Reliability and validity study of the Spanish adaptation of the "Creighton Simulation Evaluation Instrument (C-SEI)".

There are multiple advantages to using human patient simulation (HPS) as a teaching method for clinical nursing education. Valid, reliable tools that can be used when applying this teaching method are needed to evaluate nursing student skill acquisition. The aim of this study was to translate the Creighton Simulation Evaluation Instrument (C-SEI) into Spanish and to analyse the reliability and validity of the Spanish C-SEI version with nursing students. The study was conducted in two phases: (1) Adaptation of the instrument into Spanish. (2) Cross-sectional study in a sample of 249 nursing students who were evaluated by two observers. The psychometric properties were analysed in terms of reliability (internal consistency and inter-observer consistency) and construct validity using an exploratory factor analysis. Questionnaire internal consistency was 0.839 for the tool as a whole. Inter-observer concordance for the tool as a whole was 0.936 and greater than 0.80 for the majority of the items. The exploratory factor analysis showed a four-factor structure that explains 49.5% of the total variance. The results of this study show that the C-SEI-sp tool is a valid and reliable tool that is easy to apply in the monitoring of student performance in clinical simulation scenarios.

Psychometric evaluation of a new instrument in Spanish to measure the wellness of university nursing faculty.

The aim of this study was to design and validate an instrument to measure the wellness among university nursing faculty. The study was performed in two phases. Phase I consisted of the development of the instrument with discussion groups and participant consensus. We designed an instrument including the 21 items or psychosocial risk factors identified and estimated an index by evaluating the frequency and intensity of each item. The items were grouped into 3 dimensions: teaching work demands, curricular demands, and organizational difficulties. Phase II, we evaluated the psychometric properties of the tool in a sample of 263 participants. Exploratory factor analysis showed a 3-factor structure that explained 53% of the total variance. The internal consistency of the instrument was 0.91 for the whole instrument. The results indicate that the tool developed is valid and reliable and may be a good instrument to monitor the wellness of university nursing faculty.

Análisis de dos estrategias para el manejo de la amenaza de parto pretérmino / Analysis of two strategies for the management of threatened preterm labor

Objetivo. Comparar dos formas de abordar el trabajo prematuro de parto. La primera basándonos exclusivamente en criterios clínicos y la segunda empleando como herramientas auxiliares la prueba de la fibronectina y la longitud cervical por ecografía vaginal. Material y métodos. Estudio comparativo de ambas estrategias, enfatizando en costes hospitalarios y resultados perinatales. Para el grupo de estudio, en el que empleábamos ambos marcadores para seleccionar a las mujeres de mayor riesgo, empleamos un grupo prospectivo de 122 gestantes que acudieron de urgencia por amenaza de parto pretérmino (APP), y el grupo control (n=112) formado con una cohorte histórica de gestantes ingresadas por APP. Las gestantes catalogadas como de riesgo bajo para tener un parto prematuro eran dadas de alta en urgencias y controladas de forma ambulatoria. Se estimaron los valores predictivos de ambas pruebas y los resultados medidos fueron la tasa de prematuridad, las complicaciones neonatales, los días de hospitalización y los costes hospitalarios resultantes de la hospitalización, la medicación y las visitas posteriores. Resultados. Los resultados perinatales y las tasas de prematuridad en ambos grupos eran comparables. El uso de los tocolíticos y corticoides se redujo al emplear ambos marcadores. La estancia hospitalaria mediana fue 0 en el grupo de estudio (2,6 días cuando eran hospitalizadas), frente a 5 días en el grupo control. Los costes hospitalarios por paciente fueron de 446.24 € en el grupo de estudio (rango intercuartílico (IQ) 1.390,08) y de 1.634,04 € (IQ 1.092,65) en el grupo control. Conclusiones. Empleando estas técnicas para el diagnóstico del verdadero trabajo prematuro de parto, y obteniendo resultados perinatales comparables, no está justificado el tratamiento universal de aquellas gestantes que consultan de urgencia por APP. Esta estrategia puede conducirnos a un ahorro aproximado de 1.200 € por gestante (AU)

