Strategies for livestock wastewater treatment and optimised nutrient recovery using microalgal-based technologies.

Global sustainable development faces several challenges in addressing the needs of a growing population. Regarding food industries, the heightening pressure to meet these needs has resulted in increased waste generation. Thus, recognising these wastes as valuable resources is crucial to integrating sustainable models into current production systems. For instance, the current 24 billion tons of nutrient-rich livestock wastewater (LW) generated yearly could be recovered and valorised via biological uptake through microalgal biomass. Microalgae-based livestock wastewater treatment (MbLWT) has emerged as an effective technology for nutrient recovery, specifically targeting carbon, nitrogen, and phosphorus. However, the viability and efficacy of these systems rely on the characteristics of LW, including organic matter and ammonium concentration, content of suspended solids, and microbial load. Thus, this systematic literature review aims to provide guidance towards implementing an integral MbLWT system for nutrient control and recovery, discussing several pre-treatments used in literature to overcome the challenges regarding LW as a suitable media for microalgae cultivation.

Prognostic Value of the Circumferential Resection Margin After Curative Surgery for Rectal Cancer: A Multicenter Propensity Score-Matched Analysis.

BACKGROUND: Recently, positive circumferential resection margin has been found to be an indicator of advanced disease with a high risk of distant recurrence rather than local recurrence. OBJECTIVE: The study aimed to analyze the prognostic impact of the circumferential resection margin on long-term oncological outcomes in patients with rectal cancer. DESIGN: This was a multicenter, propensity score-matched (2:1) analysis comparing the positive and negative circumferential resection margins. SETTINGS: The study was conducted at 5 high-volume centers in Spain. PATIENTS: Patients who underwent total mesorectal excision with curative intent for middle-low rectal cancer between 2006 and 2014 were included. MAIN OUTCOME MEASURES: The main outcomes were local recurrence, distant recurrence, overall survival, and disease-free survival. RESULTS: The unmatched initial cohort consisted of 1599 patients, of whom 4.9% had a positive circumferential resection margin. After matching, 234 patients were included (156 with a negative circumferential margin and 78 with a positive circumferential margin). The median follow-up period was 52.5 (22.0-69.5) months. Local recurrence was significantly higher in patients with a positive circumferential margin (33.3% vs 11.5%; p < 0.001). Distant recurrence was similar in both groups (46.2% vs 42.3%; p = 0.651). There were no statistically significant differences in 5-year overall survival (48.6% vs 43.6%; p = 0.14). Disease-free survival was lower in patients with a positive circumferential margin (36.1% vs 52.3%; p = 0.026). LIMITATIONS: This study was limited by its retrospective design. The different neoadjuvant treatment options were not included in the propensity score. CONCLUSIONS: The positive circumferential resection margin was associated with a higher local recurrence rate and worse disease-free survival in comparison with the negative circumferential resection margin. However, the positive circumferential resection margin was not a prognostic indicator of distant recurrence and overall survival. See Video Abstract at http://links.lww.com/DCR/B950 . VALOR PRONSTICO DEL MARGEN DE RESECCIN CIRCUNFERENCIAL DESPUS DE LA CIRUGA CURATIVA PARA EL CNCER DE RECTO UN ANLISIS MULTICNTRICO EMPAREJADO POR PUNTAJE DE PROPENSIN: ANTECEDENTES:En los últimos años, se ha encontrado que el margen de resección circunferencial positivo es un indicador de enfermedad avanzada con alto riesgo de recurrencia a distancia más que de recurrencia local.OBJETIVO:El objetivo fue analizar el impacto pronóstico del margen de resección circunferencial sobre la recidiva local, a distancia y las tasas de supervivencia en pacientes con cáncer de recto.DISEÑO:Este fue un análisis multicéntrico emparejado por puntaje de propensión 2: 1 que comparó el margen de resección circunferencial positivo y negativo.AJUSTES:El estudio se realizó en 5 centros Españoles de alto volumen.PACIENTES:Se incluyeron pacientes sometidos a escisión total de mesorrecto con intención curativa por cáncer de recto medio-bajo entre 2006-2014. Las características clínicas e histológicas se utilizaron para el emparejamiento.PRINCIPALES MEDIDAS DE RESULTADO:Los resultadoes principales fueron la recurrencia local, la recurrencia a distancia, la supervivencia global y libre de enfermedad.RESULTADOS:La cohorte inicial no emparejada consistió en 1599 pacientes; El 4,9% tuvo un margen de resección circunferencial positivo. Tras el emparejamiento se incluyeron 234 pacientes (156 con margen circunferencial negativo y 78 con margen circunferencial positivo). La mediana del período de seguimiento fue de 52,5 meses (22,0-69,5). La recurrencia local fue significativamente mayor en pacientes con margen circunferencial positivo, 33,3% vs 11,5% [HR 3,2; IC 95%: 1,83-5,43; p < 0,001]. La recidiva a distancia fue similar en ambos grupos (46,2 % frente a 42,3 %) [HR 1,09, IC 95 %: 0,78-1,90; p = 0,651]. No hubo diferencias significativas en la supervivencia global a 5 años (48,6 % frente a 43,6 %) [HR 1,09, IC 95 %: 0,92-1,78; p = 0,14]; La supervivencia libre de enfermedad fue menor en pacientes con margen circunferencial positivo, 36,1% vs 52,3% [HR 1,5; IC 95%: 1,05-2,06; p = 0,026].LIMITACIONES:Este estudio estuvo limitado por el diseño retrospectivo. Las diferentes opciones de tratamientos neoadyuvantes no se han incluido en la puntuación de propensión.CONCLUSIONES:El margen de resección circunferencial positivo se asocia con una mayor tasa de recurrencia local y peor supervivencia libre de enfermedad en comparación con el margen de resección circunferencial negativo. Sin embargo, el margen de resección circunferencial positivo no fue un indicador pronóstico de recidiva a distancia ni de supervivencia global. Consulte el Video del Resumen en http://links.lww.com/DCR/B950 . (Traducción- Dr. Yesenia Rojas-Khalil ).

