SARS-CoV-2 S protein activates NLRP3 inflammasome and deregulates coagulation factors in endothelial and immune cells.

BACKGROUND: Hyperinflammation, hypercoagulation and endothelial injury are major findings in acute and post-COVID-19. The SARS-CoV-2 S protein has been detected as an isolated element in human tissues reservoirs and is the main product of mRNA COVID-19 vaccines. We investigated whether the S protein alone triggers pro-inflammatory and pro-coagulant responses in primary cultures of two cell types deeply affected by SARS-CoV-2, such are monocytes and endothelial cells. METHODS: In human umbilical vein endothelial cells (HUVEC) and monocytes, the components of NF-κB and the NLRP3 inflammasome system, as well as coagulation regulators, were assessed by qRT-PCR, Western blot, flow cytometry, or indirect immunofluorescence. RESULTS: S protein activated NF-κB, promoted pro-inflammatory cytokines release, and triggered the priming and activation of the NLRP3 inflammasome system resulting in mature IL-1ß formation in both cell types. This was paralleled by enhanced production of coagulation factors such as von Willebrand factor (vWF), factor VIII or tissue factor, that was mediated, at least in part, by IL-1ß. Additionally, S protein failed to enhance ADAMTS-13 levels to counteract the pro-coagulant activity of vWF multimers. Monocytes and HUVEC barely expressed angiotensin-converting enzyme-2. Pharmacological approaches and gene silencing showed that TLR4 receptors mediated the effects of S protein in monocytes, but not in HUVEC. CONCLUSION: S protein behaves both as a pro-inflammatory and pro-coagulant stimulus in human monocytes and endothelial cells. Interfering with the receptors or signaling pathways evoked by the S protein may help preventing immune and vascular complications driven by such an isolated viral element. Video Abstract.

Barriers and Facilitators of Communication in the Medication Reconciliation Process during Hospital Discharge: Primary Healthcare Professionals' Perspectives.

The WHO established that medication errors are the most common and preventable errors and represent an expenditure of 42 billion U.S. dollars annually. The risk of medication errors increases in transitions between levels of care, mainly from hospital care to primary healthcare after hospital discharge. In this context, communication is a key element in the safety of the medication reconciliation process. The aim of this paper was to describe the barriers to, and facilitators of, effective communication during the medication reconciliation process at hospital discharge in people over 65 years of age, from the perspective of primary healthcare professionals. A qualitative descriptive study was designed, and in-depth interviews were conducted with 21 individuals, of whom 13 were nurses and 8 were physicians. This study was carried out with healthcare professionals belonging to primary healthcare centres in Huelva (Spain). Following content analysis of the discourses we identified 19 categories, grouped into three areas: interlevel communication, communication between primary healthcare professionals, and communication between healthcare professionals and patients/caregivers. The barriers found mainly relate to the adequacy and use of technological tools, time available, workload and the level of collaboration of patients/caregivers. Facilitating elements for communication in medication reconciliation included technologies, such as computerized medical history, protocolization of clinical sessions, the presence of case management nurse and interdisciplinary teamwork.

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.

A Prospective Study of Longitudinal Risks of Cognitive Deficit for People Undergoing Glioblastoma Surgery Using a Tablet Computer Cognition Testing Battery: Towards Personalized Understanding of Risks to Cognitive Function.

Glioblastoma and the surgery to remove it pose high risks to the cognitive function of patients. Little reliable data exist about these risks, especially postoperatively before radiotherapy. We hypothesized that cognitive deficit risks detected before surgery will be exacerbated by surgery in patients with glioblastoma undergoing maximal treatment regimens. We used longitudinal electronic cognitive testing perioperatively to perform a prospective, longitudinal, observational study of 49 participants with glioblastoma undergoing surgery. Before surgery (A1), the participant risk of deficit in 5/6 cognitive domains was increased compared to normative data. Of these, the risks to Attention (OR = 31.19), Memory (OR = 97.38), and Perception (OR = 213.75) were markedly increased. These risks significantly increased in the early period after surgery (A2) when patients were discharged home or seen in the clinic to discuss histology results. For participants tested at 4-6 weeks after surgery (A3) before starting radiotherapy, there was evidence of risk reduction towards A1. The observed risks of cognitive deficit were independent of patient-specific, tumour-specific, and surgery-specific co-variates. These results reveal a timeframe of natural recovery in the first 4-6 weeks after surgery based on personalized deficit profiles for each participant. Future research in this period could investigate personalized rehabilitation tools to aid the recovery process found.

