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Objective: To describe the delay in the diagnosis of breast cancer in primary care and to identify the patient, care process and disease variables involved in the delay to diagnosis and treatment., Design: Retrospective study with follow-up of a cohort of women with breast cancer, from the first symptoms to the start of treatment. SITE: In total 24 family medicine practices with information from both primary care and hospital settings., Participants: 446 women were evaluated (period 2014-2023)., Main Measurements: Patient characteristics (age, history and comorbidity), care process (screening, consultation site and referral priority) and disease characteristics (stage, presentation and risk factors) were included. Time intervals considered included, among others, «primary care interval», «health system interval», «diagnosis interval» and «treatment interval»., Results: The mean value of the «primary care interval» was 24.7days (median: 16); that of the «hospital care interval», 77.2days (median: 68); and that of the «health system interval», 93.6days (median: 83). Multiple linear regression showed a significantly shorter duration of the interval in women referred preferentially, in advanced stages, with a breast lump at presentation and with risk factors., Conclusions: Most are diagnosed in early stages at the health centre. The duration of the «health system interval» is shorter in preferential referrals, when the form of presentation is a breast lump, with risk factors and in advanced stages., Competing Interests: Conflicto de intereses Los autores declaran que no presentan ningún conflicto de intereses., (Copyright © 2024 The Authors. Publicado por Elsevier España S.L.U. All rights reserved.)

Background: The healthcare professional who performs sedation for digestive endoscopy procedures is usually the nurse. Therefore, knowledge and training on the part of the nurse is an important factor for the correct sedation of the patient and may affect, among other factors, the quality of health care and the recovery and well-being of the patient., Objective: To determine the training opportunities and resources available to the specialists involved in digestive endoscopy services in hospitals in Spain in which sedation is performed by the nursing staff., Methods: This was a descriptive cross-sectional study performed in the Digestive Endoscopy Service at Toledo University Hospital and nearby hospitals in central Spain. The sample consisted of 75 nurses who administer sedation in digestive endoscopic procedures., Results: Regarding the training of nurses, the vast majority were generalist nurses, and only a small percentage obtained specialized training through ongoing training. Most had been working in the service for more than two years, and very few had previous experience in sedation, although the vast majority currently applied sedation. Life support training was also critical. There were significant differences in the availability of resources between different hospitals., Conclusions: The training of nurses who perform sedation in digestive endoscopy services could be improved since there is a high proportion of personnel without specific training in sedation before starting to work in the service. It is crucial to implement targeted and ongoing training programs to improve competencies in this area, as they are essential to ensure the safety and effectiveness of the procedure. Given the variability in resources and personnel training that exists between different hospitals, it seems important to establish standards at the institutional level.

Background: Despite the availability of numerous treatments for Crohn disease, there are patients who do not respond to any therapy, thereby diminishing their quality of life. The aim of this review is to analyze the efficacy and safety of autologous hematopoietic stem cell transplantation therapy for refractory Crohn disease., Methods: This work is a systematic review with meta-analysis conducted in accordance with the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analyses. Electronic databases such as PubMed, Scopus, Web of Science, and ClinicalTrials were consulted. The searches were carried out in August 2024. To evaluate the efficacy of autologous hematopoietic stem cell transplantation in inducing remission, the mean and standard deviation of the Crohn's Disease Activity Index pre- and post- treatment were used, and a fixed-effects meta-analysis was conducted. Additionally, to assess the efficacy in perianal fistulas, a random-effects meta-analysis was performed, collecting data on the number of subjects with fistulas at the beginning and end of the intervention. All 95% confidence intervals were calculated, and the I2 statistic was used to assess the heterogeneity of the outcome variables., Results: A total of 609 records were identified from databases, with 12 studies selected for inclusion in the review. Immediate intervention proved effective in inducing a decrease in the Crohn Disease Activity Index compared to late intervention with conventional therapies. Moreover, the meta-analysis demonstrated efficacy for Crohn disease and associated fistulas with a mean decrease in the CDAI of -217.53 ± 14.3. When evaluating the efficacy of the procedure in perianal fistulas, a risk ratio of 0.47 with a 95% CI of [0.26, 0.86] was obtained. However, the procedure showed adverse effects, such as infections, acute renal failure or deaths., Conclusion: Systemic autologous hematopoietic stem cell transplantation has shown efficacy in patients who fail to achieve remission of their Crohn disease with conventional therapies. This procedure has also demonstrated efficacy in treating perianal fistulas. However, it is essential to carefully evaluate de implementation of this procedure due to the associated risks., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Aim: To describe the latest scientific evidence regarding community-based interventions performed on patients in need of palliative care worldwide., Introduction and Background: Given the rise of chronic diseases, their complexities and the fragility of patients, we are facing around 56.8 million people in need of palliative care. Community-based healthcare, particularly palliative care, can address social inequalities and improve the biopsychosocial health of disadvantaged populations. Therefore, primary care, as the main health referent in the community, has a central role in the care of these patients., Methods: This is an integrative review from January 2017 to June 2022 that follows the PRISMA statement and has been registered in PROSPERO. PubMed, Cuiden, the Web of Science (WoS), Cochrane and LILACS were the five databases searched. The scientific quality assessment of the articles was carried out following the CASPe methodology. Study selection was carried out by two researchers, A.V.L. and J.M.C.T., using the inclusion and exclusion criteria mentioned below. In cases of doubt or discrepancy, a third author (J.R.S.) was consulted., Results: The interventions mentioned in the 16 articles analysed were classified under the following categories: music therapy, laughter therapy, spiritual and cognitive interventions, aromatherapy, interdisciplinary and community-based teams, advance care planning and community, volunteering, telemedicine and care mapping., Example: Educating people to talk about different ethical issues could improve their quality of life and help develop more compassionate cities., Conclusions: We have identified interventions that are easily accessible (laughter therapy, telemedicine or music therapy), simple enough to be carried out at the community level and do not incur high costs. This is why they are recommended for people with palliative care needs in order to improve their quality of life.

