contrapulsation. Patients transplanted under ECLS were 80% men and average age of 53 (SD 15) years old. The most prevalent diagnosis was acute myocardial infarction Killip IV (32%), followed by terminal heart failure (28%). 32% of the patients were under peripheral ECMO, 36% under left ventricular assistance, 20% under biventricular assist device, and 12% required ECPR. 72% of devices were implanted in the operating room and 16% in the ICU. The one-year survival of the sample was 88%. 2 patients died after transplantation (8%) during the first month, and 1 patient died within the first year. All three patients had terminal heart failure and the VAD implant was inserted electively Conclusions ECLS prior to cardiac transplantation allow selected patients to arrive alive to the transplant. The choice among devices is related to the diagnosis and expected duration of the therapy but we have not found in our series effects on subsequent mortality. Survival at one year in the subjects analysed is greater than the national registry of the last 10 years, although the tendency is to improve every year. This new scenario implies an increment of the complexity in the management of these patients and requires an special effort in terms of staff ratio and training. In our centre, the implementation of ECLS resulted in an increment of our staff and formative sessions. Funding Acknowledgement Type of funding source: None

espanolEn los pacientes postoperados de cirugia cardiaca, la mayoria de las paradas cardiorrespiratorias (PCR) requieren una reapertura esternal emergente. Cuando esta situacion no revierte, la colocacion de un dispositivo de membrana de oxigenacion extracorporea (ECMO) se ha definido como una terapia eficaz para mejorar la supervivencia y disminuir los danos neurologicos. La canulacion de ECMO central en estos pacientes supone una opcion rapida y segura, aunque es necesaria la formacion continua y la realizacion de guias de procedimiento para que todo el personal pueda actuar de manera rapida y eficaz. El desarrollo de este protocolo tiene como objetivos: a) Estandarizar la secuencia de intervenciones en la colocacion de ECMO central en PCR. b) Establecer y definir los roles de cada uno de los profesionales implicados durante el proceso. c) Describir las posibles complicaciones que pueden aparecer para poder prevenir su aparicion o minimizar sus consecuencias. d) Identificar los diagnosticos de Enfermeria y planificar los cuidados adecuados. EnglishIn patients who have undergone cardiac surgery, most cardiorespiratory arrests (CRAs) require emergent sternal reopening. When this situation is not reversed, the use of extracorporeal membrane oxygenation (ECMO) has been defined as an effective therapy in order to improve survival and reduce neurological damage. Central ECMO cannulation in these patients represents a fast and safe option, though continuous training is required, as well as preparing procedure guidelines so that all the staff can act in a fast and effective manner. The objectives for developing this protocol are: a) To standardize the sequence of interventions in the placement of central ECMO at CRA; b) To determine and define the roles of each professional involved during the process; c) To describe any potential complications that might appear, in order to prevent them or minimize their consequences; d) To identify nursing diagnoses and determine the adequate plan of care.

Titanyl sulfate (TiOSO4) extracted with sulfuric acid from the mineral ilmenite (FeTiO3), which has a high content of titanium (32.2 wt.%) was study as acid solid catalyst for the oleic acid esterification. The maximum extraction of Ti was 98 wt.%. As reference catalysts sulfated titania ( SO 4 2 - – TiO 2 ) and titania (TiO2) were synthesized by sol–gel route using as starting precursor titanyl sulfate. Characterization by XRD, XRF, FT-IR and nitrogen adsorption was made on calcined samples at 673 and 923 K. The acid strength and number of acid sites of the solids were determinate by potentiometric titration with n-butylamine. The catalytic activity of the characterized solids was evaluated in the esterification of oleic acid (79 wt.%) with ethanol at 353 K using an oleic acid:ethanol molar ratio of 1:10. Titanyl sulfate (673 K) catalyst under such reaction conditions and without additional treatments showed to be more active (86%) than sulfated titania (64%).

