Caregiver Burden and Family Quality of Life in Early Intervention: The Role of Mothers and Family Confidence.

(1) Background: Because life events when there is a family member with a disability can affect the overall family wellbeing, contributing to enhance family quality of life (FQoL) in the field of early childhood intervention has become a priority. However, it is a distal outcome that needs other short-term outcomes to be addressed, some of them under the potential impact of support services. This study examines the relationships between caregiver burden, family confidence, and FQoL, as well as the influence of child and family variables. (2) Method: A total of 58 families with children in early intervention from four Spanish communities participated. Hierarchical regression was conducted to assess the relevance of each predictor. Also, a mediation was performed to investigate the mediating role of family confidence. (3) Results: The family income impacted FQoL scores, and when burden and confidence were added, it was no longer relevant. Mothers with higher levels of confidence predicted a higher FQoL. Finally, we found a complete mediation of family confidence in the relations between severity and caregiver burden on FQoL. (4) Conclusions: Caregiver burden and family confidence affect FQoL. Building families' confidence contributes to attenuating the impact of burden on FQoL.

Factores asociados con caídas de pacientes y su relación con la valoración de riesgo / Patient fall risk factors and their relationship with fall risk assessment

Introducción: la seguridad como atributo de la calidad de atención incluye las actividades orientadas a reducir o mitigar un evento adverso. Las caídas intrahospitalarias son un problema grave y una de las principales causas de lesiones, incapacidad e incluso muerte. El profesional de la salud debe realizar la valoración del riesgo del paciente, determinando la probabilidad de sufrir una caída según sus condiciones individuales. Objetivo: describir los factores asociados con caídas de pacientes en el Hospital de San José de Bogotá y su relación con la valoración del riesgo en el período 2018. Metodología: estudio descriptivo de corte transversal de 90 historias clínicas de pacientes adultos que presentaron este evento adverso. Las variables cuantitativas se reportan como frecuencias absolutas y relativas. Según la Resolución 8430 de 1993 del Ministerio de Salud y Protección Social de Colombia, este estudio se clasifica sin riesgo. Resultados: la edad promedio fue 55 años, 81% estaban clasificados de bajo riesgo, 21% alto, siendo 51% de las valoraciones acorde con la situación del paciente; 38% de las caídas ocurrieron en el baño y con mayor frecuencia (43%) en el turno de la mañana, 27% requirió exámenes adicionales y 12% aumentó la estancia hospitalaria. Conclusión: las caídas constituyen un fenómeno frecuente independiente de la causa de hospitalización, por lo que la "clasificación del riesgo" exige evaluación permanente para conocer los factores predisponentes e intervenir en las causas para mejorar los resultados en salud y favorecer el aprendizaje organizacional.

Introduction: patient safety, as an attribute of quality care, includes actions aimed at reducing or mitigating an adverse event. In-hospital falls are a serious problem and a leading cause of injury, disability, and even death. Patients should be evaluated for fall risk by the healthcare provider, to determine their likelihood of falling, consonantly with their individual features. Objective: to describe patient fall risk factors at Hospital de San José in Bogotá and their relationship to fall risk assessment during 2018. Methodology: a descriptive cross-sectional study including 90 adult patients in whom this adverse event was reported in their medical records. Quantitative variables were reported as absolute and relative frequencies. This study was classified as non-risk in accordance with Resolution 8430 of 1993 issued by the Colombian Ministry of Health and Social Protection. Results: the mean age of participants was 55 years, 81% were classified as low risk, 21% as high risk, and in 51% risk assessment correlated with their comorbid conditions; 38% of falls occurred in the bathroom, most of them (43%) in the morning shift, 27% required further scrutiny and 12% were associated with prolonged hospitalization. Conclusion: patient falls are a common event, regardless of the reason for hospitalization, thus, "risk classification" requires permanent evaluation to identify predisposing factors and the implementation of proper interventions to improve health outcomes and promote organizational learning.

Global influence of dupilumab on Quality of Life in a severe asthma patient with T2 multimorbidities: a case report on atopic dermatitis, chronic rhinosinusitis with nasal polyposis, and eosinophilic esophagitis.

