Breastfeeding knowledge in university nursing students. A multicentre study in Spain.

BACKGROUND: Exclusive breastfeeding is one of the main health and infant survival elements. To start and maintain breastfeeding, health professionals must receive culturally sensitive evidence-based breastfeeding training to offer future mothers the required information and support. While studying the nursing degree, acquiring the necessary knowledge and skills to successfully perform this work is essential. OBJECTIVE: Study the level of nursing students' breastfeeding knowledge at three Spanish public universities; explore which variables are related to acquire this knowledge. DESIGN: An observational, descriptive, cross-sectional multicentre study. METHODS: Participants were the students registered for the 4 nursing degree years at the three participating universities (N = 1540). They were asked about their breastfeeding knowledge with the self-administered AprendeLact Questionnaire; breastfeeding-related socio-demographic variables were included. RESULTS: The overall mean score of the 684 returned questionnaires was 4.659 (±2.377) out of 10. The year-4 students from the Castellón university obtained significantly higher mean scores and had been on practicals in maternity or neonatology units, belonged to breastfeeding associations and were artificially fed as infants. University belonged to, current academic year and placements in maternity or neonatology units were relevant factors for acquiring breastfeeding knowledge. CONCLUSIONS: Syllabi based on progressive transversal learning, and participating in real maternity-related health settings, could be facilitating strategies to acquire a suitable level of breastfeeding knowledge.

Nursing student's knowledge about breastfeeding: Design and validation of the AprendeLact questionnaire.

BACKGROUND: Breastfeeding is the best source of food that a mother can offer her child during the first months of life because it provides numerous benefits for both mother and baby. Despite breastfeeding being an innate act, it requires qualified health professionals for advice and support. OBJECTIVES AND PARTICIPANTS: To design and validate a questionnaire to evaluate nursing student breastfeeding knowledge. METHODS AND DESIGN: Cross-sectional study. Construction and validation of the questionnaire (content validity, test-retest reliability and internal consistency). Descriptive and bivariate analyses of socio-demographic variables and the questionnaire results. RESULTS: Optimum results were obtained in terms of internal consistency (KR-20 = 0.9) and test-retest reliability (ICC = 0.925) with a samples of 144 participants (mean age of 22.69 years). Statistical significance were observed among the questionnaire score and academic year, clinical practice, type of breastfeeding in childhood, knowing about support groups and participating in a breastfeeding workshop or course. CONCLUSION: A questionnaire on breastfeeding knowledge was validated. Nursing students progressively acquire breastfeeding skills as they advance in their undergraduate studies.

Burnout syndrome in nursing students: An observational study.

BACKGROUND: Academic burnout appears attributable to work and academic overload and may negatively affect learning and care quality during clinical clerkship. OBJECTIVES: To evaluate the presence of burnout syndrome in nursing students and to detect the main stressors that occur during clinical clerkship. DESIGN: Observational, descriptive and cross-sectional study carried out between January and July 2017. SETTINGS AND PARTICIPANTS: Second-, third- and fourth-year nursing students at Jaume I University (Universitat Jaume I) (Spain) (n = 126). METHODS: The KEZKAK questionnaire and the Maslach Burnout Inventory Student Survey were used when carrying out the data collection; sociodemographic and clinical clerkship variables were also collected. Descriptive and bivariate analyses of these instruments' variables were performed. RESULTS: No student manifested high levels of depersonalisation or low personal accomplishment. Moreover, depersonalisation was found to increase as the academic year progressed (p = 0.027). The most stressful factors were Helplessness and Uncertainty (m = 3.61, sd = 0.345) and Confusion of Medication (m = 2.50, sd = 0.754). The female subsample showed higher stress levels due to multiple factors, such as Lack of Competence (p = 0.001) and Having to Give Bad News (p = 0.01). CONCLUSION: This study found that its sample did not meet the criteria indicating the presence of burnout syndrome. In addition, the main stressors affecting nursing students during clinical clerkship were identified.

