Estimated Impact of Nirsevimab on the Incidence of Respiratory Syncytial Virus Infections Requiring Hospital Admission in Children < 1 Year, Weeks 40, 2023, to 8, 2024, Spain.

BACKGROUND: Data from the sentinel surveillance system of severe acute respiratory infections in Spain were used to estimate the impact of administration of nirsevimab to children born from 1 April 2023 onwards. METHODS: Estimated RSV hospitalisations in < 1-year-olds during weeks 40, 2023, to 8, 2024, were compared to the number that would be expected after accounting for the background change in RSV circulation in the 2023/24 season, compared to 2022/23. RESULTS: We estimated 9364-9875 RSV hospitalisations less than expected, corresponding to a 74%-75% reduction.

Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability. / Associação de Nível de Renda e Doença Isquêmica do Coração: Papel Potencial da Caminhabilidade.

BACKGROUND: Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability Association of ischemic heart disease (adjusted for traditional risk factors and socioeconomics variables) and income level (A), and walkability z-score (B), and association of walkability z-score and income level (C). BACKGROUND: Socioeconomic status has been linked to ischemic heart disease (IHD). High-income neighborhoods may expose individuals to a walking-promoting built environment for daily activities (walkability). Data from the association between income and IHD is lacking in middle-income countries. It is also uncertain whether walkability mediates this association. OBJECTIVES: To investigate whether income is associated with IHD in a middle-income country and whether neighborhood walkability mediates the income-IHD association. METHODS: This cross-sectional study evaluated 44,589 patients referred for myocardial perfusion imaging (SPECT-MPI). Income and walkability were derived from participants' residential census tract. Walkability quantitative score combined 4 variables: street connectivity, residential density, commercial density, and mixed land use. IHD was defined by abnormal myocardial perfusion during a SPECT-MPI study. We used adjusted mixed effects models to evaluate the association between income level and IHD, and we performed a mediation analysis to measure the percentage of the income-IHD association mediated by walkability. We considered p values below 0.01 as statistically significant. RESULTS: From 26,415 participants, those living in the lowest-income tertile census tract were more physically inactive (79.1% versus 75.8% versus 72.7%) when compared to higher-income tertile census tracts (p < 0.001). Income was associated with IHD (odds ratio: 0.91 [95% confidence interval: 0.87 to 0.96] for each 1,000.00 international dollars increase in income) for both men and women equally (p for interaction = 0.47). Census tracts with a higher income were associated with better walkability (p < 0.001); however, walkability did not mediate the income-IHD association (percent mediated = -0.3%). CONCLUSIONS: Income was independently associated with higher prevalence of IHD in a middle-income country irrespective of gender. Although walkability was associated with census tract income, it did not mediate the income-IHD association.

Quality of Life after Radical Prostatectomy: A Longitudinal Study.

BACKGROUND: Men with prostate cancer who undergo radical prostatectomy experience a decrease in quality of life, often related to sexual disfunction and urinary incontinence. Knowing and measuring the impact of radical prostatectomy on the individual's social, emotional, and family quality of life could help to plan and develop an appropriate, patient-centred therapeutic approach. AIM: In this study, we aimed to evaluate changes in quality of life of patients with prostate cancer before and after radical prostatectomy. METHODS: A longitudinal, observational study of 114 participants was conducted using the method of test-retest. Quality of life before and after radical prostatectomy was measured through the following self-administered questionnaires: (1) The EORTC QLQ-C30 in its Spanish version was used to assess the generic quality of life the participants; (2) the EORTC QLQ-PR25 in its Spanish version was used to assess the specific, health-related quality of life of prostate cancer patients. RESULTS: A total of 114 men took part in this study. The results from the QLQ-C30 questionnaire indicated an improvement in the dimensions of emotional role and cognitive function, as well as in the symptoms of fatigue, pain, nausea and vomiting, insomnia, and loss of appetite, after surgery. Patients scored lower in the dimensions of role functioning, social function, and economic impact after radical prostatectomy. According to the results from the QLQ-PR25 questionnaire, 61.40% of the participants experienced sexual impotence and 26.31% suffered urinary incontinence after surgery. There were significant differences in some postsurgical outcomes between patients who had neurovascular bundles preserved and those who had not. CONCLUSIONS: In-depth knowledge of, and measurement of changes in, quality of life after radical prostatectomy should allow for comprehensive, multidisciplinary, patient-centred care planning. Psychosocial assessment, both before and after surgery, is crucial in patients with prostate cancer. This study was prospectively registered with the CEIC-A on 2012-06-27, with registration number C.P.-C.I. PI12/0088.