Electroencephalography (EEG) has been a fundamental technique in the identification of health conditions since its discovery. This analysis specifically centers on machine learning (ML) and deep learning (DL) methodologies designed for the analysis of electroencephalogram (EEG) data to categorize individuals with Alzheimer's Disease (AD) into two groups: Moderate or Advanced Alzheimer's dementia. Our study is based on a comprehensive database comprising 668 volunteers from 5 different hospitals, collected over a decade. This diverse dataset enables better training and validation of our results. Among the methods evaluated, the CNN (deep learning) approach outperformed others, achieving a remarkable classification accuracy of 97.45% for patients with Moderate Alzheimer's Dementia (ADM) and 97.03% for patients with Advanced Alzheimer's Dementia (ADA). Importantly, all the compared methods were rigorously assessed under identical conditions. The proposed DL model, specifically CNN, effectively extracts time domain features from EEG data in time, resulting in a significant reduction in learnable parameters and data redundancy., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Electroencephalography is a method of detecting and analyzing electrical activity in the brain. This electrical activity can be recorded and processed to aid in the clinical diagnosis of mental disorders. In this study, a novel system for classifying schizophrenia patients from EEG recordings is presented. The developed algorithm decomposes the EEG signals into a system of radial basis functions using the method of fuzzy means. This decomposition helps to obtain the information from the various electrodes of the EEG and allows separating between healthy controls and patients with schizophrenia. The proposed method has been compared with classical machine learning algorithms, such as, K-Nearest Neighbor, Adaboost, Support Vector Machine, and Bayesian Linear Discriminant Analysis. The results show that the proposed method obtains the highest values in terms of balanced accuracy, recall, precision and F1 score, close to 93 % in all cases. The model developed in this study can be implemented in brain activity analysis systems that help in the prediction of patients with schizophrenia., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Objective: Scientific evidence has rarely, if at all, been reported in the literature demonstrating analytical confirmation of the physical compatibility and stability of glycopyrrolate and rocuronium combined. The purpose of this experiment was to determine if glycopyrrolate and rocuronium are physically compatible., Methods: Glycopyrrolate and rocuronium were combined in various containers, observed over a 60-minute period, and compared against positive and negative controls. Measured metrics included color change, precipitate formation, Tyndall beam test, turbidity, and pH. Statistical analyses were used to assess significance of data trends., Results: The combination of glycopyrrolate and rocuronium did not result in any color change, precipitate formation, a positive Tyndall beam test, or a significantly positive turbidity and did not result in any significant change in pH, regardless of container., Conclusion: Per the protocol used in this study, glycopyrrolate and rocuronium were determined to be physically compatible., (© 2023 by the American Dental Society of Anesthesiology.)