Inflammasomes NLRP3 and AIM2 in peri-implantitis: A cross-sectional study.

BACKGROUND: Inflammasome components NLRP3 and AIM2 contribute to inflammation development by the activation of caspase-1 and IL-1ß. They have not been yet evaluated in samples from patients with active peri-implantitis. Thus, the aim of the present study is to analyze the expression of inflammasomes NLRP3 and AIM2 and subsequent caspase 1 and IL-1ß assessing the microenvironment of leukocyte subsets in samples from patients with active peri-implantitis. METHODS: Biopsies were collected from 33 implants in 21 patients being treated for peri-implantitis. Biopsies from gingival tissues from 15 patients with healthy periodontium were also collected for control. These tissues were evaluated through conventional histological stainings. Then, immunohistochemical detection was performed to analyze NLRP3, AIM2, caspase-1, and IL-1ß and markers of different leukocyte subsets. PCR for inflammasomes and related genes was also done. RESULTS: This manuscript reveals a high immunohistochemical and mRNA expression of NLRP3 and AIM2 inflammasomes, caspase-1, and IL-1ß in biopsies collected from human peri-implantitis. The expression of the tested markers was significantly correlated with the increase in inflammatory infiltrate, probing depth, presence of biofilm, and bleeding on probing. In these peri-implantitis lesions, the area of biopsy tissue occupied by inflammatory infiltrate was intense while the area occupied by collagen was significantly lower. In comparison with periodontal healthy tissues, the inflammatory infiltrate was statistically significantly higher in the peri-implantitis biopsies and was mainly composed of plasma cells, followed by T and B lymphocytes. CONCLUSION: In human peri-implantitis, chronic inflammation can be explained in part by the action of IL-1ß/caspase 1 induced through NLRP3 and AIM2 inflammasome activation.