Human Metastatic Cholangiocarcinoma Patient-Derived Xenografts and Tumoroids for Preclinical Drug Evaluation.

PURPOSE: Cholangiocarcinoma (CCA) is usually diagnosed at advanced stages, with limited therapeutic options. Preclinical models focused on unresectable metastatic CCA are necessary to develop rational treatments. Pathogenic mutations in IDH1/2, ARID1A/B, BAP1, and BRCA1/2 have been identified in 30%-50% of patients with CCA. Several types of tumor cells harboring these mutations exhibit homologous recombination deficiency (HRD) phenotype with enhanced sensitivity to PARP inhibitors (PARPi). However, PARPi treatment has not yet been tested for effectiveness in patient-derived models of advanced CCA. EXPERIMENTAL DESIGN: We have established a collection of patient-derived xenografts from patients with unresectable metastatic CCA (CCA_PDX). The CCA_PDXs were characterized at both histopathologic and genomic levels. We optimized a protocol to generate CCA tumoroids from CCA_PDXs. We tested the effects of PARPis in both CCA tumoroids and CCA_PDXs. Finally, we used the RAD51 assay to evaluate the HRD status of CCA tissues. RESULTS: This collection of CCA_PDXs recapitulates the histopathologic and molecular features of their original tumors. PARPi treatments inhibited the growth of CCA tumoroids and CCA_PDXs with pathogenic mutations of BRCA2, but not those with mutations of IDH1, ARID1A, or BAP1. In line with these findings, only CCA_PDX and CCA patient biopsy samples with mutations of BRCA2 showed RAD51 scores compatible with HRD. CONCLUSIONS: Our results suggest that patients with advanced CCA with pathogenic mutations of BRCA2, but not those with mutations of IDH1, ARID1A, or BAP1, are likely to benefit from PARPi therapy. This collection of CCA_PDXs provides new opportunities for evaluating drug response and prioritizing clinical trials.

Therapy-Induced Senescence Enhances the Efficacy of HER2-Targeted Antibody-Drug Conjugates in Breast Cancer.

Antibody-drug conjugates (ADC) are antineoplastic agents recently introduced into the antitumor arsenal. T-DM1, a trastuzumab-based ADC that relies on lysosomal processing to release the payload, is approved for HER2-positive breast cancer. Next-generation ADCs targeting HER2, such as [vic-]trastuzumab duocarmazine (SYD985), bear linkers cleavable by lysosomal proteases and membrane-permeable drugs, mediating a bystander effect by which neighboring antigen-negative cells are eliminated. Many antitumor therapies, like DNA-damaging agents or CDK4/6 inhibitors, can induce senescence, a cellular state characterized by stable cell-cycle arrest. Another hallmark of cellular senescence is the enlargement of the lysosomal compartment. Given the relevance of the lysosome to the mechanism of action of ADCs, we hypothesized that therapies that induce senescence would potentiate the efficacy of HER2-targeting ADCs. Treatment with the DNA-damaging agent doxorubicin and CDK4/6 inhibitor induced lysosomal enlargement and senescence in several breast cancer cell lines. While senescence-inducing drugs did not increase the cytotoxic effect of ADCs on target cells, the bystander effect was enhanced when HER2-negative cells were cocultured with HER2-low cells. Knockdown experiments demonstrated the importance of cathepsin B in the enhanced bystander effect, suggesting that cathepsin B mediates linker cleavage. In breast cancer patient-derived xenografts, a combination treatment of CDK4/6 inhibitor and SYD985 showed improved antitumor effects over either treatment alone. These data support the strategy of combining next-generation ADCs targeting HER2 with senescence-inducing therapies for tumors with heterogenous and low HER2 expression. SIGNIFICANCE: Combining ADCs against HER2-positive breast cancers with therapies that induce cellular senescence may improve their therapeutic efficacy by facilitating a bystander effect against antigen-negative tumor cells.