Taphonomic skeletal disturbances in the Sima de los Huesos postcranial remains.

The postcranial skeleton of fossil hominins is crucial for reconstructing the processes that occurred between the time of death and the recovery of the bones. Thousands of postcranial skeletal fragments from at least 29 hominin individuals have been recovered from the Sima de los Huesos Middle Pleistocene site in Spain. This study's primary objective is to address the main taphonomic features of the postcranial remains from the Sima de los Huesos sample, including antemortem, perimortem, and postmortem skeletal disturbances. We present an updated assessment of the bone surface modification analysis, the fracture pattern analysis, and the skeletal part representation to facilitate interpretation of the biostratinomic and fossil-diagenetic processes in this large paleoanthropological collection. We conclude that carnivores (probably bears) had limited access to the hominin bones and complete bodies were probably placed in the site.

Black truffle aroma transfer kinetics to food matrices.

Nowadays black truffles are so highly valued that truffled products are available in supermarkets whereas fresh truffle is mainly used in the restaurants. It is known that truffle aroma can change because heat treatments, but there is no scientific evidence about what molecules are transferred, in which concentration, and how much time is needed to aromatize products with truffle. In this study, four different fat-based food products (milk, sunflower oil, grapeseed oil and egg's yolk), were used to study black truffle (Tuber melanosporum) aroma transference for 14 days. Gas chromatography and olfactometry results showed different volatile organic compounds profile depending on the matrix used. After 24 h, some key truffle aromatic compounds were detected in all the food matrices. Among them, grape seed oil was the most aromatized product probably because of its odorless properties. According to our results, dimethyl disulphide, 3-methyl-1-butanol and 1-octen-3-one odorants showed the highest aromatization power.

Ageism and nursing students, past or reality?: A systematic review.

OBJECTIVE: This systematic review aimed to summarise and update existing knowledge about ageism among nursing students through the following research question: what is the perception and attitudes of ageism among student nurses? DESIGN: A systematic review of longitudinal and cross-sectional studies of ageism in nursing students was carried out. DATA SOURCES: The literature search was conducted in the scientific databases Pubmed and Scopus in February 2021. REVIEW METHODS: After the screening process, 22 studies meeting the selection criteria were selected; 8 more were identified after manually searching the selected paper' reference lists. A total of 30 studies were included in the review. The JBI Critical Appraisal Checklists for Analytical Cross-Sectional studies and for Cohort Studies were used to appraise the articles' quality. RESULTS: There was large variability in the manifestation of ageism among student nurses, as well as in the instruments used for assessment. Most of the articles analysed attitudes towards old age, the majority of which were positive. Being a female student, being on the final year of study and having regular contact or cohabitation with an older adult were three of the main determinants in the expression of positive attitudes towards the elderly. CONCLUSIONS: Our findings suggest that student nurses generally have positive attitudes towards old age, although ageist beliefs and discriminatory behaviours were identified and should be studied in greater depth. Training programs for future care professionals have a responsibility to educate from a non-stereotypical perspective based on current societal needs.

Translation, Cultural Adaptation and Validation of the Nurses Self-Concept Instrument (NSCI) to Spanish.