Short version of the Multidimensional Scale of Dating Violence (MSDV 2.0) in Spanish-language: Instrument development and psychometric evaluation.

AIMS: To develop and psychometrically test the short version of the Multidimensional Scale of Dating Violence (MSDV 2.0) in Spanish-language to detect violence perpetrated and suffered in dating relationships. DESIGN: A psychometric instrument development and validation study. METHODS: A two-phase approach was used: Phase (1) the items of the original instrument were revised and new items related to online violence and sexual violence were incorporated. Content validation by a Delphi panel with 25 psychometric and dating violence experts were performed. Next, a face validity was performed in 32 students followed by a pilot study in another 74 participants. Phase (2) Psychometric validation, the instrument was tested in a sample of 1091 university students, analysing the psychometric properties based on construct validity and internal consistency. The study was conducted from September to November 2020 in the context of the Andalusian Public University System. RESULTS: In phase (1) 42 items for each subscale (perpetration, victimization) were accepted by the Delphi panel, and acceptable values were obtained for the criteria of clarity, coherence, and relevance. In phase (2) the MSDV 2.0 showed acceptable psychometric properties. Confirmatory factor analysis showed a five-dimensional structure with 18 items for each subscale with excellent fit rates. Reliability analysis indicated adequate internal consistency (α = .879-.802) and correlations with the Depression, Anxiety, and Stress Scale (ρ = .418-.225) and the self-perceived health item (ρ = .380-.179), providing evidence of its convergent validity. Cut-off points were also calculated for each dimension, with their corresponding sensitivity and specificity, indicating to be a good instrument for detecting possible cases of dating violence. CONCLUSION: The MSDV 2.0 is the only short instrument published to date that measures the dating violence suffered and perpetrated taking into account all its dimensions. Its use would serve as support in prevention programs and design of public policies. IMPACT: The short version of the MSDV 2.0 could be a comprehensive enough instrument to enable a detection and evaluation of dating violence in the educational setting.

Effectiveness of the best practice spotlight organizations program to reduce the prevalence of pressure injuries in acute care settings for hospitalized patients in Spain: A quasi-experimental study.

BACKGROUND: Pressure injuries are a major public health problem because of their impact on morbidity and mortality, quality of life, and increased healthcare costs. The Centros Comprometidos con la Excelencia en Cuidados/Best Practice Spotlight Organization (CCEC/BPSO®) program provides guidelines that can improve these outcomes. AIMS: This study aimed to assess the effectiveness of the CCEC/BPSO® program in improving the care of patients at risk of pressure injury (PI) at an acute care hospital in Spain. METHODS: A quasi-experimental regression discontinuity design in three periods was used: (1) baseline (2014), (2) implementation (2015-2017), and (3) sustainability (2018-2019). The study population was comprised of 6377 patients discharged from 22 units of an acute care hospital. The performance of the PI risk assessment and reassessment, the application of special pressure management surfaces, and the presence of PIs were all monitored. RESULTS: Forty-four percent of patients (n = 2086) met the inclusion criteria. After implementing the program, the number of patients assessed (53.9%-79.5%), reassessed (4.9%-37.5%), the application of preventive measures (19.6%-79.7%), and the number of people identified with a PI in implementation (1.47%-8.44%) and sustainability (1.47%-8.8%) all increased. LINKING EVIDENCE TO ACTION: The implementation of the CCEC/BPSO® program achieved improved patient safety. Risk assessment monitoring, risk reassessment, and special pressure management surfaces were practices that increased during the study period and were incorporated by professionals to prevent PIs. The training of professionals was instrumental to this process. Incorporating these programs is a strategic line to improve clinical safety and the quality of care. The implementation of the program has been effective in terms of improving the identification of patients at risk and the application of surfaces.

Multiplexed orthogonal genome editing and transcriptional activation by Cas12a.