Gasdermin B over-expression modulates HER2-targeted therapy resistance by inducing protective autophagy through Rab7 activation.

BACKGROUND: Gasdermin B (GSDMB) over-expression promotes poor prognosis and aggressive behavior in HER2 breast cancer by increasing resistance to therapy. Decoding the molecular mechanism of GSDMB-mediated drug resistance is crucial to identify novel effective targeted treatments for HER2/GSDMB aggressive tumors. METHODS: Different in vitro approaches (immunoblot, qRT-PCR, flow cytometry, proteomic analysis, immunoprecipitation, and confocal/electron microscopy) were performed in HER2 breast and gastroesophageal carcinoma cell models. Results were then validated using in vivo preclinical animal models and analyzing human breast and gastric cancer samples. RESULTS: GSDMB up-regulation renders HER2 cancer cells more resistant to anti-HER2 agents by promoting protective autophagy. Accordingly, the combination of lapatinib with the autophagy inhibitor chloroquine increases the therapeutic response of GSDMB-positive cancers in vitro and in zebrafish and mice tumor xenograft in vivo models. Mechanistically, GSDMB N-terminal domain interacts with the key components of the autophagy machinery LC3B and Rab7, facilitating the Rab7 activation during pro-survival autophagy in response to anti-HER2 therapies. Finally, we validated these results in clinical samples where GSDMB/Rab7/LC3B co-expression associates significantly with relapse in HER2 breast and gastric cancers. CONCLUSION: Our findings uncover for the first time a functional link between GSDMB over-expression and protective autophagy in response to HER2-targeted therapies. GSDMB behaves like an autophagy adaptor and plays a pivotal role in modulating autophagosome maturation through Rab7 activation. Finally, our results provide a new and accessible therapeutic approach for HER2/GSDMB + cancers with adverse clinical outcome.

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.

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.

Rhodium-catalysed ortho-alkynylation of nitroarenes.

The ortho-alkynylation of nitro-(hetero)arenes takes place in the presence of a Rh(iii) catalyst to deliver a wide variety of alkynylated nitroarenes regioselectively. These interesting products could be further derivatized by selective reduction of the nitro group or palladium-catalysed couplings. Experimental and computational mechanistic studies demonstrate that the reaction proceeds via a turnover-limiting electrophilic C-H metalation ortho to the strongly electron-withdrawing nitro group.

HER2 + breast cancers evade anti-HER2 therapy via a switch in driver pathway.

Inhibition of HER2 in HER2-amplified breast cancer has been remarkably successful clinically, as demonstrated by the efficacy of HER-kinase inhibitors and HER2-antibody treatments. Whilst resistance to HER2 inhibition is common in the metastatic setting, the specific programs downstream of HER2 driving resistance are not established. Through genomic profiling of 733 HER2-amplified breast cancers, we identify enrichment of somatic alterations that promote MEK/ERK signaling in metastatic tumors with shortened progression-free survival on anti-HER2 therapy. These mutations, including NF1 loss and ERBB2 activating mutations, are sufficient to mediate resistance to FDA-approved HER2 kinase inhibitors including tucatinib and neratinib. Moreover, resistant tumors lose AKT dependence while undergoing a dramatic sensitization to MEK/ERK inhibition. Mechanistically, this driver pathway switch is a result of MEK-dependent activation of CDK2 kinase. These results establish genetic activation of MAPK as a recurrent mechanism of anti-HER2 therapy resistance that may be effectively combated with MEK/ERK inhibitors.