INTRODUCTION: Interleukin (IL)-4 and IL-13 are considered key drivers of type 2 inflammatory diseases. Dupilumab is a fully human monoclonal antibody that blocks the shared receptor component for IL-4 and IL-13, thus inhibiting signaling of both cytokines. CASE STUDY: We report a case of a patient with uncontrolled severe asthma and other T2 inflammatory diseases (atopic dermatitis, chronic rhinosinusitis with nasal polyposis and eosinophilic esophagitis) treated with dupilumab. RESULTS: After one year of treatment, dupilumab improved asthma control together with lung function parameters and airway inflammation. Additionally, a positive impact on quality of life (QoL), evaluated by validated questionnaires, across all the diseases was observed. CONCLUSION: In this case report, a positive and objectively measurable of global improvement on QoL across all four T2 comorbidities was observed after treatment with dupilumab, demonstrating the important role of IL-4 and IL-13 and the existence of a unifying pathological mechanism in T2 diseases.

Impact of hospitalization on nutritional status in persons aged 65 years and over (NUTRIFRAG Study): Protocol for a prospective observational study.

BACKGROUND: Malnutrition is a recurring problem that has become more relevant in recent years. The aim of this study is to assess the risk of malnutrition and nutritional status on admission and its evolution until discharge in patients aged 65 and over admitted to medical and surgical hospitalization units in hospitals of the Spanish National Health System. METHODS: Prospective observational study to be carried out in the medical-surgical hospitalization units of 9 public hospitals between 01/09/2022 and 31/12/2024. Using consecutive sampling, a total of 4077 patients will be included (453 in each hospital). Variables included are related to the care process, functionality, cognition and comorbidity, risk profile, nutritional status and dysphagia; as well as frailty, dietary quality and contextual variables. The incidence of risk of malnutrition, undernutrition and dysphagia during the care process and at discharge will be calculated. The association with risk factors will be studied with logistic regression models and multivariate Cox regression models. In addition, an analysis of participants' satisfaction with food services will be carried out. The study was approved by the Ethics and Research Committee on 30/09/2020, approved for funding on 02/12/2021 and with registration number RBR-5jnbyhk in the Brazilian clinical trials database (ReBEC) for observational studies. DISCUSSION: Some studies address nutritional status or dysphagia in older people in various care settings. However, there is a lack of large sample studies including both processes of the impact of hospitalization. The results of the project will provide information on the incidence and prevalence of both pathologies in the study subjects, their associated factors and their relationship with the average length of stay, mortality and early readmission. In addition, early detection of a problem such as malnutrition related to the disease and/or dysphagia during a hospital stay will favor the action of professionals to resolve both pathologies and improve the health status of patients.

CHOICE international survey: Clusters of allergen immunotherapy prescription from French and Spanish cohorts.

Background: There is no description of the drivers of prescription for allergen immunotherapy (AIT) for respiratory allergic diseases. Methods: A prospective, multicentre, observational, non-interventional real-life study was performed in France and Spain for 20 months. Data were gathered using 2 different questionnaires, anonymously collected in an online platform. No names of AIT products were recorded. Multivariate analysis and unsupervised cluster analysis were performed. Results: One hundred and three physicians (50.5% from Spain and 49.5% from France) reported 1735 patients (433 in France and 1302 in Spain), 47.9% males, 64.8% adults with a mean age 26.2 years old. They suffered from allergic rhinitis (99%), allergic conjunctivitis (70.4%), allergic asthma (51.8%), atopic dermatitis (13.9%), and food allergy (9.9%). A clustering analysis based on 13 predefined relevant variables for AIT-prescription identified 5 different clusters, each of them including information regarding doctor's profile and patient demographics, baseline disease characteristics, and main AIT indication: 1) Looking at the future: focusing on asthma prevention (n = 355), 2) Efficacy after discontinuation of AIT (n = 293), 3) Fighting severe allergic disease (n = 322), 4) Looking at the present, facing current symptoms (n = 265) and 5) Doctor's own clinical experience (n = 500). Each one of these clusters have specific patients' and doctors' characteristics, representing distinctive AIT prescription drivers. Conclusion: Using data-driven analysis, we identified for the first time some reasons and patterns of AIT prescriptions in real-life clinical settings. There is no uniform indication for prescribing AIT, which varies amongst patients and doctors with multiple but specific drivers, taking into account several relevant parameters.