CRISPR-Cas9-based combinatorial perturbation approaches for orthogonal knockout and gene activation have been impeded by complex vector designs and co-delivery of multiple constructs. Here, we demonstrate that catalytically active CRISPR-Cas12a fused to a transcriptional-activator domain enables flexible switching between genome editing and transcriptional activation by altering guide length. By leveraging Cas12a-mediated CRISPR-RNA array processing, we illustrate that Cas12a-VPR enables simplified multiplexed knockout and transcriptional activation in vitro and in vivo.

Maxillary sinus floor augmentation comparing bovine versus porcine bone xenografts mixed with autogenous bone graft. A split-mouth randomized controlled trial.

AIM: To compare the effectiveness of two xenografts for maxillary sinus floor augmentation in terms of clinical, radiographical, histologic, and molecular outcomes. MATERIALS AND METHODS: A split-mouth randomized clinical trial was conducted at the University of Granada. Ten consecutive patients in need of bilateral two-staged maxillary sinus floor augmentation were included. Each patient received both biomaterials (porcine bone mineral and anorganic bovine bone), which were randomly assigned for bilateral sinus augmentation. The maxillary autogenous bone scraped from the sinus access window was mixed with each xenograft at a 20:80 ratio. After a healing period of 6 months, bone biopsies were collected with a trephine during the implant placement in the regenerated area. Histologic, histomorphometrical, immunohistochemical, and molecular outcomes were analyzed. Clinical and radiographical data throughout the treatment phases were also evaluated. RESULTS: The resulting anatomic features were similar between both groups. After six months of graft consolidation, the graft resorption rates were similar between both biomaterials. The histologic, histomorphometrical, and immunohistochemical results showed no statistical differences between groups. CONCLUSION: Anorganic bovine bone and porcine bone mineral combined with maxillary autogenous cortical bone show similar biologic and radiologic features in terms of biomaterial resorption, osteoconduction, and osteogenesis when used for maxillary sinus floor augmentation.

Worldwide prevalence of inadequate work ability among hospital nursing personnel: A systematic review and meta-analysis.

PURPOSE: To estimate the worldwide pooled prevalence of inadequate work ability among hospital nursing personnel using the Work Ability Index (WAI). DESIGN: Systematic review and meta-analysis. METHODS: A systematic search was conducted on Medline/PubMed, Scopus, Web of Science, Scielo, PsychInfo, CINAHL, Nursing and Allied Health, LILACS, and Google Scholar from inception to July 2021 to identify observational studies on work ability among hospital nursing personnel using the WAI. Two researchers independently completed the study selection, quality assessments, and data extraction on the prevalence of inadequate work ability that was pooled using the random effects model. Finally, subgroup analyses were performed to explore sources of heterogeneity. FINDINGS: A total of 42 studies were included, consisting of 24,728 subjects worldwide from 14 countries. Of these, 35 studies were included in the meta-analytical analyses. The worldwide pooled prevalence of inadequate work ability among hospital nursing personnel was 24.7% (95% CI = 20.2%-29.4%). High levels of heterogeneity were detected in all studies. Prevalence was higher in studies where samples were composed of nurses and nursing assistive personnel (26.8%; 95% CI = 22.4%-31.5%) than in those of nurses alone (22.2%; 95% CI = 13.1%-32.9%) and in studies where the sample was over 40 (28.1%; 95% CI = 19.5%-37.5%) than in those with a sample under that age (22.4%; 95% CI = 15.8%-29.7%). CONCLUSIONS: Almost one in four members of hospital nursing staff in the world has inadequate work ability and therefore are at risk of several negative outcomes during their working life. These prevalence data correspond to the pre-pandemic period, so new studies should also be especially useful in quantifying the impact of the COVID-19 pandemic on work ability in the hospital nursing workforce. CLINICAL RELEVANCE: The above findings justify the launch of initiatives that include annual assessment for the early identification of inadequate work ability, offering the possibility of anticipated corrective measures. Nursing workforce older than 40 years and those belonging to the professional category of nursing assistive personnel should be priority target groups for screening and intervention to improve work ability.

Microalgae-based livestock wastewater treatment (MbWT) as a circular bioeconomy approach: Enhancement of biomass productivity, pollutant removal and high-value compound production.

