Changes in the quality of life of adults with an ostomy during the first year after surgery as part of the Best Practice Spotlight Organisation® Programme.

The aim was to analyse changes in the perceived quality of life of patients with an ostomy during the first year after surgery at two or three follow-ups. This is a prospective study of a cohort of 55 patients who were ostomised between June 2021 and September 2022 and cared for under the recommendations set out in the Registered Nurses' Association of Ontario® best practice guideline Supporting Adults Who Anticipate or Live with an Ostomy as part of the Best Practice Spotlight Organisation® (BPSO®) programme. The Stoma Quality of Life tool was used. A univariate analysis was performed to identify variables associated with a non-improvement in quality of life. Variables showing p < 0.1 were included in a multivariate model. Patients with an ostomy exhibited a moderate-to-good perception of quality of life in both the personal and social dimensions, with no worsening over the first year. Being female (OR = 10.32) and being younger (OR = 0.89) were associated with a higher risk of no improvement in quality of life. The most frequent complications were urinary leakage (p = 0.027) and dermatitis (p = 0.052) at first follow-up; and parastomal hernia (p = 0.009) and prolapse (p = 0.05) at third follow-up. However, they did not lead to a worsening of quality of life, suggesting that these patients were adequately supported under the BPSO® programme.

Clinical-epidemiological characteristics and maternal-foetal outcomes in pregnant women hospitalised with COVID-19 in Venezuela: a retrospective study.

BACKGROUND: In low- and middle-income countries, pregnant women and newborns are more vulnerable to adverse outcomes from coronavirus disease 2019 (COVID-19). However, in Venezuela, there are no integrated data in a national surveillance system to identify the clinical-epidemiological characteristics and maternal-foetal outcomes of pregnant women hospitalised with COVID-19. METHODS: A retrospective study was conducted among Venezuelan pregnant women hospitalised with COVID-19 seen at the "Ruiz y Páez" University Hospital Complex and the San Cristobal Central Hospital between June 2020 and September 2021. Information was obtained from physical and digitised clinical records using a purpose-designed proforma to collect epidemiological, clinical, paraclinical, treatment, obstetric and perinatal complications, and maternal-foetal outcomes data. RESULTS: A total of 80 pregnant women with confirmed severe acute respiratory syndrome coronavirus 2 infection were seen within the study period, 59 (73.8%) survived and 21 (26.2%) died. The median (interquartile range) age was 29 (23-33) years, the majority being in the third trimester of pregnancy (81.2%; n = 65). Interestingly, four (5%) pregnant women were co-infected with malaria by Plasmodium vivax and three (3.8%) with syphilis. The most frequent symptoms were fever (75%; n = 60), dry cough (68.8%; n = 55), dyspnoea (55%; n = 44), and headache (53.8%; n = 43). The most frequent maternal complications were anaemia (51.5%; n = 66) and hypertensive disorders of pregnancy (17.5%; n = 14). The most frequent perinatal complications were preterm delivery (39.2%; n = 20/51) and oligohydramnios (31.3%; n = 25). A total of 29 (36.3%) adverse foetal outcomes were documented, 21 stillbirth and eight abortions. CONCLUSION: This is the first study to describe the clinical-epidemiological behaviour of COVID-19 in hospitalised Venezuelan pregnant women. Anaemia, hypertensive disorders of pregnancy, oligohydramnios, and low birth weight were the most frequent maternal-foetal complications in this population of pregnant women.

Auditing completion of nursing records as an outcome indicator for identifying patients at risk of developing pressure ulcers, falling, and social vulnerability: An observational study.

AIM: To evaluate the completion of nursing records through scheduled audits to analyse risk outcome indicators. BACKGROUND: Nursing records support clinical decision-making and encourage continuity of care, hence the importance of auditing their completion in order to take corrective action where necessary. METHOD: This was an observational descriptive study carried out from February to November 2020 with a sample of 1131 electronic health records belonging to patients admitted to COVID-19 hospital units during three observation periods: pre-pandemic, first wave, and second wave. RESULTS: A significant reduction in nursing record completion rates was observed between pre-pandemic period and first and second waves: Braden scale 40.97%, 28.02%, and 30.99%; Downton scale: 43.74%, 22.34%, and 33.91%; Gijón scale: 40.12%, 26.23%, and 33.64% (p < 0.001). There was an increase in the number of records completed between the first and second waves following the measures adopted after the quality audit. CONCLUSIONS: The use of scheduled audits of nursing records as quality indicators facilitated the detection of areas for improvement, allowing timely corrective actions. IMPLICATIONS FOR NURSING MANAGEMENT: Support from nursing managers at health care facilities to implement quality assessment programmes encompassing audits of clinical record completion will encourage the adoption of measures for corrective action.