Efectividad de una intervención sobre el registro de la valoración enfermera al ingreso / Efficacy of an intervention about nursing assessment compliance at admission

Objetivo: evaluar la eficacia de una intervención sobre cumplimentación de la entrevista de valoración enfermera al ingreso.Método: estudio analítico cuasi-experimental pre-post de grupo único en el Hospital del Mar de Barcelona. La variable de interés principal fue el grado de cumplimentación, recogida según el Modelo de Patrones Funcionales de la Salud de Marjory Gordon. Se analizaron 60 historias clínicas antes de la intervención y 60 después. La intervención fue una sesión formativa en la que se compartieron los resultados del primer análisis, se abordó la fundamentación teórica del Proceso de Atención de Enfermería y la importancia de su registro. Se realizó un análisis descriptivo con frecuencias absolutas y relativas, y para el análisis de la efectividad se calcularon diferencias porcentuales.Resultados: la cumplimentación de la historia clínica al ingreso aumentó de un 66,9% a un 74,5% tras la intervención. En la valoración por patrones aumentó de un 64,9% a un 75,7%, aunque los patrones 6 (Cognitivo/perceptivo) y 11 (Valores/creencias) disminuyeron su grado de cumplimentación. Lo mismo sucedió con los ítems de antecedentes personales y el apartado de observaciones. Sin embargo, aumentó el grado de cumplimentación de la firma del informe de un 96,7% a un 98,3% y la asignación de la trayectoria de cuidados de un 95,0% a un 100%, siendo el único que aumentó a cumplimentación total.Conclusiones: la intervención fue efectiva de forma global aumentando el grado de cumplimentación de la historia clínica al ingreso, aunque no en todos los ítems ni patrones.(AU)

Objective: to assess the efficacy of an intervention on compliance with the nursing assessment interview at admission.Method: an analytical, quasi-experimental, pre-post study on a single arm at the Hospital del Mar of Barcelona. The primary variable of interest was the level of compliance, collected according to the Functional Health Patterns Model by Marjory Gordon. There was an analysis of 60 clinical records before the intervention, and 60 after the intervention. The intervention consisted in a training session, where the results of the first analysis were shared, and the theoretical basis of the Nursing Care Process was addressed, as well as the importance of its compliance. A descriptive analysis was conducted with absolute and relative frequencies, and percentage differences were calculated for the analysis of efficacy.Results: the completion of clinical record at admission increased from 66.9% to 74.5% after the intervention. In the assessment by patterns, there was an increase from 64.9% to 75,7%, though patterns 6 (Cognitive/perceptive) and 11 (Values/beliefs) reduced their level of compliance. The same occurred with the items for personal background and the Observations section. However, there was an increase in the level of compliance with signing the report, from 96.7% to 98.3%, and in the care path assignment, from 95.0% to 100%, which was the only one which increased up to total compliance.Conclusions: the intervention was effective in an overall way, increasing the level of compliance with clinical record at admission, although not in all items or patterns.(AU)

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.

Breast uptake on a myocardial perfusion scan.

A 42-year-old female underwent a myocardial perfusion scan (MPS) for the evaluation of coronary artery disease. Raw and cine loop images hinted at abnormal tracer accumulation in the chest. Review of short-axis slices and low-dose computed tomography images taken for attenuation correction and their subsequent fusion confirmed the presence of focal tracer uptake localized to nodular breast masses. This case demonstrates that despite MPS not being optimized to detect breast pathologies, careful inspection of unprocessed images and the application of available software for fusion can help detect concurrent pathology.

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.

Emotional Comprehension Is Not Related to Duration of Distress from Daily Life Events.

The main aim of this paper is to analyze to what extent insight (i.e., mentalization referring to one's own mental state) moderates recovering from daily life events. A total of 110 participants (84.5% women; mean age: M = 21.5; SD = 3.2) filled in the Trait Meta-Mood Scale (TMMS-24) and the Eysenck Personality Questionnaire (EPQ-R), and were interviewed about impairment derived from daily life events (everyday life stresses) during the past year. Multivariate regression models were adjusted for neuroticism, sex, and socioeconomic status to analyze whether different degrees of insight moderated the relationship between the intensity and the duration of emotional distress. Results showed that the global measure of insight did not moderate recovering from daily-life distress. Regarding the subdimensions, attention to emotional reactions was related to an increased duration of distress. Results showed that, against our hypothesis, deeper comprehension of emotional reactions, operationalized here as "true insight", was not associated to faster recovery. Limitations and recommendations for further studies are discussed considering these results.