Evaluation of the incisive canal using cone beam computed tomography

The incisive canal is innervated by the nasopalatine nerve and irrigated by the anterior branches of the descending palatine vessels, the sphenopalatine and greater palatine artery. Sometimes, the incisor canal interferes with the placement of implants or other surgical procedures, it is necessary to resort to previous treatments in order to have the ideal conditions in the area to be treated and avoid complications. Methods: 100 cone beam computed tomography were studied evaluating the diameter, length and shape of the incisor canal, distance from the lower edge of the incisor canal to the alveolar ridge, length and width of the bone anterior to the incisor canal, and width of the palatal bone. Results and conclusions: The variables that showed a statistically significant difference comparing between male and female patients were vestibulo-palatal and incisor foramen diameter, incisor canal length, distance from the canal to the central incisor, coronal and medial width of the vestibular bone; and the width of the palatal bone at apical and mid-level; being greater in male patients.

Reasons for choosing and completing nursing studies among incoming and outgoing students: A qualitative study.

BACKGROUND: The shortage of nurses is causing instability and crisis in health systems and will continue. The WHO reinforced the importance of recruiting and retaining new students. Authors of various studies recommend the need to identify and understand the reasons for pursuing a nursing degree. OBJECTIVES: To determine students' preference for nursing studies and to identify the reasons for choosing, continuing, and completing a bachelor's degree in nursing. DESIGN: Qualitative, descriptive study. PARTICIPANTS: 106 nursing students at the University of Huelva (Spain) participated during their first year (2017) and final year (2021) of the nursing degree. METHODS: This study was conducted with the same group of students in two phases. Data were collected in writing in a document with open-ended questions and no maximum wordcount. The responses were analysed using content analysis. RESULTS: A total of 76.4 % of participants stated that nursing had been their first choice. The main reasons for choosing a nursing degree were associated with fulfilment, and a desire to help others and interact with them. The reasons for completing their studies were primarily related to an interest in providing professional care, showing a deeper and more concrete knowledge of nursing care work. CONCLUSION: For most participants, nursing was their first choice due to a strong intrinsic motivation related to self-satisfaction in helping others. The reasons for completing this degree had extrinsic motivations linked to nursing activity in hospital. Areas such as management, teaching, or research were not interesting to our students. Knowing the causes of this lack of interest could help us attract them to these areas.

Once-Weekly Semaglutide in Adolescents with Obesity.

BACKGROUND: A once-weekly, 2.4-mg dose of subcutaneous semaglutide, a glucagon-like peptide-1 receptor agonist, is used to treat obesity in adults, but assessment of the drug in adolescents has been lacking. METHODS: In this double-blind, parallel-group, randomized, placebo-controlled trial, we enrolled adolescents (12 to <18 years of age) with obesity (a body-mass index [BMI] in the 95th percentile or higher) or with overweight (a BMI in the 85th percentile or higher) and at least one weight-related coexisting condition. Participants were randomly assigned in a 2:1 ratio to receive once-weekly subcutaneous semaglutide (at a dose of 2.4 mg) or placebo for 68 weeks, plus lifestyle intervention. The primary end point was the percentage change in BMI from baseline to week 68; the secondary confirmatory end point was weight loss of at least 5% at week 68. RESULTS: A total of 201 participants underwent randomization, and 180 (90%) completed treatment. All but one of the participants had obesity. The mean change in BMI from baseline to week 68 was -16.1% with semaglutide and 0.6% with placebo (estimated difference, -16.7 percentage points; 95% confidence interval [CI], -20.3 to -13.2; P<0.001). At week 68, a total of 95 of 131 participants (73%) in the semaglutide group had weight loss of 5% or more, as compared with 11 of 62 participants (18%) in the placebo group (estimated odds ratio, 14.0; 95% CI, 6.3 to 31.0; P<0.001). Reductions in body weight and improvement with respect to cardiometabolic risk factors (waist circumference and levels of glycated hemoglobin, lipids [except high-density lipoprotein cholesterol], and alanine aminotransferase) were greater with semaglutide than with placebo. The incidence of gastrointestinal adverse events was greater with semaglutide than with placebo (62% vs. 42%). Five participants (4%) in the semaglutide group and no participants in the placebo group had cholelithiasis. Serious adverse events were reported in 15 of 133 participants (11%) in the semaglutide group and in 6 of 67 participants (9%) in the placebo group. CONCLUSIONS: Among adolescents with obesity, once-weekly treatment with a 2.4-mg dose of semaglutide plus lifestyle intervention resulted in a greater reduction in BMI than lifestyle intervention alone. (Funded by Novo Nordisk; STEP TEENS ClinicalTrials.gov number, NCT04102189.).