The intensive livestock activities that are carried out worldwide to feed the growing human population have led to significant environmental problems, such as soil degradation, surface and groundwater pollution. Livestock wastewater (LW) contains high loads of organic matter, nitrogen (N) and phosphorus (P). These compounds can promote cultural eutrophication of water bodies and pose environmental and human hazards. Therefore, humanity faces an enormous challenge to adequately treat LW and avoid the overexploitation of natural resources. This can be accomplished through circular bioeconomy approaches, which aim to achieve sustainable production using biological resources, such as LW, as feedstock. Circular bioeconomy uses innovative processes to produce biomaterials and bioenergy, while lowering the consumption of virgin resources. Microalgae-based wastewater treatment (MbWT) has recently received special attention due to its low energy demand, the robust capacity of microalgae to grow under different environmental conditions and the possibility to recover and transform wastewater nutrients into highly valuable bioactive compounds. Some of the high-value products that may be obtained through MbWT are biomass and pigments for human food and animal feed, nutraceuticals, biofuels, polyunsaturated fatty acids, carotenoids, phycobiliproteins and fertilizers. This article reviews recent advances in MbWT of LW (including swine, cattle and poultry wastewater). Additionally, the most significant factors affecting nutrient removal and biomass productivity in MbWT are addressed, including: (1) microbiological aspects, such as the microalgae strain used for MbWT and the interactions between microbial populations; (2) physical parameters, such as temperature, light intensity and photoperiods; and (3) chemical parameters, such as the C/N ratio, pH and the presence of inhibitory compounds. Finally, different strategies to enhance nutrient removal and biomass productivity, such as acclimation, UV mutagenesis and multiple microalgae culture stages (including monocultures and multicultures) are discussed.

Predictive validity of the INTEGRARE scale in identifying the risk of hospital-acquired pressure ulcers in acute care hospital settings.

BACKGROUND: Hospital-acquired pressure ulcers (HAPUs) are prevalent around the world and are an indicator of care quality. Numerous instruments are available to predict their appearance, but few evaluate predictive validity. No instruments based on Nursing Outcomes Classification indicators have been found, despite these indicators reflecting the patient's condition. The aim of the study was to analyse the predictive validity of the INTEGRARE scale in preventing the risk of HAPUs. METHODS: A multicentre prospective observational cohort study design was used. 1,004 patients from 11 public hospitals in Andalusia (Spain) were recruited between February 2015 and October 2017. Participants were aged over 18 and had been admitted to medical and surgical units, with a predicted stay exceeding 48 h. Predictive validity was checked using a multivariate logistic regression model and a receiver operating characteristic curve, with development of pressure ulcers during the hospital stay as the dependent variable. RESULTS: The INTEGRARE scale obtained an area under the curve of 0.886 (95% CI = 0.85-0.923). Within the 30-point range, the optimal cut-off value is 23 points with a sensitivity of 80.8% and a specificity of 80%. The odds ratio was 16.86 (95% CI = 8.54-33.28). Among the patient variables, age was significant, while among the hospital variables, the type of unit and the Nurse Staffing Level (NSL) were significant. CONCLUSIONS: The INTEGRARE scale has robust predictive validity when patients are admitted to medical and surgical inpatient units. Patients with a higher risk of developing HAPUs are in surgical units, are elderly, and have an NSL exceeding 10.4.

Efficacy of a Social Interaction Intervention in Early Postoperative Period to Improve Coping in Persons With an Ostomy: A Randomized Controlled Trial.