Excessive alcohol consumption is a major public health issue that can negatively affect behavior among university students. The objective of this study was to estimate the frequency of alcohol consumption in nursing students as well as to describe the pattern of alcohol consumption after COVID-19 lockdown. A descriptive, cross-sectional observational study was carried out, in which 1162 degree-level nursing students were evaluated. Sociodemographic characteristics, lifestyles and levels of physical activity were determined using the International Physical Activity Questionnaire: Short Form (IPAQ-SF), and alcohol consumption was determined using the ISCA (Systematized Alcohol Consumption Questionnaire) and AUDIT (Alcohol Use Disorders Inventory Test) questionnaires. According to the AUDIT questionnaire, 36.7% of the students met the criteria for excessive alcohol consumption (26.8% men vs. 39.9% women; p < 0.001). The prevalence of hazardous drinkers was found to be 10.2% (95% CI 5.6-11.7), with the difference between men and women being statistically significant. The IPAQ-SF questionnaire indicated that 26.1% of students were sedentary. No relationship was observed between alcohol consumption and the level of physical activity. The frequency of hazardous drinkers was significantly higher in women (OR: 2.2) and in smokers (OR: 4.2). In conclusion, approximately 10% of nursing students can be considered hazardous drinkers, with significant differences between the sexes. The percentage is higher in women and in smokers. Strategies should be created that encourage healthy lifestyles, emphasizing preventive activities against excessive alcohol consumption. Furthermore, given the differences in excessive alcohol consumption between men and women, it would be advisable to include the gender perspective in these activities.

Background: In pursuit of diagnostic tools capable of targeting distinct stages of Alzheimer's disease (AD), this study explores the potential of electroencephalography (EEG) combined with machine learning (ML) algorithms to identify patients with mild or moderate AD (ADM) and advanced AD (ADA)., Objective: This study aims to assess the classification accuracy of six classical ML algorithms using a dataset of 668 patients from multiple hospitals., Methods: The dataset comprised measurements obtained from 668 patients, distributed among control, ADM, and ADA groups, collected from five distinct hospitals between 2011 and 2022. For classification purposes, six classical ML algorithms were employed: support vector machine, Bayesian linear discriminant analysis, decision tree, Gaussian Naïve Bayes, K-nearest neighbor and random forest., Results: The RF algorithm exhibited outstanding performance, achieving a remarkable balanced accuracy of 93.55% for ADA classification and 93.25% for ADM classification. The consistent reliability in distinguishing ADA and ADM patients underscores the potential of the EEG-based approach for AD diagnosis., Conclusions: By leveraging a dataset sourced from multiple hospitals and encompassing a substantial patient cohort, coupled with the straightforwardness of the implemented models, it is feasible to attain notably robust results in AD classification.

(1) Background: The aim is to ascertain health science students’ attitudes towards tattoos and their association with healthy lifestyles and socio-demographic variables. (2) Methods: Descriptive study conducted on pharmacy, medical and nursing students (n = 423). To ascertain attitudes towards tattoos, we used the Attitudes Towards Tattoos Scale. Other variables were physical activity, healthy diet, harmful habits and socio-demographic variables. (3) Results: A total of 12.6% (95% CI 9.1−16.2) of students reported having a tattoo; 58.9% did not regard tattoos as a health risk. In terms of attitudes, the mean score in the range of 7−35 (7—most unfavourable to 35—most favourable) was 22.6 (SD 5.2; 95% CI: 22.0−23.2). Scores were higher (p < 0.05) among women (23.1; SD: 5.3), persons aged <20 years (23.6; SD: 5.0) and smokers (23.9; SD: 4.6). Attitudes were found to be more favourable (p < 0.05) in nursing students than in pharmacy or medical students. No relationship was observed with physical activity, healthy diet or drug use. (4) Conclusions: The attitude to tattoos is most favourable among women, persons aged under 20 years and nursing students. In terms of health habits, attitudes are more favourable among smokers, regardless of their level of physical activity, compliance with healthy eating guidelines or consumption of alcohol or other drugs.

To examine the performance of a novel low-cost, ultra-compact, and attractive auditory feedback device for training laypeople in external chest compressions (ECCs), we conducted a quasi-experimental cross-sectional study from September to November 2021 at the Faculty of Nursing of Albacete, University of Castille-La Mancha, Spain. The ECC sequence was performed in the laboratory with the new device for basic hands-on CPR training. Results: One hundred college students were included in this study. The compression rate/min with the new device was 97.6, and the adequate %ECC was 52.4. According to the status of body mass index (BMI) and muscle strength of the upper limbs in the bivariate analysis, it was observed that the new device discriminated between those who performed correct ECCs according to their BMI and muscle strength and those who did not, which led to significantly influenced results in terms of the percentage of ECCs with correct depth. Conclusions: The new ultra-compact auditory feedback device "Salvando a Llanetes ® " demonstrated utility for teaching and learning ECCs in basic CPR. We can affirm that the analyzed device is an adequate, safe and economical method for teaching "CPR Hands-Only™" to the general population.