Estado nutricional en las personas con insuficiencia cardíaca crónica y/o enfermedad pulmonar obstructiva crónica. Impacto en la calidad de vida y en las exacerbaciones / Nutritional status in people with chronic heart failure and / or chronic obstructive pulmonary disease. Impact on quality of life and exacerbations

Objetivo: Conocer el estado nutricional de los pacientes con Insuficiencia cardiaca (IC) y/o Enfermedad pulmonar obstructiva crónica (EPOC) atendidos en un centro de atención primaria de la ciudad de Barcelona y describir las características clínicas y sociodemográficas que puedan tener relación con el estado nutricional.Método: Estudio descriptivo transversal, durante los meses del 2014. En las visitas realizadas por enfermería, se recogieron las siguientes variables: en el caso de la IC grado de funcionalidad mediante la escala NYHA, en el caso de la EPOC, Grado de disnea mediante la escala BMRC. En ambos se determina el IMC, se administra la escala MNA, se valora el nivel de actividad física y la calidad de vida a través de la escala EQ-5D.Resultado: De los 192 participantes, el 59,4% eran Hombres y la media de edad de 77,64 años(ds10,12). De las enfermedades estudiadas el 40,1% eran IC, el 45,8% EPOC y ambas enfermedades el 14,1%. El riesgo de malnutrición fue del 11,4% de las personas con EPOC, el 16,9% de las personas con IC y el 33,3% de las personas con ambas patologías.(P 0,028)Al hacer la regresión logística con el resto de variables, el único factor asociado es el sexo, obteniendo los Hombres un OR 3 (1,008-8,95).Conclusiones El estado nutricional empeora cuando se padecen las dos patologías de manera concomitante.En la malnutrición o en el riesgo de padecerla, el sexo juega un papel muy importante

Targets: To know the nutritional status in patients with heart failure (HF) and with chronic obstructive pulmonary disease (COPD), cared in a Barcelona's primary health center and to describe the clinical and socio-demographic characteristics which may be related with the nutritional status.Method: A transversal descriptive study was performed during de year 2014. In nursing visits the following variables were collected: in HF patients, levels of functionality based in NYHA scale, in COPD patients, dyspnea grade based in BMRC scale. In both cases the body mass index (BMI) was determined; MNA scale is used, and also the physical activity and quality of life is evaluated by the EQ-5D scale.Results: Of the 192 participants, 59, 4% were men and had a mean age of 77, 64 years (ds10, 12. Of the studied diseases, 40, 1% were HF, 45, 8% COPD and 14, 1% both diseases). The risk of malnutrition was 11, 4% in COPD patients, 16, and 9% in people with HF and 33, 3% in both HF and COPD patients. (P 0,028)With the logistic regression with the other variables, the only associated factor was gender, having men an OR 3 (1,008-8, 95)Conclusions: The nutritional status gets worse in people with both pathologies in concomitantly way. Gender plays a crucial role in malnutrition or risk of the disease

Implantación electiva de stent recubierto en la coartación y recoartación en el joven y en el adulto / Elective implantation of covered stents for coarctation and recoarctation in adolescents and adults

Introducción y objetivos. El stent es un tratamiento eficaz en la coartación y la recoartación. Sin embargo, en jóvenes y adultos pueden ocurrir rotura de pared y disección de aorta y, en el seguimiento, aneurismas. Con el fin de reducir estas complicaciones, implantamos el stent recubierto mayoritariamente de manera electiva. Métodos. Desde 2005 realizamos el procedimiento en 17 pacientes (2 adolescentes y 15 adultos) acceso femoral, 16 de manera electiva y en 1 como rescate. Seguimos técnica de Mullins con implantación de stent recubierto de NuMED®. Resultados. Buena aposición del stent en 17 casos, con acampanamiento distal en 8. Reducción del gradiente de 40±16 a 2±2mmHg (p<0,001) y aumento del diámetro de luz de 4±2 a 19±3mm (p<0,001). Se comentan dos casos excepcionales: uno con rotura que se trató de rescate con stent en el stent, y otro con obstrucción total y aneurisma intercostal que presentó una evolución fatal, pues murió a las 48 h del procedimiento (se muestra la necropsia). El seguimiento clínico fue de 4 años, con estudio con ecocardiograma Doppler, y en 13 de los pacientes con otra técnica de imagen, todos ellos con buena evolución. Conclusiones. El stent recubierto es un tratamiento eficaz en la coartación y la recoartación del joven y el adulto, de elección en los casos con anatomía compleja, y es necesario como dispositivo de rescate en los casos de stent no recubierto (AU)

