Dinámicas de información en profesionales de enfermería desde el análisis de redes sociales / Information dynamics in nursing professionals based on social network análisis

Introducción: El conocimiento es una herramienta necesaria para la investigación científica y el progreso de cualquier disciplina. Pero el conocimiento científico y las dinámicas de información no sólo están sostenidas por los individuos, sino que son producidas y mantenidas por grupos de personas que trabajan en un mismo entorno donde los vínculos y las relaciones pueden influir en el proceso.Objetivo:Analizar las redes sociales de utilización de fuentes de información, de ayuda/consejo para la transferencia de conocimiento y los lugares donde los profesionales de enfermería comparten información.Método:Análisis de Redes Sociales a través de un cuestionario validado. Se reclutaron profesionales de 6 unidades hospitalarias.Resultados:Participaron 77 profesionales con una edad media de 42,9 (DE:11,48). Los compañeros son la fuente de información más utilizada (76 elecciones) frente a las bases de datos y artículos científicos que son la menos seleccionada (63 elecciones). Las redes homófilas horizontales (profesionales con estatus/intereses similares) son las más frecuentes para obtener información sobre resultados de investigación (74 elecciones). La unidad asistencial es el entorno más señalado para compartir información (50 elecciones).Conclusiones:Los profesionales consideran el conocimiento de sus compañeros como la principal fuente para obtener información sobre resultados de investigación. Unidades con determinado grado de especialización utilizan guías de práctica clínica y protocolos como fuente principal de información. Los profesionales de enfermería utilizan redes homófilas-horizontales para obtener información. El entorno laboral en sus diferentes ámbitos (unidad, office, reuniones) es el más utilizado para compartir información sobre resultados de investigación. (AU)

SUMAMOS EXCELENCIA® Project: Results of the Implementation of Best Practice in a Spanish National Health System (NHS).

The use of certain strategies for the implementation of a specific recommendation yields better results in clinical practice. The aim of this study was to assess the effectiveness of an evidence-based model using clinical audits (GRIP model), for the implementation of recommendations in pain and urinary incontinence management as well as fall prevention, in the Spanish National Health System during the period 2015-2018. A quasi-experimental study has been conducted. The subjects were patients treated in hospitals, primary care units and nursing home centers. There were measures related to pain, fall prevention and urinary incontinence. Measurements were taken at baseline and at months 3, 6, 9, and 12. The sample consisted of 22,114 patients. The frequency of pain assessment increased from 59.9% in the first cycle to a mean of 71.6% in the last cycle, assessments of risk of falling increased from 56.8% to 87.8% in the last cycle; and finally, the frequency of assessments of urinary incontinence increased from a 43.4% in the first cycles to a mean of 62.2% in the last cycles. The implementation of specific evidence-based recommendations on pain, fall prevention, and urinary incontinence using a model based on clinical audits improved the frequency of assessments and their documentation.

Retrospective Cohort Noninferiority Analysis of Barrier Cream in Preventing Pressure Injuries.

OBJECTIVE: To assess the effectiveness of a dimethicone- and zinc-based barrier cream compared with hyperoxygenated fatty acids in preventing pressure injuries (PIs) in patients at high or very high risk. METHODS: Researchers conducted a retrospective noninferiority study in an inpatient acute care hospital in Spain that included hospitalized patients in nonsurgical departments with impaired mobility. RESULTS: The study authors reviewed 522 patients in a control group (hyperoxygenated fatty acids) and an experimental group (barrier cream) over a period of 7 days. The incidence of PI was 31% in the control group and 31.1% in the experimental group. The hazard ratio for developing PI was 0.84 (confidence interval, 0.61-1.17; P = .32) in the experimental group compared with the control group, meeting the criteria for noninferiority. The Kaplan-Meier estimator indicated no statistically significant difference between groups (log-rank = 0.654). CONCLUSIONS: Dimethicone- and zinc-based barrier cream was not inferior to hyperoxygenated fatty acids in preventing PIs in hospitalized patients at high or very high risk of developing them during their hospital stay.

Substance Use and Addictive Behavior in Spanish Adolescents in Secondary School.

The detection and prevention of addictive behaviour at an early age is essential given the relationship between the age of the onset of consumption and the appearance of addiction disorders. The aim of this study was to describe the behavior related to substance use and addictive behaviors in adolescents at secondary school from 12 to 16 years of age. A cross-sectional descriptive study has been conducted. The prevalence of consumption of different addictive substances (alcohol, tobacco, cannabis, cocaine) and addictive behaviours (use of social networks and video games) were collated, and the influence of the surrounding social environment and risk perception were evaluated. The final sample was 1298 students. Alcohol, tobacco and cannabis use reflect the prevalence of last month's consumption: 14% (11.8-15.6), 15% (13.4-17.4) and 3% (1.9-2.7) respectively. 76% of the sample frequently use the Internet (5-7 days per week). There is a positive association between the frequency of use and use in the immediate environment. The relationships found show the need for educational and preventive intervention aimed at parents and students that will allow them to know and effectively deal with possible problems associated with the consumption of addictive substances.