Professional self-concept in nurses is understood as the way nurses think and feel about themselves in their nursing role and is both a predictor of quality of care and a protective factor against burnout. The aim of this study was to translate, culturally adapt and validate the Spanish version of the Nurses Self-Concept Instrument in a sample of 483 Spanish registered nurses. In addition, we analyzed gender differences in its dimensions in the same sample. Internal reliability was evaluated using Cronbach's Alpha, while construct validity was assessed using both exploratory and confirmatory factor analysis. The differences between groups were analyzed using the Mann-Whitney U test. Factor distribution was different from the original model. A gender gap was observed in the Nurse Thinking and Perception of Capabilities dimensions with higher values in the women group, while in the Leadership dimension, higher values were observed in the men group. While the Spanish version of the Nurses Self-Concept Instrument is a valid and reliable tool to measure this construct, the differences in its dimensions lead to a deeper understanding of the cultural differences in the construction of professional self-concept.

Associação de Nível de Renda e Doença Isquêmica do Coração: Papel Potencial da Caminhabilidade / Association of Income Level and Ischemic Heart Disease: Potential Role of Walkability

Resumo Fundamento O nível socioeconômico tem sido associado à doença isquêmica do coração (DIC). Bairros de alta renda podem expor os indivíduos a um ambiente construído que promova caminhadas para atividades diárias (caminhabilidade). Faltam dados sobre a associação entre renda e DIC em países de renda média. Também é incerto se a caminhabilidade medeia essa associação. Objetivos Investigar se a renda está associada à DIC em um país de renda média e se a caminhabilidade dos bairros medeia a associação entre renda e DIC. Métodos O presente estudo transversal avaliou 44.589 pacientes encaminhados para imagem de perfusão miocárdica (SPECT-MPI). A renda e a caminhabilidade foram derivadas do setor censitário residencial dos participantes. A pontuação quantitativa da caminhabilidade combinou as seguintes 4 variáveis: conectividade viária, densidade residencial, densidade comercial e uso misto do solo. A DIC foi definida pela presença de perfusão miocárdica anormal durante um estudo SPECT-MPI. Utilizamos modelos ajustados com efeitos mistos para avaliar a associação entre nível de renda e DIC e realizamos uma análise de mediação para medir o percentual da associação entre renda e DIC mediada pela caminhabilidade. Consideramos valores de p abaixo de 0,01 como estatisticamente significativos. Resultados Dos 26.415 participantes, aqueles que residiam no setor censitário do tercil de menor renda eram mais fisicamente inativos (79,1% versus 75,8% versus 72,7%) quando comparados aos setores censitários do tercil de maior renda (p < 0,001). A renda foi associada à DIC (odds ratio: 0,91 [intervalo de confiança de 95%: 0,87 a 0,96] para cada aumento de 1000,00 dólares internacionais na renda), para homens e mulheres igualmente (p para interação = 0,47). Os setores censitários com maior renda estiveram associados a uma melhor caminhabilidade (p < 0,001); no entanto, a caminhabilidade não mediou a associação entre renda e DIC (porcentagem mediada = −0,3%). Conclusões A renda foi independentemente associada a maior prevalência de DIC em um país de renda média, independentemente de gênero. Embora a caminhabilidade tenha sido associada à renda do setor censitário, ela não mediou a associação entre renda e DIC.

Abstract Background Socioeconomic status has been linked to ischemic heart disease (IHD). High-income neighborhoods may expose individuals to a walking-promoting built environment for daily activities (walkability). Data from the association between income and IHD is lacking in middle-income countries. It is also uncertain whether walkability mediates this association. Objectives To investigate whether income is associated with IHD in a middle-income country and whether neighborhood walkability mediates the income-IHD association. Methods This cross-sectional study evaluated 44,589 patients referred for myocardial perfusion imaging (SPECT-MPI). Income and walkability were derived from participants' residential census tract. Walkability quantitative score combined 4 variables: street connectivity, residential density, commercial density, and mixed land use. IHD was defined by abnormal myocardial perfusion during a SPECT-MPI study. We used adjusted mixed effects models to evaluate the association between income level and IHD, and we performed a mediation analysis to measure the percentage of the income-IHD association mediated by walkability. We considered p values below 0.01 as statistically significant. Results From 26,415 participants, those living in the lowest-income tertile census tract were more physically inactive (79.1% versus 75.8% versus 72.7%) when compared to higher-income tertile census tracts (p < 0.001). Income was associated with IHD (odds ratio: 0.91 [95% confidence interval: 0.87 to 0.96] for each 1,000.00 international dollars increase in income) for both men and women equally (p for interaction = 0.47). Census tracts with a higher income were associated with better walkability (p < 0.001); however, walkability did not mediate the income-IHD association (percent mediated = −0.3%). Conclusions Income was independently associated with higher prevalence of IHD in a middle-income country irrespective of gender. Although walkability was associated with census tract income, it did not mediate the income-IHD association.