Estimating the impact of COVID-19 pandemic on alternative semi-intensive shrimp (Penaeus vannamei) production schedules in Mexico: a stochastic bioeconomic approach.

This study uses a stochastic bioeconomic approach to estimate the COVID-19 pandemic economic impact on shrimp farming in Mexico. Seeding-harvesting schedules - March-June, May-August, and August-November - were analyzed using shrimp prices and production costs corresponding to 2017-2019 (pre-pandemic) and 2020 (pandemic). The analyses estimated net revenue varied within 597.97-2758.88 USD$ ha-1 and 1262.40-1701.32 USD$ ha-1 under the pre-pandemic and pandemic scenarios, respectively. Significant decreases (38%) were estimated in net revenue values in March-June and May-August under the pandemic scenario. However, probability distributions estimated that uncertainty on the expected net revenues was not affected by the pandemic conditions, and the probability of losing was null or negligible in all the cases. Unfavorable conditions under the pandemic also required significantly higher break-even production for March-June (25.7%) and May-August (28.5%) schedules. The cost of post-larvae was the most important economic factor influencing net revenue. To conclude, although the operating conditions during the pandemic were conducive to worsening the economic outcome, no evidence still exists that uncertainty and economic risk increased compared with pre-pandemic conditions.

Current Stereotypes Associated with Nursing and Nursing Professionals: An Integrative Review.

Nursing and nursing professionals are associated with social stereotypes, which may hinder the profession's development and future prospects as a scientific discipline. The aim of this study was to identify and describe the stereotypes associated with the nursing profession-students and professionals. Therefore, we carried out an integrative review. The search was conducted using PubMed, WOS, and CINAHL databases, and its search strategy was based on a combination of standardised keywords and natural vocabulary, with a temporal limit between 2016 and 2021. The data extraction and analysis was based on the conceptual framework developed by Whittemore and Knafl. Twenty-seven studies were included in the review, and their results were classified and coded. Two categories emerged, namely, stereotypes relating to the professionals' gender and stereotypes relating to the profession itself. We concluded that the nursing profession is viewed as female with low skills, social status, salary, academic level and entry requirements, and with little autonomy. Male nurses' professional competencies and masculinity are questioned, while the work carried out by female nurses is viewed as unprofessional. To reduce these stereotypes and bias we must present the nursing profession as a scientific discipline, developed by both men and women. Specific channels for this awareness-raising work include interventions from universities and the media, and participation in health policies.

Influence of Agaricus bisporus establishment and fungicidal treatments on casing soil metataxonomy during mushroom cultivation.