PURPOSE: The purpose of this study was to analyze the efficacy of a social interaction intervention delivered during the early postoperative time period on the coping process in persons with a new ostomy. DESIGN: Randomized controlled trial. SUBJECTS AND SETTING: The sample comprised 52 persons who underwent surgical management of colorectal including a fecal ostomy; 27 were randomly allocated to the intervention group and 25 to the control group. One participant allocated to the control group died before data collection; thus, findings are based on data from 51 participants. The study setting is the Regional University Hospital of Malaga, located on the southern coast of Spain. METHODS: Ostomy visitors (persons living with an ostomy) were taught to listen to the experiences and the concerns of the participant and to serve as an example of an individual who has successfully learned to live with a fecal ostomy. The intervention was a visit with a person with a new ostomy during the early postoperative period. Control group participants were offered standard care that did not include the visit from a person with an ostomy. Outcome measures were taken from the Nursing Outcomes Classification taxonomy. The main outcome measure was coping; secondary outcome measures were health beliefs and acceptance of health status. Bivariate analyses were performed to evaluate differences between groups in terms of the primary and secondary outcomes. A multivariate linear regression analysis was performed to identify predictor variables of the primary outcome, and effect size calculations were used to differentiate statistical significance versus clinical relevance. RESULTS: There were no differences in demographic or pertinent characteristics of participants in the 2 groups. Participants who received the intervention achieved a higher mean coping process scores: 3.90 vs 3.19, P = .002 and Cohen d = 0.97. In addition, intervention group participants achieved a higher mean efficacy for the secondary outcomes: 3.78 versus 2.97 (P = .0004) and Cohen d = 1.11 for health beliefs, and 3.68 versus 2.83 (P = .0001) and Cohen d = 1.24 for acceptance of health status. Linear regression analysis indicated that the social interaction intervention (ß= .799; P = .000) and undergoing urgent versus routine ostomy surgery (ß=-.610; P = .005) were related to coping. CONCLUSIONS: Findings indicate that a visit with a trained person living with an ostomy facilitated coping and improved health beliefs and acceptance of health status.

Defining and characterising the nurse-patient relationship: A concept analysis.

The nurse-patient relationship involves complex attitudes and behaviours with ethical and deontological implications. It has been linked to improvements in patient health outcomes, although there is still no consensus in the scientific literature as to the definition and characterisation of the concept. This article aim to define the concept of the nurse-patient relationship. A concept analysis was conducted using the Walker and Avant method to identify the attributes defining the nurse-patient relationship. An integrative review of the literature was conducted using the PubMed, Web of Science, Scopus, and Cumulative Index to Nursing & Allied Health Literature databases. A review of the grey literature and other minor non-indexed publications on the topic was also conducted. A total of 36 articles were included in the review. A model case, a contrary case, a related case, and empirical references were produced to clarify the concept and identify its essential attributes. The concept is defined as a helping relationship involving interaction between different players. It is the basis of nursing care and is intended to meet the healthcare needs of the individual receiving this care. It is also viewed as an intervention in itself, requiring a specific training process just like any other nursing skill. The essential attributes of the relationship are empathy, presence, contact, authenticity, trust, and reciprocity. In conclusion, the nurse-patient relationship is a helping relationship established with the patient and/or their family based on interaction, communication, respect for ethical values, acceptance, and empathy in order to encourage introspection and behavioural change. Key components include communication, active listening, and respect. Bioethical values and confidentiality must also be present to ensure that the relationship is built on equality and intimacy.

Factors That Influence Nurse Staffing Levels in Acute Care Hospital Settings.

PURPOSE: To identify which patient and hospital characteristics are related to nurse staffing levels in acute care hospital settings. DESIGN: A cross-sectional design was used for this study. METHODS: The sample comprised 1,004 patients across 10 hospitals in the Andalucian Health Care System (southern Spain) in 2015. The sampling was carried out in a stratified, consecutive manner on the basis of (a) hospital size by geographical location, (b) type of hospital unit, and (c) patients' sex and age group. Random criteria were used to select patients based on their user identification in the electronic health record system. The variables were grouped into two categories, patient and hospital characteristics. Multilevel linear regression models (MLMs) with random intercepts were used. Two models were fitted: the first was the null model, which contained no explanatory variables except the intercepts (fixed and random), and the second (explanatory) model included selected independent variables. Independent variables were allowed to enter the explanatory model if their univariate association with the nurse staffing level in the MLM was significant at p < .05. RESULTS: Two hierarchical levels were established to control variance (patients and hospital). The model variables explained 63.4% of the variance at level 1 (patients) and 71.8% at level 2 (hospital). Statistically significant factors were the type of hospital unit (p = .002), shift (p < .001), and season (p < .001). None of the variables associated with patient characteristics obtained statistical significance in the model. CONCLUSIONS: Nurse staffing levels were associated with hospital characteristics rather than patient characteristics. CLINICAL RELEVANCE: This study provides evidence about factors that impact on nurse staffing levels in the settings studied. Further studies should determine the influence of patient characteristics in determining optimal nurse staffing levels.