An evaluation of undergraduate student nurses' gameful experience whilst playing a digital escape room as part of a FIRST year module: A cross-sectional study.

BACKGROUND: The circumstances arising from the COVID-19 pandemic have accelerated the use of digital teaching and learning in health professions education. Digital gamification-based teaching and learning activities are innovative and versatile tools for the acquisition of professional competencies in higher education, which can be used on a range of topics and can be supplemental to other teaching methods. OBJECTIVES: This study aimed to investigate nursing students' gameful experience whilst playing a digital escape room. In addition, we aimed to analyze the students' motivation, learning experience and outcome of the activity, and the students' perception of the degree of achievement of the intended learning outcomes. DESIGN: Cross-sectional descriptive study. PARTICIPANTS: A total of 136 undergraduate first year student nurses enrolled in a "Fundamentals of Nursing" course. METHOD: The digital escape room game took place online during the academic year 2020-2021. The measures included the GAMEX scale in its Spanish version and a self-reported questionnaire to evaluate the outcome of the scape room game and the degree of achievement of the intended learning outcomes. RESULTS: More than 80 % of the participants were moderately to very motivated to play the game. Three GAMEX dimensions achieved a mean score of 3 or above 3, namely Enjoyment, Creative Thinking and Absence of Negative effects. The mean score for each of the outcome variables was over 3. However, the degree of achievement of the learning outcomes after exiting the digital escape room was uneven. CONCLUSION: Gamification-based teaching and learning activities, such as digital escape rooms, can be effective in fostering specific skills, including teamwork, communication and critical thinking. However, they should be designed carefully, and used as a complement, rather than a substitute, of other educational activities.

Clinical and Epidemiological Approach to Delirium in an Acute Care Unit: A Cross-Sectional Study.

During hospital admissions, the union of various factors, those related to acute pathology, dependency conditions, cognitive impairment, change of habitual environment, and others, can cause delirium. Acute delirium in the elderly (ADE) occurs in around a third of patients over 70 years of age. The syndrome generates serious complications that increase hospital morbidity and mortality and a high cost for the health administration. This study aimed to determine the clinical and epidemiological profile of ADE in an internal medicine unit. A descriptive cross-sectional study was carried out using a convenience test. A total of 356 patients participated between September and November 2021. Sociodemographic variables, predisposing and precipitating factors of ADE, methods of action against ADE, and the impact on functional and cognitive deterioration were analyzed. A total of 35.1% of the patients developed ADE, mostly of the hyperactive type and of nocturnal appearance. ADE was mainly treated with psychoactive drugs and 22% required mechanical restraint, with non-pharmacological preventive strategies, support, and caregiver training being the main tools for controlling ADE during hospital admission.

Infective Endocarditis in the Elderly: Challenges and Strategies.