The cultivation of edible mushroom is an emerging sector with a potential yet to be discovered. Unlike plants, it is a less developed agriculture where many studies are lacking to optimize the cultivation. In this work we have employed high-throughput techniques by next generation sequencing to screen the microbial structure of casing soil employed in mushroom cultivation (Agaricus bisporus) while sequencing V3-V4 of the 16S rRNA gene for bacteria and the ITS2 region of rRNA for. In addition, the microbiota dynamics and evolution (bacterial and fungal communities) in peat-based casing along the process of incubation of A. bisporus have been studied, while comparing the effect of fungicide treatment (chlorothalonil and metrafenone). Statistically significant changes in populations of bacteria and fungi were observed. Microbial composition differed significantly based on incubation day, changing radically from the original communities in the raw material to a specific microbial composition driven by the A. bisporus mycelium growth. Chlorothalonil treatment seems to delay casing colonization by A. bisporus. Proteobacteria and Bacteroidota appeared as the most dominant bacterial phyla. We observed a great change in the structure of the bacteria populations between day 0 and the following days. Fungi populations changed more gradually, with A. bisporus displacing the rest of the species as the cultivation cycle progresses. A better understanding of the microbial communities in the casing will hopefully allow us to increase the biological efficiency of the crop.

Once-Weekly Dulaglutide for the Treatment of Youths with Type 2 Diabetes.

BACKGROUND: The incidence of type 2 diabetes mellitus is increasing among youths. Once-weekly treatment with dulaglutide, a glucagon-like peptide-1 receptor agonist, may have efficacy with regard to glycemic control in youths with type 2 diabetes. METHODS: In a double-blind, placebo-controlled, 26-week trial, we randomly assigned participants (10 to <18 years of age; body-mass index [BMI], >85th percentile) being treated with lifestyle modifications alone or with metformin, with or without basal insulin, in a 1:1:1 ratio to receive once-weekly subcutaneous injections of placebo, dulaglutide at a dose of 0.75 mg, or dulaglutide at a dose of 1.5 mg. Participants were then included in a 26-week open-label extension study in which those who had received placebo began receiving dulaglutide at a weekly dose of 0.75 mg. The primary end point was the change from baseline in the glycated hemoglobin level at 26 weeks. Secondary end points included a glycated hemoglobin level of less than 7.0% and changes from baseline in the fasting glucose concentration and BMI. Safety was also assessed. RESULTS: A total of 154 participants underwent randomization. At 26 weeks, the mean glycated hemoglobin level had increased in the placebo group (0.6 percentage points) and had decreased in the dulaglutide groups (-0.6 percentage points in the 0.75-mg group and -0.9 percentage points in the 1.5-mg group, P<0.001 for both comparisons vs. placebo). At 26 weeks, a higher percentage of participants in the pooled dulaglutide groups than in the placebo group had a glycated hemoglobin level of less than 7.0% (51% vs. 14%, P<0.001). The fasting glucose concentration increased in the placebo group (17.1 mg per deciliter) and decreased in the pooled dulaglutide groups (-18.9 mg per deciliter, P<0.001), and there were no between-group differences in the change in BMI. The incidence of gastrointestinal adverse events was higher with dulaglutide therapy than with placebo. The safety profile of dulaglutide was consistent with that reported in adults. CONCLUSIONS: Treatment with dulaglutide at a once-weekly dose of 0.75 mg or 1.5 mg was superior to placebo in improving glycemic control through 26 weeks among youths with type 2 diabetes who were being treated with or without metformin or basal insulin, without an effect on BMI. (Funded by Eli Lilly; AWARD-PEDS ClinicalTrials.gov number, NCT02963766.).

A study on pharmacokinetics, pharmacodynamics and safety of lixisenatide in children and adolescents with type 2 diabetes.