Analyzing Nursing Leadership at an Academic Historical Event: A Descriptive Study Based on Social Networks.

PURPOSE: To analyze the leadership network structure among nursing leaders in Spain identified through the Grupo40Enfermeras y Universidad event. METHODS: A descriptive cross-sectional study using social network analysis was used. Study sample consisted of 210 individuals, of whom 119 received nominations as referents. Structural analysis of the network was conducted using centrality and cohesion. RESULTS: A network structure was generated in which different leadership strategies were identified through InDegree, Eigenvector, and Betweenness Centrality. Five leaders were identified as bridges to other individuals using Betweenness. The whole network presented little cohesion although two highly cohesive cores were detected by K-core measurements. CONCLUSION: A strategy is needed to support nursing leaders with high degree of Betweenness to serve as bridges to connect other nursing leaders.

The SUMAMOS EXCELENCIA Project.

AIM: The gap between research and clinical practice leads to inconsistent decision-making and clinical audits are an effective way of improving the implementation of best practice. Our aim is to assess the effectiveness of a model that implements evidence-based recommendations for patient outcomes and healthcare quality. DESIGN: National quasi-experimental, multicentre, before and after study. METHODS: This study focuses on patients attending primary care and hospital care units and associated socio-healthcare services. It uses the Joanna Brigg's Institute Getting Research into Practice model, which improves processes by referring to prior baseline clinical audits. The variables are process and outcome criteria for pain, urinary incontinence, and fall prevention, with data collection at baseline and key points over 12 months drawn from clinical histories and records. Project funding was received from the Spanish Strategic Health Action in November 2014. DISCUSSION: The project results will provide knowledge on the effectiveness of the Getting Research into Practice model, to apply evidence-based recommendations for the detection and management of pain, urinary incontinence, and fall prevention. It will also establish whether using research results, based on clinical audits and situation analysis, is effective for implementing evidence-based recommendations and improving patients' health. IMPACT: This nationwide Spanish project aims to detect and prevent high-prevalence healthcare problems, namely pain in patients at any age and falls and urinary incontinence in people aged 65 and over. Tailoring clinical practice to evidence-based recommendations will reduce unjustified clinical variations in providing healthcare services. Clinical Trial ID: NCT03725774.

Novel LMX1B mutation in familial nail-patella syndrome with variable expression of open angle glaucoma.

PURPOSE: To describe the genetic and clinical findings in a large Spanish pedigree with nail-patella syndrome (NPS) and to investigate the expressivity of open angle glaucoma (OAG) in the family members. METHODS: All individuals underwent a complete ophthalmologic examination, including optical coherence tomography (OCT) of the optic disc and peripapillary region and ultrasound pachymetry. Screening for mutations in the LMX1B gene was performed by denaturing gradient gel electrophoresis and direct genomic sequencing analysis. RESULTS: Ten family members had NPS, seven with varying degrees of ocular hypertension (OHT). Only one of these had advanced OAG. The others showed high pachymetry values and OCT retinal nerve fiber layer (RNFL) thickness above the normal values. Screening for mutations in the exonic and flanking sequences of the LMX1B gene showed a deletion of one G (289delG) within the coding sequence of exon 3 at codon 97, resulting in a frame shift that creates a premature stop at codon 105 (E97fsX105), predicting a truncated protein. This mutation was present in all NPS patients and absent in the unaffected family members. CONCLUSIONS: A novel mutation in the homeobox transcription factor LMX1B causes NPS in a family with variable expressivity of the syndrome, including OAG. The pathogenic mechanism resulting from the mutation is presumably haploinsufficiency rather than a dominant negative effect, which would explain the clinical variability in this family. All NPS OHT patients had considerably thick corneas and RNFL.

Three novel and the common Arg677Ter RP1 protein truncating mutations causing autosomal dominant retinitis pigmentosa in a Spanish population.

BACKGROUND: Retinitis pigmentosa (RP), a clinically and genetically heterogeneous group of retinal degeneration disorders affecting the photoreceptor cells, is one of the leading causes of genetic blindness. Mutations in the photoreceptor-specific gene RP1 account for 3-10% of cases of autosomal dominant RP (adRP). Most of these mutations are clustered in a 500 bp region of exon 4 of RP1. METHODS: Denaturing gradient gel electrophoresis (DGGE) analysis and direct genomic sequencing were used to evaluate the 5' coding region of exon 4 of the RP1 gene for mutations in 150 unrelated index adRP patients. Ophthalmic and electrophysiological examination of RP patients and relatives according to pre-existing protocols were carried out. RESULTS: Three novel disease-causing mutations in RP1 were detected: Q686X, K705fsX712 and K722fsX737, predicting truncated proteins. One novel missense mutation, Thr752Met, was detected in one family but the mutation does not co-segregate in the family, thereby excluding this amino acid variation in the protein as a cause of the disease. We found the Arg677Ter mutation, previously reported in other populations, in two independent families, confirming that this mutation is also present in a Spanish population. CONCLUSION: Most of the mutations reported in the RP1 gene associated with adRP are expected to encode mutant truncated proteins that are approximately one third or half of the size of wild type protein. Patients with mutations in RP1 showed mild RP with variability in phenotype severity. We also observed several cases of non-penetrant mutations.