The specific management of infective endocarditis (IE) in elderly patients is not specifically addressed in recent guidelines despite its increasing incidence and high mortality in this population. The term "elderly" corresponds to different ages in the literature, but it is defined by considerable comorbidity and heterogeneity. Cancer incidence, specifically colorectal cancer, is increased in older patients with IE and impacts its outcome. Diagnosis of IE in elderly patients is challenging due to the atypical presentation of the disease and the lower performance of imaging studies. Enterococcal etiology is more frequent than in younger patients. Antibiotic treatment should prioritize diminishing adverse effects and drug interactions while maintaining the best efficacy, as surgical treatment is less commonly performed in this population due to the high surgical risk. The global assessment of elderly patients with IE, with particular attention to frailty and geriatric profiles, should be performed by multidisciplinary teams to improve disease management in this population.

Psychological distress and fear of Covid-19 in student nurses before clinical placement: a cross-sectional study.

OBJECTIVE: To determine the degree of psychological distress and fear of COVID-19 experienced by undergraduate student nurses who were about to begin their clinical placements. METHOD: A cross-sectional study was carried out with 100 second- and third-year undergraduate student nurses of the University of Zaragoza (Spain). Measures included the Fear of COVID-19 Scale and the Depression Anxiety Stress Scales. RESULTS: Regularly, student nurses did not think of themselves as vulnerable to COVID-19. However, a significant association was observed between the student nurses' level of psychological distress and cohabiting with relatives or people who were considered vulnerable to the infection (p = 0.035). The Depression Anxiety Stress Scale results revealed a low level of psychological distress in general; the Fear of COVID-19 Scale indicated moderate fear (2.94). CONCLUSION: Student nurses who lived with their relatives experienced higher levels of stress due to the perceived risk of transmission, but were less fearful of loss of work and income. Anxiety in our sample was associated principally with not knowing their upcoming placement location.

Taphonomic-forensic analysis of the hominin skulls from the Sima de los Huesos.

The Sima de los Huesos (SH) hominin assemblage is composed of thousands of fossil fragments, including pieces of crania and mandibles. The main objective of this work is to address the main taphonomic features of the cranial and mandibular remains from the SH sample, including antemortem, perimortem, and postmortem skeletal disturbances. We present an updated assessment of healed cranial trauma, first described in 1997 and now including new skulls. In addition, this study reviews the perimortem fractures in relation to their location and features of the affected individuals. Finally, this paper deals with the modifications affecting the cranial sample from the SH at the postmortem stage, including physical and biological postdepositional modifications. The SH collection provides a unique opportunity for conducting a complete forensic-taphonomic study on a Middle Pleistocene population.

Serological evidence of SARS-CoV-2 and co-infections in stray cats in Spain.

A new coronavirus known as SARS-CoV-2 emerged in Wuhan in 2019 and spread rapidly to the rest of the world causing the pandemic disease named coronavirus disease of 2019 (COVID-19). Little information is known about the impact this virus can cause upon domestic and stray animals. The potential impact of SARS-CoV-2 has become of great interest in cats due to transmission among domestic cats and the severe phenotypes described recently in a domestic cat. In this context, there is a public health warning that needs to be investigated in relation with the epidemiological role of this virus in stray cats. Consequently, in order to know the impact of the possible transmission chain, blood samples were obtained from 114 stray cats in the city of Zaragoza (Spain) and tested for SARS-CoV-2 and other selected pathogens susceptible to immunosuppression including Toxoplasma gondii, Leishmania infantum, feline leukaemia virus (FeLV) and feline immunodeficiency virus (FIV) from January to October 2020. Four cats (3.51%), based on enzyme-linked immunosorbent assay (ELISA) using the receptor binding domain (RBD) of Spike antigen, were seroreactive to SARS-CoV-2. T. gondii, L. infantum, FeLV and FIV seroprevalence was 12.28%, 16.67%, 4.39% and 19.30%, respectively. Among seropositive cats to SARS-CoV-2, three cats were also seropositive to other pathogens including antibodies detected against T. gondii and FIV (n = 1); T. gondii (n = 1); and FIV and L. infantum (n = 1). The subjects giving positive for SARS-CoV-2 were captured in urban areas of the city in different months: January 2020 (2/4), February 2020 (1/4) and July 2020 (1/4). This study revealed, for the first time, the exposure of stray cats to SARS-CoV-2 in Spain and the existence of concomitant infections with other pathogens including T. gondii, L. infantum and FIV, suggesting that immunosuppressed animals might be especially susceptible to SARS-CoV-2 infection.