OBJECTIVE: The aim of this study was to investigate the pharmacokinetic, pharmacodynamic and safety profile of the glucagon-like peptide-1 receptor agonist, lixisenatide, for the treatment of type 2 diabetes (T2D) in pediatric individuals. MATERIALS AND METHODS: In this Phase 1, multicenter, randomized, double-blind, placebo-controlled, parallel-group, ascending repeated dose study (NCT02803918), participants aged ≥10 and < 18 years were randomized 3:1 to receive once-daily lixisenatide in 2-week increments of 5, 10, and 20 µg (n = 18) or placebo (n = 5) for 6 weeks. RESULTS: Mean lixisenatide concentrations generally increased with increasing doses irrespective of anti-drug antibody (ADA) status; however, mean lixisenatide concentrations and inter-subject variability were higher for participants with positive ADA status. Improvements in fasting plasma glucose, post-prandial glucose, AUC0-4.5 , HbA1c , and body weight were observed with lixisenatide. Overall, the safety profile was consistent with the known profile in adults, with no unexpected side effects and no treatment-emergent adverse events resulting in death or discontinuation. The most common events in the lixisenatide group were vomiting (11.1%) and nausea (11.1%). No symptomatic hypoglycemia was reported in either group. No clinically significant hematologic, biochemical or vital sign abnormalities were observed. CONCLUSIONS: Mean lixisenatide concentrations generally increased with increasing dose, irrespective of ADA status. Lixisenatide was associated with improved glycemic control and a trend in body weight reduction compared with placebo. The safety and tolerability profile of repeated lixisenatide doses of up to 20 µg per day in children and adolescents with T2D was reflective of the established safety profile of lixisenatide in adults.

Current Social Perception of and Value Attached to Nursing Professionals' Competences: An Integrative Review.

In order to develop nurses' identities properly, they need to publicise their professional competences and make society aware of them. For that, this study was conducted to describe the competences that society currently attributes to nursing professionals and how nursing is valued in society. This review was based on the conceptual framework by Whittemore and Knafl. The literature search was conducted using PubMed, WOS, and CINAHL databases, and the search strategy was based on a combination of natural language and standardised keywords, with limits and criteria for inclusion, exclusion, and quality. The results of the studies were classified and coded in accordance with the competence groups of the professional profile described in the Tuning Educational Structures in Europe programme. Fourteen studies were selected. The most commonly reported competence groups were as follows: nursing practice and clinical decision making; and communication and interpersonal competences. Nursing is perceived as a healthcare profession dedicated to caring for individuals. Its other areas of competence and its capacity for leadership are not well known. In order to develop a professional identity, it is essential to raise awareness of the competences that make up this professional profile.

Caracterización de lesiones de piel en una institución de salud en Bogotá / Characterization of skin lesions in a health institution in Bogotá / Caracterização de lesões de pele em uma instituição de saúde em Bogotá

Objetivo: Describir las características de las lesiones de piel que ocurren como evento ad-verso al cuidado clínico en una institución de salud de IV nivel de complejidad. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en donde se tomaron 50 historias clínicas correspondientes a un periodo de 12 meses, de pacientes que estuvieron hospitalizados; en los que se valoró la historia desde la primera valoración y las siguientes a esta cada 7 días según protocolo institucional y por medio de la escala de Braden. Resulta-dos: El tipo de lesión de piel más frecuente son las úlceras por presión con 24 casos (40%), el lugar anatómico de lesión más reportado fue la región sacra con un 40% seguido del 30% que tenían más de una localización. En el 94% (n=47) de los casos las consecuencias del even-to ocasionaron a los pacientes tratamientos y procedimientos adicionales con un desenlace moderado. Conclusión: Las lesiones de piel más frecuentes fueron las úlceras por presión, puesto que este evento adverso representa un indicador de calidad del cuidado de enfermería, se deben mejorar las estrategias de prevención en el plan de cuidados de enfermería

Objective: To describe the characteristics of skin lesions that occur as an adverse events in a health institution of IV level of complexity. Materials and methods: A descriptive cross-sec-tional study was carried out in which 50 medical records corresponding to a period of 12 months were taken from patients who were hospitalized; starting the follow-up between the first assessment and the subsequent ones every 7 days according to institutional protocol and using the Braden scale. Results: The most frequent type of skin lesion is pressure ulcers with 24 cases (40%), the most reported anatomical site of injury was the sacral region with 40% followed by 30% with more than one location. In most cases (94%) the consequences of the event cause patients additional treatments and procedures with a moderate outcome. Conclusion: The most frequent skin lesions were pressure ulcers, since this adverse event represents an indicator of the quality of nursing care, prevention strategies must be improved in the nursing care plan