Objective. To compare two strategies for the management of threatened preterm labor (TPL). The first strategy was based on clinical criteria alone, while the second used rapid fibronectin testing and cervical length measured by vaginal ultrasound. Material and methods. We compared the costs and perinatal outcomes of both strategies. In the study group, both markers were used to select women at highest risk. The study group consisted of a prospective group of 122 women attending the emergency department for TPL. The control group (n=112) was composed of a historical cohort of women admitted for TPL. Pregnant women classified as low risk for premature birth were discharged from the emergency department and were monitored on an outpatient basis. The sensitivity and specificity of both tests in predicting preterm labor were estimated. The results measured were prematurity < 37 weeks, neonatal complications, length of hospital stay and costs resulting from admission, medication and subsequent follow-up visits. Results. Prematurity and perinatal outcomes were similar in both groups. The use of tocolytics and corticosteroids was reduced by employing the two markers. The median length of hospital stay was 0 days in the study group (2.6 days among hospitalized patients) and 5 days in the control group. The costs incurred per patient were 446.24 euros in the study group (IQR: 1,390.08) and 1,634.04 euros (IQR: 1,092.65) in the control group. Conclusions. Based on the use of these techniques to select patients with true preterm labor and the similar perinatal results obtained in both groups, we conclude that universal treatment of all women with suspected preterm labor is not warranted. This strategy saves approximately 1,200 € per patient (AU)

Análisis de la variabilidad interobservador en la interpretación de la radiopelvimetría y su utilidad en la práctica obstétrica actual / Analysis of interobserver variability in the interpretation of X-ray pelvimetry and its utility in current obstetric practice

Introducción: La radiopelvimetría es una técnica en desuso porque su utilidad ha sido cuestionada al imputársele directamente un incremento de la tasa de cesáreas. Objetivos: Analizar el impacto de la subjetividad del evaluador en la interpretación y valoración de la radiopelvimetría para determinar su utilidad como prueba complementaria objetiva. Material y métodos: Se ha realizado un estudio prospectivo sobre 113 radiopelvimetrías realizadas en otras tantas gestantes primíparas de forma previa a la inducción del parto. Fueron medidas e interpretadas, independientemente y de forma ciega por tres investigadores de amplia experiencia obstétrica. Resultados: Hubo discrepancia entre los dos primeros investigadores en 60 (45,11%) ocasiones y 49 (36,84%) casos fue preciso que las evaluase el tercer investigador. Conclusiones: La radiopelvimetría carece de valor predictivo para pronosticar la vía del parto por la gran variabilidad interobservador a la que están sometidas su medición y su interpretación (AU)

Introduction: X-ray pelvimetry has been directly associated with an increase in the rate of cesarean sections and consequently this technique has fallen into disuse. Objectives: To analyze the impact of evaluator subjectivity in the interpretation and evaluation of X-ray pelvimetry in order to determine the usefulness of this technique as an objective complementary test. Materials and methods: We carried out a prospective study of X-ray pelvimetry in 113 primiparous pregnant women prior to labor induction. The scans were measured and interpreted independently and blindly by three researchers with wide experience in obstetrics. Results: There were discrepancies between the first two researchers on 60 occasions (45.11%) and assessment by the third researcher was required on 49 occasions (36.84%). Conclusions: X-ray pelvimetry lacks value in predicting delivery route since there is wide interobserver variability in the measurement and interpretation of scans (AU)

Utilidad de la prueba de la fibronectina fetal y de la longitud del c¨¦rvix en la predicci¨®n del parto prematuro en gestantes sintom¨¢ticas / Utility of fetal fibronectin and cervical length in predicting preterm birth in women with preterm uterine contractions