Psychological distress and fear of Covid-19 in student nurses before clinical placement: a cross-sectional study / Sofrimento psicológico e medo da Covid-19 em estudantes de enfermagem antes do estágio clínica: um estudo transversal / Distrés psicológico y miedo a la Covid-19 en estudiantes de enfermería antes de la colocación clínica: un estudio transversal

ABSTRACT Objective: To determine the degree of psychological distress and fear of COVID-19 experienced by undergraduate student nurses who were about to begin their clinical placements. Method: A cross-sectional study was carried out with 100 second- and third-year undergraduate student nurses of the University of Zaragoza (Spain). Measures included the Fear of COVID-19 Scale and the Depression Anxiety Stress Scales. Results: Regularly, student nurses did not think of themselves as vulnerable to COVID-19. However, a significant association was observed between the student nurses' level of psychological distress and cohabiting with relatives or people who were considered vulnerable to the infection (p = 0.035). The Depression Anxiety Stress Scale results revealed a low level of psychological distress in general; the Fear of COVID-19 Scale indicated moderate fear (2.94). Conclusion: Student nurses who lived with their relatives experienced higher levels of stress due to the perceived risk of transmission, but were less fearful of loss of work and income. Anxiety in our sample was associated principally with not knowing their upcoming placement location.

RESUMO Objetivo: Determinar el grado de angustia psicológica y miedo al COVID-19 que experimentan los estudiantes de pregrado de enfermería que estaban a punto de empezar sus prácticas clínicas. Método: Se realizó un estudio transversal en 100 estudiantes de enfermería de segundo y tercer año de la Universidad de Zaragoza (España). Las medidas incluyeron la Escala de Miedo a la COVID-19 y la Escala de Depresión, Ansiedad y Estrés. Resultados: Normalmente, los estudiantes de enfermería no se consideraban vulnerables a la COVID-19. Sin embargo, se observó una asociación significativa entre el nivel de distrés psicológico de los estudiantes de enfermería y la convivencia con familiares o personas percibidas como vulnerables a la infección (p = 0,035). Los resultados del Escala de Depresión, Ansiedad y Estrés revelaron un bajo nivel de distrés psicológico en general; la Escala de Miedo a la COVID-19 indicó un miedo moderado (2,94). Conclusión: Los estudiantes de enfermería que vivían con sus familiares experimentaron mayores niveles de estrés debido al riesgo percibido de transmisión, pero tenían menos miedo a la pérdida de trabajo e ingresos. La ansiedad en nuestra muestra se asoció principalmente con el desconocimiento de su próxima ubicación de colocación.

RESUMEN Objetivo: Determinar o grau de sofrimento psicológico e medo da COVID-19 experimentado por estudantes de enfermagem que estavam prestes a iniciar seus estágios clínicos. Método: Um estudo transversal foi realizado em 100 estudantes de enfermagem do segundo e terceiro anos da Universidade de Zaragoza (Espanha). As medidas incluíram a Escala de Medo da COVID-19 e as escalas de Depressão, Ansiedade e Estresse. Resultados: Regularmente, os estudantes de enfermagem não se consideravam vulneráveis à COVID-19. No entanto, observou-se associação significativa entre o nível de sofrimento psicológico dos estudantes de enfermagem e a convivência com familiares ou pessoas percebidas como vulneráveis à infecção (p = 0,035). Os resultados da Escala de Depressão, Ansiedade e Estresse revelaram um baixo nível de sofrimento psicológico em geral; a Escala de Medo da COVID-19 indicou um medo moderado (2,94). Conclusão: Estudantes de enfermagem que moravam com seus familiares experimentaram níveis mais altos de estresse devido ao risco percebido de transmissão, mas tinham menos medo de perda de trabalho e renda. A ansiedade em nossa amostra foi associada principalmente ao desconhecimento de seu próximo local de estágio.