Introduction and objectives. Stent implantation is an effective therapy for aortic coarctation and recoarctation. However, in adolescents and adults, aortic wall rupture and dissection can occur, as well as aneurysms during follow-up. In order to reduce these complications, we electively implant covered stents. Methods. Since 2005, we have performed the procedure using femoral access in 17 patients (2 adolescents and 15 adults), 16 electively and 1 as a rescue procedure. We used the Mullins technique in all cases, implanting a NuMED® covered stent. Results. Good stent apposition was achieved in all 17 procedures; 8 patients required a distal flare. Gradient was reduced from 40 (16) mmHg to 2 (2) mmHg (P<.001) and lumen diameter increased from 4 (2) mm to 19 (3) mm (P<.001). Two exceptional cases are discussed: one patient with aortic wall rupture who underwent a rescue procedure using a stent within a covered stent and another patient with total obstruction and intercostal aneurysm in whom the outcome was fatal at 48 h postprocedure (autopsy is shown). Four-year clinical follow-up included Doppler echocardiography; an additional imaging technique was required in 13 patients. All patients recovered well and there were no complications. Conclusions. Covered stents are effective in treating coarctation and recoarctation in adolescents and adults, are the treatment of choice in patients with complex anatomy, and must be available in the operating room as a rescue device when implanting a conventional stent (AU)

Elective implantation of covered stents for coarctation and recoarctation in adolescents and adults.

INTRODUCTION AND OBJECTIVES: Stent implantation is an effective therapy for aortic coarctation and recoarctation. However, in adolescents and adults, aortic wall rupture and dissection can occur, as well as aneurysms during follow-up. In order to reduce these complications, we electively implant covered stents. METHODS: Since 2005, we have performed the procedure using femoral access in 17 patients (2 adolescents and 15 adults), 16 electively and 1 as a rescue procedure. We used the Mullins technique in all cases, implanting a NuMED(®) covered stent. RESULTS: Good stent apposition was achieved in all 17 procedures; 8 patients required a distal flare. Gradient was reduced from 40 (16) mmHg to 2 (2) mmHg (P<.001) and lumen diameter increased from 4 (2) mm to 19 (3) mm (P<.001). Two exceptional cases are discussed: one patient with aortic wall rupture who underwent a rescue procedure using a stent within a covered stent and another patient with total obstruction and intercostal aneurysm in whom the outcome was fatal at 48 h postprocedure (autopsy is shown). Four-year clinical follow-up included Doppler echocardiography; an additional imaging technique was required in 13 patients. All patients recovered well and there were no complications. CONCLUSIONS: Covered stents are effective in treating coarctation and recoarctation in adolescents and adults, are the treatment of choice in patients with complex anatomy, and must be available in the operating room as a rescue device when implanting a conventional stent.

Embolia pulmonar múltiple tras vertebroplastia con polimetilmetacrilato, con evolución fatal a pesar de la extracción percutánea de un microfragmento / Multiple fatal pulmonary embolism during polymethyl-methacrylate vertebroplasty with successful percutaneous retrieval of a large cement fragment

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[Pulmonary atresia with intact ventricular septum. Perforation and pulmonary valvuloplasty using a modified mechanical technique. Medium-term follow-up]. / Atresia pulmonar con septo íntegro. Perforación y valvuloplastia pulmonar mediante técnica mecánica modificada. Seguimiento a medio plazo.

INTRODUCTION AND OBJECTIVES: In patients with pulmonary atresia with intact ventricular septum (PAIVS), radiofrequency-assisted perforation of the valve is the most widely used initial therapy when the anatomy is favorable. We report our experience with a modified mechanical technique that gave good results. METHODS: Between November 2001 and October 2006, valve opening was carried out successfully in 11 consecutive neonates with a favorable anatomy (i.e., Alwi groups A and B, and tricuspid valve Z-score -1.1 [1.3]). The technique involved snare-assisted anterograde or retrograde perforation with the soft tip of a special guidewire used for chronic total coronary artery occlusions, use of an arteriovenous loop, and progressive balloon dilatation from a diameter of 2 mm to a maximum diameter of 9.6 [1.2] mm. RESULTS: Valve opening was achieved in all patients, and right ventricular (RV) systolic pressure fell from 97 [17] mmHg to 48 [13] mmHg (P< .001). No pericardial effusion or cardiac tamponade was observed, though one neonate died 24 hours after the procedure due to pulmonary embolism. Six patients (54%) were discharged without any further intervention, while 4 (36%) required an additional increase in pulmonary blood flow. During the follow-up period of 25 [21] months, two patients died. Eight (72%) survived and were in New York Heart Association functional class 1. Two required additional surgery on the outflow tract, one of whom also needed a one-and-a-half ventricular repair. Data indicate that the valves remain open as RV structures grow, though without any change in the tricuspid valve Z-score. CONCLUSIONS: Pulmonary valvuloplasty using a mechanical technique proved effective in patients with PAIVS. Modification of the standard mechanical technique by using the soft tip of a special guidewire used for chronic total coronary artery occlusions was less aggressive and improved results. In patients with a favorable anatomy, results were comparable to those obtained using the radiofrequency technique.