Objetivo: Descrever as características das lesões de pele que ocorrem como evento adverso ao atendimento clínico em uma instituição de saúde de nível de complexidade IV. Materi-ais e métodos: Realizar um estudio descritivo de corte transversal em donde se tomaron 50 historias clínicas correspondentes a um periodo de 12 meses, de pacientes que estuvieron hospitalizados; iniciando o seguimento entre a primeira valoração e os siguientes a esta cada 7 dias según protocolo institucional e por meio da escala de Braden. Resultados: El tipo de lesão de piel más frecuente son las úlceras por presión con 24 casos (40%), el lugar anatóm-ico de lesión más reportado fue la región sacra con un 40% seguido del 30% que tenían más de una localización. Em 94% (n=47) dos casos, as consequências do evento ocasionan a los pacientes tratamientos e procedimentos adicionais con un desenlace moderado. Conclusão: As lesões de pele mais frequentes foram as úlceras por pressão, visto que este evento adverso representa um indicador da qualidade da assistência de enfermagem, as estratégias de pre-venção devem ser aprimoradas no plano de cuidados de enfermagem

Barriers and facilitators to the participation of subjects in clinical trials: An overview of reviews.

BACKGROUND: The demand for clinical trial participants is today one of the highest it has ever been and continues to increase. At the same time, subject recruitment continues to be problematic and the major reason for clinical trial premature terminations. The literature on clinical trial recruitment, which spans several decades and includes hundreds of studies, has an abundance of findings that can be synthesized by way of an overview to provide a well-informed and complete picture of the factors that determine subject participation. OBJECTIVES: An overview of the systematic reviews that report barriers and facilitators to clinical trial participation was conducted. The extracted data were synthesized, and a thematic framework of the factors that affect subject participation in clinical trials was developed. The overview extended across medical subjects and demographics. METHODS: Thirty reviews that complied with the inclusion criteria were included. These reviews covered 753 relevant primary studies and reported 881 barriers and facilitators. The barriers and facilitators were thematically synthesized and a thematic framework of 20 themes was developed. The quality of the included reviews was assessed and reported. MAIN RESULTS: Several opportunities to increase clinical trial participation, by developing interventions and changing the trial design, derived from an analysis of the thematic framework. That analysis also showed that most of the 20 themes operate mainly as a barrier or as a facilitator, and that most have an effect across medical subjects. As to the quality elements assessed, some reviews complied almost fully but most only partially.

[Girl with hypersensitivity pneumonitis. A case report]. / Niña con neumonitis por hipersensibilidad. Reporte de un caso.

BACKGROUND: Hypersensitivity pneumonitis entails several inflammatory lung diseases that preferentially affect the alveolar and perialveolar tissue. It is a very rare disease in children, with a complicated diagnosis due to the fact that antigen exposure usually goes unnoticed. CASE REPORT: A 12-year-old girl with dry cough, dyspnea, wheezing, and tachypnea, with partial improvement after treatment with inhaled bronchodilators and corticoids. The spirometry showed a restrictive pattern and reduced lung diffusion capacity; in the CT scan, centrilobular ground-glass opacities were observed, and a lymphocyte count of CD4/CD8 of 2.46 (lymphocytosis) was obtained from the bronchoalveolar lavage. IgG positivity to bird feathers was obtained. CONCLUSIONS: The treatment of hypersensitivity pneumonitis is based on avoiding exposure to the causative agent, which is determined by the prognosis; for which taking an extensive medical history is of paramount importance. Corticosteroids can be prescribed based on the clinical response, the pulmonary function, and the radiological improvement.