Impact of Reducing Sitting Time in Women with Fibromyalgia and Obesity: A Randomized Controlled Trial.

BACKGROUND: Sitting time has negative effects on health, increasing the risk of obesity, osteoporosis, diabetes, and cancer. Thus, primary health care education interventions aimed to reduce sitting time and sedentary behavior could have beneficial effects on people's health and wellbeing. The purpose of this study was to assess the effectiveness of an intervention based on reducing sitting time to decrease cardiometabolic risk on a sample of women diagnosed with fibromyalgia and moderate obesity. METHODS: Randomized controlled trial to evaluate the effectiveness of an intervention to decrease cardiometabolic risk in 84 participants. Sedentary behavior was monitored using an accelerometer before and at 3-month follow-up. RESULTS: Compared with the control group, body mass index decreased, and the number of steps taken increased, in the intervention group 3 months after the intervention. No significant differences were found in the rest of the variables measured. CONCLUSION: The intervention group decreased sitting time after the intervention. Group activities and support from primary care may be useful to improve treatment adherence. RCT registration: NCT01729936.

An evaluation of undergraduate student nurses' gameful experience while playing an escape room game as part of a community health nursing course.

BACKGROUND: The integration of innovative strategies to teaching and learning in higher education, such as escape room games, can enhance the acquisition of key professional competencies including communication, teamwork and critical thinking. OBJECTIVES: This study aimed to evaluate undergraduate student nurses' gameful experience while playing an escape room game as part of a nursing course. DESIGN: Cross-sectional descriptive study. PARTICIPANTS: A total of 126 third year student nurses enrolled in the "Community Health Nursing II" course. METHOD: The escape room game took place in a classroom at the Faculty of Health Ciences. The measures included the GAMEX scale in its Spanish version and a self-reported questionnaire to evaluate the student's outcome of scape room game immediately after the end of the activity. RESULTS: The vast majority (99.21%) considered the escape room game to be an appropriate and an innovative teaching and learning strategy. The mean score for each of the GAMEX dimensions was over 3, with the exception of Absence of negative effects. Our results suggest that the students enjoyed playing the game (mean = 4.40; SD = 0.71), that escape room games should be integrated in nursing courses (mean = 4.54; SD = 0.74) and that playing the game increased their motivation for learning (mean = 3.06; SD = 1.09). Gender differences were observed in the GAMEX Dominance dimension (p < 0.005). CONCLUSION: Gamification in general, and escape rooms in particular, have proven to be a valid tool for the acquisition of professional competencies in higher education.

Sense of Coherence and Quality of Life in Patients Treated with Antivitamin K Oral Anticoagulants: A Cross-Sectional Study.

The aim of this study was to analyze the correlation between the participants' self-reported quality of life and their sense of coherence in a sample (n = 85) of patients on treatment with oral antivitamin K anticoagulants. A cross-sectional design was used. The measurement instruments included a questionnaire on sociodemographic variables, the Spanish version of the Abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-BREF), an oral-anticoagulant-treatment-specific quality-of-life questionnaire, and the sense-of-coherence (SOC) scale. We analyzed the correlations between the participants' characteristics and the results from the quality-of-life and SOC scales. Age, level of education, employment status, living arrangement, and treatment length were the determinants of the quality of life in people treated with oral anticoagulants. We found a significant association between the four domains of the WHOQOL-BREF questionnaire and general treatment satisfaction (p < 0.01); no significant correlations were found between the SOC subscales and the oral-anticoagulant-treatment-specific quality of life in our sample. Women had a worse level of self-management than men. Nursing interventions should be tailored to the needs of the populations on treatment with oral anticoagulants in order to facilitate a higher level of self-management.

Precision Radiation Therapy for Metastatic Spinal Cord Compression: Final Results of the PRE-MODE Trial.