Atresia pulmonar con septo íntegro. Perforación y valvuloplastia pulmonar mediante técnica mecánica modificada. Seguimiento a medio plazo / Pulmonary atresia with intact ventricular septum. Perforation and pulmonary valvuloplasty using a modified mechanical technique. Medium-term follow-up

Introducción y objetivos. En la atresia pulmonar con septo íntegro, si la anatomía es favorable, el tratamiento inicial más extendido es la apertura valvular mediante radiofrecuencia. Presentamos nuestra experiencia mediante una técnica mecánica modificada con buenos resultados. Métodos. Entre noviembre de 2001 y octubre de 2006 realizamos apertura valvular en 11 casos consecutivos con anatomía favorable (grupo A y B de Alwi e índice z tricúspide de ­1,1 ± 1,3), mediante perforación anterógrada guiada por lazo o retrógrada mediante guías especiales para la obstrucción crónica total coronaria por su parte blanda y circuito arteriovenoso y dilatación progresiva con balón monorraíl coronario desde 2 mm de diámetro hasta un máximo de 9,6 ± 1,2 mm. Resultados. Se realizó la apertura valvular en todos los casos con reducción de la presión sistólica del ventrículo derecho de 97 ± 17 a 48 ± 13 mmHg (p < 0,001). No se observaron derrame ni taponamiento en ningún caso, y un neonato falleció a las 24 h por un tromboembolismo pulmonar. Seis casos (54%) fueron dados de alta sin otro procedimiento, y 4 (36%) precisaron un flujo pulmonar adicional. El seguimiento fue de 25 ± 21 meses. Dos pacientes fallecieron, mientras que 8 (72%) sobrevivieron y se encontraban en situación funcional I. Dos precisaron cirugía adicional del tracto de salida y en uno de ellos, además, del ventrículo y medio. Persisten datos de desobstrucción valvular con crecimiento de estructuras en el ventrículo derecho, aunque sin cambios en el índice z valvular. Conclusiones. La valvuloplastia pulmonar con técnica mecánica sigue siendo válida en la atresia pulmonar con septo íntegro. La modificación de la técnica mecánica clásica mediante guías especiales para la obstrucción crónica total coronaria por su parte blanda es menos agresiva y mejora sus resultados. En esta serie con anatomía favorable los resultados son superponibles a los obtenidos mediante radiofrecuencia (AU)

Introduction and objectives. In patients with pulmonary atresia with intact ventricular septum (PAIVS), radiofrequency-assisted perforation of the valve is the most widely used initial therapy when the anatomy is favorable. We report our experience with a modified mechanical technique that gave good results. Methods. Between November 2001 and October 2006, valve opening was carried out successfully in 11 consecutive neonates with a favorable anatomy (i.e., Alwi groups A and B, and tricuspid valve Z-score ­1.1 [1.3]). The technique involved snare-assisted anterograde or retrograde perforation with the soft tip of a special guidewire used for chronic total coronary artery occlusions, use of an arteriovenous loop, and progressive balloon dilatation from a diameter of 2 mm to a maximum diameter of 9.6 [1.2] mm. Results. Valve opening was achieved in all patients, and right ventricular (RV) systolic pressure fell from 97 [17] mmHg to 48 [13] mmHg (P<.001). No pericardial effusion or cardiac tamponade was observed, though one neonate died 24 hours after the procedure due to pulmonary embolism. Six patients (54%) were discharged without any further intervention, while 4 (36%) required an additional increase in pulmonary blood flow. During the follow-up period of 25 [21] months, two patients died. Eight (72%) survived and were in New York Heart Association functional class 1. Two required additional surgery on the outflow tract, one of whom also needed a one-and-a-half ventricular repair. Data indicate that the valves remain open as RV structures grow, though without any change in the tricuspid valve Z-score. Conclusions. Pulmonary valvuloplasty using a mechanical technique proved effective in patients with PAIVS. Modification of the standard mechanical technique by using the soft tip of a special guidewire used for chronic total coronary artery occlusions was less aggressive and improved results. In patients with a favorable anatomy, results were comparable to those obtained using the radiofrequency technique (AU)

Stent-graft deployment for aortic rupture after stenting for aortic recoarctation.