Antecedentes: La neumonitis por hipersensibilidad agrupa varias enfermedades inflamatorias pulmonares que afectan preferentemente el tejido alveolar y perialveolar. En niños se trata de una enfermedad muy rara, con diagnóstico complicado debido a que la exposición antigénica suele pasar desapercibida. Caso clínico: Niña de 12 años que presentaba tos seca, disnea, sibilancias y taquipnea con mejoría parcial al tratamiento con broncodilatadores y corticoides inhalados. En la espirometría presentó un patrón restrictivo y una capacidad de difusión pulmonar reducida; en la tomografía computarizada se observaron opacidades centrolobulillares en vidrio esmerilado y del lavado broncoalveolar se obtuvo un cociente de linfocitosis CD4/CD8 de 2.46. Se obtuvo IgG positiva a plumas de aves. Conclusiones: El manejo de la neumonitis por hipersensibilidad se basa en evitar la exposición al agente causante, lo que determina el pronóstico; de ahí que resulta de vital importancia realizar una historia clínica exhaustiva. Pueden indicarse corticosteroides en función de la respuesta clínica, la función pulmonar y la mejoría radiológica.

Standard of care for lipedema in the United States.

BACKGROUND: Lipedema is a loose connective tissue disease predominantly in women identified by increased nodular and fibrotic adipose tissue on the buttocks, hips and limbs that develops at times of hormone, weight and shape change including puberty, pregnancy, and menopause. Lipedema tissue may be very painful and can severely impair mobility. Non-lipedema obesity, lymphedema, venous disease, and hypermobile joints are comorbidities. Lipedema tissue is difficult to reduce by diet, exercise, or bariatric surgery. METHODS: This paper is a consensus guideline on lipedema written by a US committee following the Delphi Method. Consensus statements are rated for strength using the GRADE system. RESULTS: Eighty-five consensus statements outline lipedema pathophysiology, and medical, surgical, vascular, and other therapeutic recommendations. Future research topics are suggested. CONCLUSION: These guidelines improve the understanding of the loose connective tissue disease, lipedema, to advance our understanding towards early diagnosis, treatments, and ultimately a cure for affected individuals.

Components of the nursing role as perceived by first-year nursing students.

BACKGROUND: Identifying and acquiring the nursing role is key to the development of nurses' professional identity. Understanding nursing students' perceptions in this regard will enable nursing educators to choose teaching strategies that lead to positive development of their students' professional identity. OBJECTIVES: To describe how nursing students perceive the different components of the nursing role at the beginning of the nursing degree. DESIGN: Cross-sectional, descriptive, observational study. PARTICIPANTS/SETTINGS: 106 first-year nursing students at the University of Huelva, Spain. METHODS: Data on social and academic variables and variables relating to the instrumental and expressive roles were collected via an adapted, pilot-tested questionnaire assessed by experts. RESULTS: For participants, caregiving is the core of the nursing role in the clinical setting, including both technical execution and patient care aspects. They highlighted the disease prevention, health promotion, restoration, and education profiles of nurses rather than their teaching, professional, and technical profiles. They were acquainted with the concept of postgraduate professional development, but were unaware of the academic pathways leading to it. They considered nurses to be decision-makers, who are nevertheless subordinate to doctors. CONCLUSIONS: Students did not consider nursing to be an autonomous profession, although they highlighted its decision-making capacity. They placed greater emphasis on the traditional profile of primary care nurses than on their technical profile, and were able to identify the members of the multidisciplinary healthcare team.

Communication on Safe Caregiving between Community Nurse Case Managers and Family Caregivers.

Dependent elderly individuals are usually cared for at home by untrained family members who are unaware of the risks involved. In this setting, communication on safe caregiving is key. The aim of this study is to describe the factors influencing the process followed by community nurse case managers to provide communication on safe caregiving to family members caring for dependent elderly individuals. A phenomenological study, by focus group, was done in urban healthcare facilities. Key informants were seven community nurses, case managers with more than 12 years' experience. We did a thematic analysis and we identified the units of meaning to which the most relevant discourses were assigned. The concepts expressed were grouped until subcategories were formed, which were then condensed into categories. Four categories of analysis emerged: communication-related aspects; professional skills of nurse case managers; communication on safety and the caregiving role. To planner interventions, for the prevention of adverse events at home, is essential to consider these aspects: nurses' professional communication skills, factors inherent to safe caregiving, the characteristics of the home where care is provided, the personal and family circumstances of the caregiver, and whether or not the caregiver's role has been assumed by the family caregivers.