OBJECTIVE: To investigate precision radiation therapy for metastatic spinal cord compression and compare it to conventional radiation therapy. METHODS AND MATERIALS: In a multicenter phase 2 study, 40 patients received 5 Gy × 5 fractions of precision radiation therapy (38 volume modulated arc therapy, 2 intensity modulated radiation therapy) for metastatic spinal cord compression and were evaluated for local progression-free survival (LPFS), motor function, ambulatory status, sensory function, sphincter dysfunction, pain, distress, overall survival (OS), and toxicity. Maximum spinal cord dose was 101.5% (myelopathy risk, <0.03%) of the prescription dose. Patients were compared with a historical control group conventionally irradiated with 4 Gy × 5 fractions (propensity score analysis). The equivalent dose in 2 Gy-fractions of 5 Gy × 5 fractions is similar to 3 Gy × 10 fractions, which results in better LPFS than 4 Gy × 5 fractions. It was assumed that 5 Gy × 5 fractions is also superior to 4 Gy × 5 fractions for LPFS. (ClinicalTrials.gov-identifier: NCT03070431) RESULTS: Six-month rates of LPFS and OS were 95.0% and 42.6%, respectively. Improvement of motor function occurred in 24 patients (60%). Thirty-three patients (82.5%) were ambulatory after radiation therapy. Eight of 16 patients (50.0%) with sensory deficits improved. Pain and distress relief were reported by 61.9% and 54.2% of patients 1 month after radiation therapy. Grade 3 toxicities occurred in 1 patient and grade 2 toxicities in another 3 patients. Of the control group, 664 patients qualified for the propensity score analysis; 5 Gy × 5 fractions was significantly superior to 4 Gy × 5 fractions with regard to LPFS (P = .026) but not motor function (P = .51) or OS (P = .82). CONCLUSIONS: Precision radiation therapy with 5 Gy × 5 fractions was well tolerated and effective and appeared superior to 4 Gy × 5 fractions in terms of LPFS. The retrospective nature of the historic control group, which might have led to a hidden selection bias, needs to be considered when interpreting the results.

Radiotherapy for metastatic spinal cord compression with increased radiation doses (RAMSES-01): a prospective multicenter study.

BACKGROUND: Patients with metastatic spinal cord compression (MSCC) and favorable survival prognoses can benefit from radiation doses greater than 30Gy in 10 fractions in terms of improved local progression-free survival (LPFS) and overall survival (OS). METHODS/DESIGN: This prospective study mainly investigates LPFS after precision radiotherapy (volumetric modulated arc therapy or stereotactic body radiotherapy) with 18 × 2.33Gy in 3.5 weeks. LPFS is defined as freedom from progression of motor deficits during radiotherapy and an in-field recurrence of MSCC following radiotherapy. The maximum relative dose allowed to the spinal cord is 101.5% of the prescribed dose, resulting in an equivalent dose in 2Gy-fractions (EQD2) for radiation myelopathy is 45.5Gy, which is below the tolerance dose of 50Gy according to the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC). The EQD2 of this regimen for tumor cell kill is 43.1Gy, which is 33% higher than for 30Gy in 10 fractions (EQD2 = 32.5Gy). Primary endpoint is LPFS at 12 months after radiotherapy. Secondary endpoints include the effect of 18 × 2.33Gy on motor function, ambulatory status, sensory function, sphincter dysfunction, LPFS at other follow-up times, overall survival, pain relief, relief of distress and toxicity. Follow-up visits for all endpoints will be performed directly and at 1, 3, 6, 9 and 12 months after radiotherapy. A total of 65 patients are required for the prospective part of the study. These patients will be compared to a historical control group of at least 235 patients receiving conventional radiotherapy with 10x3Gy in 2 weeks. DISCUSSION: If precision radiotherapy with 18 × 2.33Gy results in significantly better LPFS than 10x3Gy of conventional radiotherapy, this regimen should be strongly considered for patients with MSCC and favorable survival prognoses. TRIAL REGISTRATION: Clinicaltrials.gov NCT04043156. Registered 30-07-2019.