Factors Relating to Nurses' Knowledge and Attitudes Regarding Pain Management in Inpatients.

PURPOSE: To describe factors associated with nurses' attitudes or lack of knowledge regarding pain management in adult inpatients. DESIGN: Transverse descriptive survey-based study. METHODS: This was a transverse descriptive survey-based study. The population was obtained through nonprobabilistic convenience sampling. The Knowledge and Attitudes Survey Regarding Pain was made available to 470 nurses at a tertiary level hospital. Associations were sought with the unit where assigned, years of experience, specific training on pain, and postgraduate education. RESULTS: The sample included 134 nurses with a mean age of 41.6 ± 10.8 years; 87% were women, 64% worked rotating shifts, 64% had more than 10 years of experience, and 31% had specific training in pain management. The greatest number of correct responses was obtained from nurses with specific training in pain management (p = .001) and nurses who worked in units of surgical hospitalization (p = .004). The lack of training was associated with a deficit in knowledge and inadequate attitudes about pain management. In nurses with less than 10 years of experience, worse results were observed in knowledge, whereas the unit of work was decisive in the results about attitude (p < .05). CONCLUSIONS: Among the nurses surveyed, some knowledge gaps were detected, as were certain inappropriate attitudes, associated with lack of training, lack of experience, and being assigned to specific hospitalization units.

Fast, Simple, and Cheap: the Kudoh-Ogawa Swab Method as an Alternative to the Petroff-Lowenstein-Jensen Method for Culturing of Mycobacterium tuberculosis.

The objective of this study was to compare the diagnostic yield of the Kudoh-Ogawa (K-O) swab method for the culturing of Mycobacterium tuberculosis from clinical samples with the standard Petroff-Lowenstein-Jensen (P-LJ) procedure. A total of 2,287 sputum samples and 685 extrapulmonary clinical specimens were processed with both decontamination methods and compared for M. tuberculosis detection rate, recovery of M. tuberculosis colonies, and culture contamination. Overall, 23.9% and 23.5% of the samples, processed with, respectively, the K-O swab method and the P-LJ procedure, yielded M. tuberculosis after 8 weeks of incubation. The K-O swab method and the P-LJ procedure provided comparable diagnostic yields for extrapulmonary clinical specimens (P = 0.688), but the K-O method showed a slightly but statistically significantly higher diagnostic yield for pulmonary samples (P = 0.002). No significant difference for culture contamination or colony recovery was found for either method. The turnaround time for the isolation of M. tuberculosis was significantly shorter for the K-O swab method, with 77% of the M. tuberculosis cultures being positive within 3 weeks of incubation, and only 6.1% positivity for the P-LJ method. Concerning the workload, the K-O swab method needs a minimum sample manipulation and takes less than 4 min per sample, as the samples are not centrifuged in this procedure. The K-O swab method is an efficient and fast (in terms of sample processing and culture growth) alternative for culturing M. tuberculosis from either pulmonary or extrapulmonary clinical specimens. The method is particularly suitable for laboratories with a high workload and for laboratories lacking a special infrastructure.

[Anatomy of the vegetative organs of two species of Atriplex (Chenopodiaceae) from Venezuela]. / Anatomía de los órganos vegetativos de dos especies de Atriplex (Chenopodiaceae) de Venezuela.

In Venezuela, Atriplex is represented by A. cristata and A. oestophora, the latter being endemic; they inhabit coastal areas with high temperatures, high solar radiation and sandy soils with high salt content. This work aimed to provide information to facilitate and clarify these species taxonomic delimitation, throughout the study of the anatomy of their vegetative organs; this may also clarify our understanding of their adaptability to soil and climatic conditions prevailing in areas they inhabit. The plant material was collected from at least three individuals of each species in Punta Taima Taima and Capatárida, Falcon. Segments of roots, located near the neck and towards the apex, apical, middle and basal internodes of stems, were taken; and of leaves, located in the middle portion of plants. This material was fixed in FAA (formaldehyde, acetic acid, 70% ethanol) until processing. Semipermanent and permanent microscope slides were prepared with transverse or longitudinal sections, made using a razor (free-hand) or a rotation microtome, in this latter case, after paraffin embedding; besides, additional plates were mounted with portions of leaf epidermis, obtained by the maceration technique. The sections were stained with aqueous toluidine blue (1%) or safranin-fast-green, and mounted in water-glycerin or in Canada balsam. In order to calculate the vulnerability index, the vessel diameter in the vascular rings of roots, as well as their density, were quantified. Our results revealed structural features in the different organs, that resulted of taxonomic value and allowed the distinction of the species: in the leaf, the presence of aquifer tissue, the number of vascular bundles and their organization in the midrib, and the collenchyma differentiation in this part of the leaf; in the roots, the xylem and phloem arrangement in the growth rings, the nature of conjunctive tissue, and the presence of included phloem in one species. In addition, the species showed typical anatomical features of halophytes and xerophytes, such as: high density of trichomes on leaves and young stems which act as salt secreting glands, abundant sclerenchyma in stems and roots, water storage tissue and Kranz anatomy in leaves, narrow cortical region in young roots, presence of cambial variants in stems and roots, as well as short and narrow xylem vessels. Vulnerability index calculations indicated that both species tend to assure conduction but not the efficiency of the system. Atriplex species have anatomical characters which facilitate their adaptation to the special conditions prevailing in their habitats and that may be used for taxonomic delimitation.