Novel c-KIT germline mutation in a family with gastrointestinal stromal tumors and cutaneous hyperpigmentation.

Mutations in the c-KIT gene have been identified in many sporadic and familial cases of gastrointestinal stromal tumor (GIST). We report a familial case of GIST with cutaneous hyperpigmentation associated with a novel germline mutation in the c-KIT gene. Screening for mutations in exon 11 of the c-KIT gene in genomic DNA from tumors and peripheral blood of the members of a family with GISTs was undertaken by direct genomic sequencing. Tumors from GIST patients were analyzed histologically and immunohistochemically. Clinical examination of GIST patients was also performed to detect other systemic diseases associated with c-KIT mutations. Histological study showed that the tumors were GISTs expressing CD34 and c-KIT protein. This GIST-hyperpigmentation disease was associated in the family with a germline mutation in the c-KIT gene. The mutation is a duplication of the sequence CAACTT located in exon 11 of the c-KIT gene, which introduces two extra glutamine and leucine residues in the encoding protein between positions 576 and 577. This Spanish family was affected with GISTs and cutaneous hyperpigmentation associated with a novel germline mutation Leu576_Pro577insGlnLeu in the juxtamembrane domain of the c-KIT receptor. These types of mutation in the c-KIT gene activate the tyrosine kinase activity of the c-KIT receptor and induce constitutive signaling leading to GISTs, in some cases associated with cutaneous hyperpigmentation.

Mutations in the pre-mRNA splicing-factor genes PRPF3, PRPF8, and PRPF31 in Spanish families with autosomal dominant retinitis pigmentosa.

PURPOSE: Mutations in the systemically expressed pre-mRNA splicing-factor genes PRPF3, PRPF8, and PRPF31 have recently been associated with autosomal dominant retinitis pigmentosa (adRP). This study was intended to identify mutations in PRPF3, PRPF8, and PRPF31 in 150 Spanish families affected by adRP, to measure the contribution of mutations in these genes to adRP in that population, and to correlate RP phenotype expression with mutations in pre-mRNA splicing-factor genes. METHODS: Denaturing gradient gel electrophoresis (DGGE) and direct genomic sequencing were used to evaluate the complete coding region and flanking intronic sequences of the PRPF31 gene, exon 42 of PRPF8, and exon 11 of PRPF3 for mutations in 150 unrelated index patients with adRP. Ophthalmic and electrophysiological examination of patients with RP and their relatives was performed according to preexisting protocols. RESULTS: Three nonsense mutations caused by insertion and deletion sequences and two missense mutations (Arg2310Gly) and within the stop codon of the PRPF8 gene (TGA-->TTG), were detected in five unrelated heterozygous patients. Three patients were heterozygous carriers of different nonsense mutations in exon 8 of the PRPF31, gene and one Thr494Met mutation was found in exon 11 of the PRPF3 gene. Cosegregation of the mutation in PRPF8 and PRPF3 with adRP was observed. However, two nonsense mutations in PRPF31 causing adRP detected in two families showed asymptomatic carriers. CONCLUSIONS: Nine mutations, six of which are novel, in the pre-mRNA splicing-factor genes PRPF3, PRPF8, and PRPF31, causing adRP have been identified in the Spanish population. Their contribution to adRP is approximately 5% after correction in relation to mutations found in other genes causing adRP. The patients carrying a mutation in the pre-mRNA splicing-factor PRPF8 gene showed a type 1 diffuse RP. The existence of asymptomatic carriers of the nonsense mutation in the PRPF31 gene suggests incomplete penetrance for these mutations in the families.

Mutación Asp-190-Tyr en el gen de la rodopsina en una familia española afectada de retinosis pigmentaria autosómica dominante / Asp-190-Tyr mutation in the rodopsin gene in a Spanish family with autosomic dominant pigmentary retinosis

Ciertas mutaciones en el gen de la rodopsina causan retinosis pigmentaria autosómica dominante (ADRP). Se presenta una extensa familia afectada de ADRP. El análisis mediante electroforesis en gel de acrilamida con gradiente desnaturalizante y secuenciación directa de ADN detectó la presencia en heterozigosis del cambio G por T en la secuencia del ADN del tercer exón del gen de la rodopsina. Esta mutación destruye una diana de restricción para la endonucleasa Taq I y produce el cambio Asp-190-Tyr en la rodopsina. Todos los portadores de la mutación en la familia presentan un fenotipo de RP regional con una clínica variable. Esta mutación es la causante de la enfermedad en esta familia. (AU)