Background is key to HIV transmission, monitoring trends in groups of men from the general population, especially those whose mobility features and difficult access to sexual health services specialised transit routes is a constant Methods From November 2012 - January 2013, men were recruited long-haul drivers as part of the Survey of Prevalence of HIV, syphilis and sexual behaviours in key populations of HIV in Guatemala. We used a convenience sample. All participants fulfilled the eligibility criteria and signed an informed consent, a questionnaire was face to face. All participants had been testing for HIV and syphilis. Data were analysed using STATA 11.1 Results 609 men long-distance drivers participated in the study, the median age was 37 years (IQR 31–46). The Guatemalans were 86.54%, 98% married or living with a woman and more than half (56%) had completed primary education. Only 9.2% had participated in activities about HIV in the past year, 22.8% correctly recognised ways of preventing HIV transmission, a 11.35% underwent an HIV test in the last 12 months, higher than that found in the general population (4.0%), but lower than in FSW´s clients (23.5%). Prevalence in HIV were found in 0.50% (0.10–1.44) and 1.98% (1.02–3.43) in syphilis Conclusions The low prevalence of HIV is similar to that found in the general population of Guatemala (0.8%). Based on the results of this study primarily: the lack of correct knowledge about HIV and the little assistance to get tested for HIV diagnosis in addition with the UNAIDS recommendations in textbooks on population mobility and AIDS interventions are required to establish this special population is a priority under the bridge populations, for their constant mobility.

Background In Guatemala, there is limited information on the situation of HIV in prisoners. Therefore performed the first representative Behavior Surveillance Survey (BSS) and Prevalence of HIV and syphilis conducted among inmate population in country. Methods From September to December 2012, inmates were recruited in 6 prisons located in Guatemala City. A two-stage random cluster sampling and a face-to-face standardised questionnaire were applied. Those who met eligibility criteria and signed informed consent were selected as participants, being all of them tested for HIV and syphilis. The proportions, medians, interquartile range (IQR) and confidence intervals (CI: 95%) were obtained using STATA 11.1. Results 605 inmates wererecruited, 87% male/13% female. The median age was 31 years (IQR 25–38). 50% had 1–5 years of imprisonment; the median was 2 years (IQR 0.8–4). Nearly 30% reported > 2 sexual partners in the last 12 months; only 23% used a condom at last intercourse. Consistent condom use in the past 30 days with regular partner, casual and business was 13%, 43%, 78% respectively. The 51% and 58%reported illicit drug use at some time- in life and in the last 30 days, 5% and 1% used injection drugs in the same periods respectively. The Index of adequate knowledge about HIV was 32%. The prevalence of HIV was 0.76% (CI 0.24–1.76) and syphilis 3.5% (CI: 2.23–5.20). Conclusions A low HIV prevalence and syphilis among inmates in Guatemala were found. However, sexual risk behaviours and low HIV knowledge put them at risk of HIV infection. Drug use was higher than reported in other Central American BSS (

Background Juveniles who are exposed to a street life are at high risk for drug addiction, pregnancy, sexually transmitted infections (STI), among others due to their biological, psychological and social vulnerabilities. Methodology A survey was conducted in Guatemala City; with the purpose to determine risk behaviours and HIV and syphilis prevalence among juvenile delinquents and in family abandonment situations. A stratified consecutive sampling method was used; a tablet was used to conduct a standardised face-to-face questionnaire, and both pre-consent from legal guardians as well as assent by the minor were required. HIV and Syphilis screenings were conducted. Proportions and confidence intervals (CI 95%) adjusted for the sampling type were calculated using STATA 11.1. Results 528 participants ages 15 to 17, 72% male and 28% female were enrolled. 58% (ICR 50.1–64.9) began having sexual relations between 10 and 14 years old, 37% (ICR 29.7–44.1) used a condom at first sexual act; only 24% (ICR 18.2–29.6) and 12% (ICR 9.11–15.0) had access to free condoms and HIV tests in the past year. 81% (ICR 75.7–85.8) reported currently being sexually active, 79% (71.22–85.67) had a stable partner, 20% (13.71–28.14%) occasional partner, and 1% (0.14–1.54) commercial partner; 40% (ICR: 32.8–47.9) reported using a condom a last sexual act. Out of the women surveyed, 16% (9.75–25.19) had been pregnant at one point and 53% of these had had an abortion. 57% (50–67.7) had consumed illicit drugs; marijuana making up 93% (ICR 87.8–96.6) and cocaine made up 31% (ICR 23.7–40.1) topping the list. HIV and Syphilis prevalences were lower than 1%. Conclusions High pregnancy and illicit drug use proportions were reported, as well as low HIV and syphilis prevalences. Strengthening HIV prevention interventions, with an integral focus on reproductive sexual health adapted to this life stage and street context of this population, is necessary.