Animals in multidimensional space: Interpreting coordinates throughout lexical-semantic features in mild cognitive impairment and control subjects.

INTRODUCTION: Semantic verbal fluency is a useful neuropsychological tool since it involves language and executive abilities that can be impaired in patients with neurodegenerative diseases in comparison to healthy controls. The present study explores retrieve and executive control processes using traditional quantitative and qualitative raw scores and examines the utility of multidimensional scaling combined with linear regression to provide new insights about the underlying semantic network in mild cognitive impairment and in healthy older adults. METHOD: A total of 165 Spanish older adults, 81 patients and 84 controls, were assessed in different cognitive domains and evoked animal names in one minute. Group differences on fluency raw scores were first explored. Regressions using tests to predict groups' fluency scores were also performed. The 12 animals that had been produced more frequently were selected to perform a multidimensional scaling analysis for each group. Four features related to animal names were extracted from normative studies and then were used as predictors in linear regression to provide an interpretation of the resulting dimensions' coordinates. RESULTS: Patients performed worse on memory and naming and produced a shorter list of animals than controls. In controls, naming and visual memory explained a small part of variance related to the total of animals produced and to the number of switches. Both groups exhibited similar semantic maps. CONCLUSIONS: Results suggest that patients' map is influenced by words with a dense associative neighborhood that were acquired at an early age, whereas in controls none of the predictors explained dimensions.

Vitamin D analogues exhibit antineoplastic activity in breast cancer patient-derived xenograft cells.

Despite advances in breast cancer (BC) treatment, its mortality remains high due to intrinsic or acquired resistance to therapy. Several ongoing efforts are being made to develop novel drugs to treat this pathology with the aim to overcome resistance, prolong patient survival and improve their quality of life. We have previously shown that the non-hypercalcemic vitamin D analogues EM1 and UVB1 display antitumor effects in preclinical studies employing conventional cell lines and animal models developed from these cells. In this work, we explored the antitumor effects of EM1 and UVB1 employing BC cells derived from patient-derived xenografts (PDXs), which are a powerful preclinical tool for testing new drugs. We demonstrated that the analogues reduced the viability of HER2-positive and Triple Negative BC-PDXs. Moreover, using an in vitro model of acquired resistance to Trastuzumab-emtansine, UVB1 displayed anti-proliferative actions under 2D and 3D culture conditions. It inhibited both formation and growth of established organoids. In addition, a direct correlation between UVB1 antitumor effects and VDR expression in PDXs was found. In conclusion, all the results reinforce the potential use of these vitamin D analogues as antitumor agents to treat HER2-positive and Triple Negative BC.

Analysis of experience of the use of plastic cannulas in Spanish haemodialysis units.

INTRODUCTION: Plastic cannulas (PC) have shown efficacy in haemodialysis (HD) and are presented as a positive innovation for patients and vascular access survival. OBJECTIVE: To analyse Spanish HD nurses' experience of using PC. DESIGN: Cross-sectional observational study. METHODS: An ad hoc questionnaire was administered on nurses' experience of PC use. RESULTS: A total of 163 Spanish HD nurses were surveyed, of whom 42.3% had PC in their workplace and 50.9% had used them. In all, 55.8% had received training and 77.9% wished to receive more training. These needles were significantly more available in public institutions than in private centres (p < 0.001). There was no significant difference between years of experience and having received training (p = 0.915). There was a moderate-strong correlation (ρ = 0.659) between greater professional satisfaction with the product and greater patient satisfaction (p < 0.001). The nurses would make a median of two [P25 , 1; P75 , 3] modifications in the product design. The characteristics of the PC were rated positively by 55.8% and negatively by 10.3%. CONCLUSIONS: A substantial proportion of the nurses surveyed did not use PC and had not received training in their use. Respondents reported that PC could be improved and a small percentage perceived them negatively. IMPLICATIONS FOR PRACTICE: Based on the evidence presented and available, if we manage to integrate this knowledge and work on the continuum of achieving excellence, we will continue to grow as a profession and provide higher quality care.