Self-perceived competences in evidence-based practice of clinical-teaching nurses versus clinical nurses.

AIM: To compare the evidence-based practice (EBP) self-perceived competences of clinical teacher nurses (CTN) versus clinical nurses (CN) to detect areas for improvement in practical training. METHOD: A cross-sectional study by means of a self-assessment questionnaire sent to nurses of two public hospitals of Castilla y León was performed, between February to May 2020. Variables included competences in evidence based practice (EBP) - attitude, knowledge, skills and use-, sociodemographic, job, academic, teaching relations and training in investigation methodology and/or EBP. A validated questionnaire EBP-COQ prof© of 35 questions with answers type Likert (1, very disagree-5, very agree) was used. Data analysis (descriptive and bivariate) was performed by means SPSS v.24 program. RESULTS: 171 questionnaires were answered by nurses. CN 52%, CTN 48%. There were no significant differences between both groups regarding sociodemographic variables. Mean age was 43.6 ±â€¯9.9 and 42.9 ±â€¯8.5 for CN and CTN, respectively. Total sample showed a mean EBP competency score of 3.54 ±â€¯1.00 (attitudes: 4.40 ±â€¯0.60; knowledge: 3.08 ±â€¯0.94; skills: 3.57 ±â€¯0.66; utilization: 3.36 ±â€¯0.75). The CTN group obtained higher mean scores in knowledge dimension, compared with CN (P = .02) and with total sample (P = .02). There were no significant differences in other dimensions. CONCLUSION: CTN showed better self-perceived competences scores only in the knowledge dimension compared with CN. Taking in account the level of responsibility they support in their daily practice, it would be advisable to design management strategies in order to improve attitudes, skills and utilize EBP, acting as professional role models for students and peer mentors.

Nurses' evidence-based practice competence and hospital practice environment after specific training under the Best Practice Spotlight Organization® Programme. A cross sectional study.

BACKGROUND: Barriers to implementing training strategies for the improvement of evidence-based practice competence of nurses in hospital practice environments still persist. OBJECTIVE: The aim of the study was to evaluate the impact of a specific training within the framework of the Best Practice Spotlight Organization® programme, on nurses' evidence-based practice competence and the practice environment in two hospitals. DESIGN: This is a observational cross-sectional study assessing evidence-based practice competence and perceptions of Practice Environments. PARTICIPANTS: The study sample were 204 nurses working at medical and surgical inpatient units at two hospitals involved in the Best Practice Spotlight Organization® programme. METHODS: The study was conducted from February 2020 to May 2020. Three questionnaires were used to collect data: a sociodemographic/occupational questionnaire, a questionnaire exploring evidence-based practice skills, and a questionnaire exploring nurses' perceptions of their hospital practice environments. RESULTS: A total of 204 nurses participated. They were classified into two groups: those who had received specific training within the framework of the programme, called trained-champions (n = 66), and those who had not yet received training, control group (n = 138). The trained-champions exhibited better evidence-based practice competence values than the control group in all dimensions (p < 0.001), with a higher difference in means in the "Utilisation" dimension (-0.80; CI:-0.99,-0.60) and the "Knowledge" dimension (-0.63; CI:-0.88,-0.38). Trained-champions also had a more positive perception of the practice environments than the controls in all dimensions (p ≤ 0.001). The largest differences in means were in the "Participation" dimension (-0.48; CI:-0.66,-0.31) and in the "Leadership" dimension (-0.41; CI:-0.59,-0.23). CONCLUSIONS: Specific EBP training within the framework of the Best Practice Spotlight Organization® programme has succeeded in nurses (trained-champions) obtaining better EBP competence than others without this training. This could have contributed to increase nurses' abilities to integrate evidence into decision making in their clinical practice, while positively influencing them to perceive their PEs more favorably.