We present the case of a 62-year-old woman who presented with recoarctation and then experienced rupture of the aorta and severe clinical deterioration after a stent was deployed. She was treated immediately by intrastent deployment of a stent-graft, which resolved the extremely serious situation.

[Guided transcatheter valvulotomy in pulmonary atresia with intact ventricular septum]. / Valvulotomía mecánica percutánea dirigida en la atresia pulmonar con septo íntegro.

Transcatheter valvulotomy in pulmonary atresia with an intact ventricular septum can be used as a first step to create biventricular circulation and to stimulate further development of the hypoplastic right ventricle. We describe our experience in a case of a neonate with this congenital cardiac defect who underwent successful transcatheter perforation of the atretic pulmonary valve. This report highlights the utility of a special technique based on the use of a gooseneck snare positioned just above the atretic valve to guide the advance of a coronary guidewire. Other therapeutic alternatives are considered.

Valvulotomía mecánica percutánea dirigida en la atresia pulmonar con septo íntegro / Guided transcatheter valvulotomy in pulmonary atresia with intact ventricular septum

La valvulotomía percutánea con catéter en la atresia pulmonar con septo íntegro puede ser el primer paso para establecer una circulación en serie con el posterior desarrollo del ventrículo derecho. Presentamos nuestra experiencia en un neonato con esta cardiopatía, al que realizamos una apertura mecánica, haciendo especial referencia a la técnica empleada con guía especial para desobstrucción coronaria y dirigida con catéter-lazo abierto sobre la válvula pulmonar atrésica. Se exponen otras técnicas alternativas y se discute la evolución de esta paciente en función de su desarrollo anatómico (AU)

Resección de lesiones traqueobronquiales con broncoscopia láser Nd: YAG / Resection of tracheobronchial lesions with bronchoscopic laser Nd: YAG a preliminary study

Existen numerosas causas mecánicas de obstrucción de la vía aérea; pueden ser benignas o malignas y, dependiendo del grado de obstrucción consecutivo a su crecimiento, pueden comprometer de manera grave la función ventilatoria, motivo por el que el diagnóstico y el tratamiento oportuno pueden prevenir, mejorar e incluso curar esta alteración al eliminar el proceso obstructivo de las vías aéreas superiores o inferiores. Este trabajo se refiere a procesos obstructivos laringotraqueobronquiales. Las lesiones benignas son postraumáticas, infecciosas y algunas neogormaciones de origen indeterminado. Las lesiones malignas pueden ser primarias o secundarias (metastásicas). El láser permite la conversión de energía lumínica en calor, que vaporiza o coagula los tejidos dependiendo de la potencia aplicada y la duración del tratamiento. El láser Nd:YAG es el que más frecuentemente se usa para endoscopia, ya que puede penetrar tejidos anormales, causando su coagulación al aplicarse por medio de un sistema de transmisión de cuarzo a través del endoscopio rígido o de fibra óptica. La resección con broncoscopia láser Nd:YAG ofrece una alternativa útil en el tratamiento paliativo, curativo o adyuvante de algunas lesiones que producen obstrucción de la vía aérea. Se evaluaron en forma consecutiva los resultados de los primeros 61 procedimientos de resección con broncoscopia láser Nd:YAG del departamento de endoscopia torácica de la Unidad de Neumología del Hospital General de México desde abril de 1995 hasta marzo de 1997. Se incluyó a 56 pacientes a quienes se practicó resección con broncoscopia láser ND:YAG, 34 resecciones de lesiones benignas y 27 de lesiones malignas. Los resultados inmediatos se consideraron como satisfactorios en 95 por ciento y no satisfactorios en 5 por ciento de los casos, Se evaluaron todos los pacientes con broncoscopia el mes, a los tres meses y a los seis meses, condiserándolos como satisfactorios en 90 por ciento e insatisfactorios en 10 por ciento de los casos