Implementing Holistic Care in Isolated Patients During COVID-19 Pandemic: A Case Study Using Nursing Outcomes (NOC) and Interventions (NIC) Classifications.

The most effective strategy against SARS-Cov-2 virus spread is therapeutic isolation. Consequences of this measure are the presence of anxiety and depression. Therefore, it is the nurse's responsibility to identify strategies to implement humanized and holistic care in order to avoid physical and mental consequences of isolation.

Intensive care nurses' experiences during the COVID-19 pandemic: A qualitative study.

BACKGROUND: Because of the COVID-19 pandemic, health care systems worldwide are working under challenging conditions. Patients, who are seriously ill, require intensive care admission. In fighting COVID-19, nurses are frontline health care workers and, as such, have a great responsibility providing needed specialized patient care in intensive care units (ICU). However, working conditions and emotional factors have an impact on the quality of the care provided. AIM: The purpose of the present study was to explore and describe the experiences and perceptions of nurses working in an ICU during the COVID-19 global pandemic. STUDY DESIGN: Qualitative research was undertaken, using an empirical approach and inductive content analysis techniques. METHODS: The selected population consisted of ICU nurses from a tertiary teaching hospital in Spain. Data were obtained via semi-structured videocall interviews from Apr 12th to Apr 30th, 2020. Subsequently, transcribed verbatims were analysed using the template analysis model of Brooks. FINDINGS: A total of 17 nurses comprised the final sample after data saturation. Four main themes emerged from the analysis and 13 subthemes: "providing nursing care," "psychosocial aspects and emotional lability," "resources management and safety" and "professional relationships and fellowship." CONCLUSION: Providing health care by intensive care nursing professionals, during the COVID-19 pandemic, has shown both strong and weak points in the health care system. Nursing care has been influenced by fear and isolation, making it hard to maintain the humanization of the health care. RELEVANCE TO CLINICAL PRACTICE: Implications for practice include optimizing resource management (human and material), providing psychological support, and adequate training for ICU nurses, as well as high-quality protocols for future emergency situations.

Factors that Influence Coping with Chronic Noncancer Pain in European Countries: A Systematic Review of Measuring Instruments.

BACKGROUND AND AIM: Coping can be defined as the cognitive efforts and behavioral practices that people develop in situations which they consider to be stressful. In people with Chronic Non-Cancer Pain (CNCP), coping is influenced by the biological, psychological, and socio-cultural resources available to them. The aim of this systematic review is to evaluate the psychometric properties of European measuring instruments related to coping with CNCP in non-hospitalized adults. DATABASE AND DATA TREATMENT: The review was conducted following the guidelines of the PRISMA Statement and the methodological framework of the Joanna Briggs Institute. The CINAHL, PubMed, Scopus, and Web of Science databases were searched by two reviewers independently. The analysis of psychometric properties was performed using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist, and the risk of bias was analyzed using the Quality Assessment of Diagnostic Accuracy Study-2 (QUADAS-2) tool. RESULTS: Thirty-six studies validated twenty-four different instruments. The Portuguese version of the Pain Beliefs and Perceptions Inventory (PBPI), which assess catastrophizing, and the Spanish version of the Roland-Morris Questionnaire (RMQ), which assess disability, are the instruments with the best methodological quality and bias control. CONCLUSIONS: There are important gaps in the measurement of different aspects of pain coping, such as stress, social and family support, or self-care. Future studies could consider the creation of an instrument to comprehensively assess the resources that influence coping with chronic non-cancer pain.