Objetivo: Evaluar la utilidad de la prueba de la fibronectina fetal (fFN) y de la longitud cervical para la predicci¨®n del parto prematuro, en mujeres que presentan din¨¢mica uterina antes del t¨¦rmino. Material y m¨¦todos: Estudio prospectivo realizado en el Hospital Virgen Macarena de Sevilla, en el que se incluy¨® a 153 gestantes con bolsa ¨ªntegra y amenaza de parto pret¨¦rmino (PP) a las que se les realiz¨®, en el momento de la consulta de urgencia, una cervicometr¨ªa mediante ecograf¨ªa transvaginal y una prueba r¨¢pida de fibronectina. No se procedi¨® a hospitalizar ni a someter a tratamiento farmacol¨®gico a las mujeres con una longitud cervical ¡Ý a 30 mm y una fFN negativa. Resultados: La edad gestacional media al diagn¨®stico fue de 223,02 ¡À 19,98 d¨ªas, y de 267,52 ¡À 14,15 d¨ªas en el parto, siendo la tasa de p < 37 semanas del 23% y la de p < 35 semanas del 7,4%. Hay una relaci¨®n significativa entre la longitud cervical < 30 mm y el p < 37 semanas (OR = 3,68; IC del 95%: 1,53-8,84) y el parto en los siguientes 14 d¨ªas (OR = 5,35; IC del 95%: 1,30-21,95). Asociando ambas pruebas se obtiene una mejor¨ªa discreta en la especificidad para la predicci¨®n del parto prematuro. Conclusi¨®n: La cervicometr¨ªa es el par¨¢metro que presenta mejor especificidad (E) y valor predictivo negativo (VPN) para la predicci¨®n del parto pret¨¦rmino en las gestantes con ametaza de parto prematuro (APP) (AU)

Objective: To evaluate the usefulness of fetal fibronectin and cervical length in predicting preterm birth in women with preterm uterine contractions. Material and methods: A prospective study was conducted at the Virgen Macarena Hospital in Seville that included 153 pregnant women with suspected preterm labor and intact membranes. Cervical length was measured by transvaginal sonography and a rapid qualitative fibronectin test was performed in the emergency consultation. Women with a negative fibronectin test and cervical length ¡Ý 30 mm were not hospitalized or treated with tocolytics or corticosteroids. Results: The mean gestational age at diagnosis was 223,02 ¡À 19,98 days, and 267,52 ¡À 14,15 days at delivery. Preterm birth <37 weeks rate was 23% and 7,4% for deliveries <35 weeks. There is an association between cervical length <30 mm and birth <37 weeks (OR, 3,68; 95% CI, 1,53-8,84), and with delivery in the following 14 days (OR, 3,35; 95% CI, 1,30-21,95). With the association of both tests we gain specificity in predicting preterm birth. Conclusion: Cervical length is the test with higher specificity (E) and negative predictive value (VPN) for the prediction of preterm birth in women with symptomatic contractions (AU)

Effect of cinacalcet on hypercalcemia and bone mineral density in renal transplanted patients with secondary hyperparathyroidism.

BACKGROUND: Persistent secondary hyperparathyroidism (SHP) is the most frequent cause of hypercalcemia observed in approximately 10% of renal transplanted (RT) patients 1 year after surgery. Persistent SHP with hypercalcemia is an important factor of bone loss after renal transplantation. This study prospectively evaluates the effects of cinacalcet therapy on serum calcium (SCa) and parathyroid hormone (PTH) blood levels, and basically on bone mineral density (BMD) in RT patients with persistent hyperparathyroidism. METHODS: Nine RT patients (eight women, one man) with allograft function more than 6 months were included based on total SCa more than 10.5 mg/dL and intact parathyroid hormone (iPTH) concentration more than 65 pg/mL. After inclusion, patients started on a single daily oral dose of 30 mg of cinacalcet. At inclusion and every study visit blood levels of creatinine, Ca, P, alkaline phosphatase, iPTH 1,25- dihydroxyvitamin D3, and 25-hydroxyvitamin D3 were assessed. Baseline and at the end of study radial BMD were measured. Study follow-up was 12 months. RESULTS: During the study period, SCa decreased from 11.72+/-0.39 to 10.03+/-0.54 mg/dL (P<0.001). iPTH decreased from 308.85+/-120.12 to 214.66+/-53.75 mg/dL (P<0.05). The mean serum creatinine decreased from 1.58+/-0.34 to 1.25+/-0.27 mg/dL (P=0.03) and the mean radial BMD increased from 0.881+/-0.155 to 0.965+/-0.123 gr/cm2 (P<0.05). There were no significant changes in the other parameters assessed. One patient was excluded for gastrointestinal intolerance. CONCLUSIONS: In RT patients with hypercalcemia secondary to persistent SHP, cinacalcet corrects hypercalcemia and PTH, simultaneously improving BMD.