Parenting practices among parents of children with attention-deficit/hyperactivity disorder: Gender-related differences.

OBJECTIVE: Further research is needed on parenting practices among parents of children with attention-deficit/hyperactivity disorder (ADHD), as these practices impact children's development and outcomes. This study analyzes these practices, distinguishing between parents' and children's gender. METHOD: Parental warmth (affection-communication and criticism-rejection responses) and control (inductive, strict, and indulgent discipline styles) were assessed in both parents of 81 children diagnosed with ADHD (aged 6-17 years). RESULTS: Mothers reported greater affection-communication responses and use of inductive disciplinary practices than fathers. Higher use of maternal strict practices was associated with female children, regardless of their age, subtype, medication, or comorbidities. However, parental practices used with male children were affected by children's age and subtype. CONCLUSIONS: Warmth levels and discipline styles used by parents of children with ADHD may differ depending on the gender of both parents and children. The implications of these findings for understanding gender differences associated with ADHD are discussed.

Instruments to measure quality of life in institutionalised older adults: Systematic review.

This study analysed the available instruments intended to measure the quality of life of institutionalised older adults, the psychometric properties of said instruments, and their use. This review was conducted using six international databases. The quality of the psychometric properties was assessed using the COSMIN checklist. Risk of bias was assessed using the QUADAS-2 tool. Twenty-four instruments which measure quality of life were analysed. The instruments assessed are related to two areas, thus establishing two stages of the concept of quality of life in the ageing process. The Dementia Quality of Life (DQoL) scale and the FACIT-Sp Spiritual Well-Being Scale were found to be the instruments with the best combination of length, high methodological quality, and bias control for use in older people with and without cognitive impairment, respectively. Knowing which instruments have higher quality will facilitate the evaluation of the aspects that influence quality of life in geriatric institutions.

Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors.

BACKGROUND: The aim of this study was to analyze the incidence, patterns and prognostic factors of recurrence in patients with complicated colon cancer who had emergency surgery within 24 h of admission. METHODS: A retrospective observational study was performed on patients with obstructing or perforated colon cancer having resection with curative intent between 1996 and 2014 at a single center. Data were obtained from a prospectively maintained database. Patients who had rectal cancer, iatrogenic endoscopic perforation, stage IV disease, palliative surgery, a colonic stent or decompressive colostomy were excluded. RESULTS: The study included 393 patients. Obstruction was observed in 320 patients (81.4%) and perforation in 73 (18.6%). Hartmann's procedure was more frequently performed by general surgeons (7.5% vs 23.3%; p = 0.023). 30-day postoperative mortality was 13.5% (53/393), including 47 (14.7%) obstructed and 6 (8.2%) perforated patients. Postoperative complications (Clavien-Dindo III-IV) occurred in 87 patients (22.1%), including 68 (21.2%) of obstructed and 19 (26.0%) of perforated patients. Anastomotic dehiscence was diagnosed in 52 of 329 (15.8%) patients with primary anastomosis and was higher in the obstructing group than in the perforated group (17.4% vs 7.6%). There was a significantly higher anastomotic dehiscence rate after procedures performed by general surgeons when compared with those performed by colorectal surgeons (10.3% vs 21.3%; p = 0.005; OR 2.81, 95% CI 1.4-5.9). With a median follow-up of 6 years, the recurrence rate was 30.1% (67.4% distant, 22.8% local, 9.8% both). Overall and cancer-related survivals were 68.7% and 77.8%, respectively. The presence of positive nodes, male gender, anastomotic dehiscence and diffuse peritonitis were independent predictors for local recurrence while type of surgeon (general) was an independent factor for distant recurrence. CONCLUSIONS: Male gender, diffuse peritonitis, positive lymph nodes, type of surgeon and postoperative anastomotic dehiscence significantly influence recurrence of colorectal cancer in this series.