First wave of the COVID-19 pandemic in Madrid: handling the unexpected in a tertiary hospital.

Introduction: The COVID-19 pandemic was declared on March 11th, 2020. By the end of January, the first imported cases were detected in Spain and, by March, the number of cases was growing exponentially, causing the implementation of a national lockdown. Madrid has been one of the most affected regions in terms of both cases and deaths. The aim of this study is to describe the epidemic curve and the epidemiological features and outcomes of COVID-19 patients hospitalized in La Paz University Hospital, a tertiary hospital located in Madrid. Methods: We included confirmed and probable COVID-19 cases admitted to our centre from February 26th to June 1st, 2020. We studied trends in hospitalization and ICU admissions using joinpoint regression analysis. Results: A sample of 2970 patients was obtained. Median age was 70 years old (IQR 55-82) and 54.8% of them were male. ICU admission rate was 8.7% with a mortality rate of 45.7%. Global CFR was 21.8%. Median time from symptom onset to death was 14 days (IQR 9-22). Conclusions: We detected an admissions peak on March 21st followed by a descending trend, matching national and regional data. Age and sex distribution were comparable to further series nationally and in western countries.

The influence of preoperative anxiety on postoperative pain in patients undergoing cardiac surgery.

Patients undergoing cardiac surgery represent a challenge in terms of pain management due to multiple factors relating to the patients and to the procedure itself. Our aim was to identify the influence of levels of preoperative anxiety on postoperative pain in patients undergoing cardiac surgery and explore associations between preoperative anxiety, postoperative pain, analgesic requirements, and sex. We present a prospective cohort study of 116 patients undergoing cardiac surgery between January and April 2020. Preoperative anxiety was evaluated using the State-Trait Anxiety Inventory and the amount of morphine needed to keep pain intensity below 4 on the verbal numerical rating scale was recorded for 48 h post-surgery. Given the extracorporeal circulation time, type of surgery and body surface, it was observed that every percentile increase in preoperative state anxiety led to an extra 0.068 mg of morphine being administered. For each extra year of age, the amount of morphine needed decreased by 0.26 mg, no difference was observed between men and women in terms of preoperative anxiety or postoperative analgesics requirements. It may be concluded that in cardiac surgery, postoperative analgesic requirements increased with higher levels of preoperative state anxiety and decreased for every extra year of age.

Dissemination of multiple drug resistance genes by class 1 integrons in Klebsiella pneumoniae isolates from four countries: a comparative study.

A comparative genetic analysis of 42 clinical Klebsiella pneumoniae isolates, resistant to two or more antibiotics belonging to the broad-spectrum ß-lactam group, sourced from Sydney, Australia, and three South American countries is presented. The study focuses on the genetic contexts of class 1 integrons, mobilizable genetic elements best known for their role in the rapid evolution of antibiotic resistance among Gram-negative pathogens. It was found that the class 1 integrons in this cohort were located in a number of different genetic contexts with clear regional differences. In Sydney, IS26-associated Tn21-like transposons on IncL/M plasmids contribute greatly to the dispersal of integron-associated multiple-drug-resistant (MDR) loci. In contrast, in the South American countries, Tn1696-like transposons on an IncA/C plasmid(s) appeared to be disseminating a characteristic MDR region. A range of mobile genetic elements is clearly being recruited by clinically important mobile class 1 integrons, and these elements appear to be becoming more common with time. This in turn is driving the evolution of complex and laterally mobile MDR units and may further complicate antibiotic therapy.

[VIM-2 metallo-ß-lactamase gen detection in a class 1 integron associated to bla(CTX-M-2) in a Pseudomonas aeruginosa clinical isolate in Uruguay: first communication]. / Detección del gen codificante de la metalo-ß-lactamasa VIM-2 en un integrón de clase 1 asociado con el gen blaCTX-M-2 en un aislamiento clínico de Pseudomonas aeruginosa en el Uruguay: primera comunicación.

In order to analyze the presence of metallo-ß-lactamase in our country, we included in this study Pseudomonas aeruginosa isolates causing nosocomial infections in a hospital from Uruguay. The presence of a metallo-ß-lactamase VIM-2 in a class 1 integron and of an extended spectrum -lactamase CTX-M-2 was detected in one isolate. This is the first report of both genes, bla(CTX-M-2) and bla(VIM-2),in the same P. aeruginosa isolate. Although carbapenemases have been extensively documented in the world, this is the first report of an acquired metallo-ß-lactamase with carbapenemase activity in pathogenic bacteria in Uruguay.

The Impact of COVID-19 on Levels of Adherence to the Completion of Nursing Records for Inpatients in Isolation.

The COVID-19 pandemic has led to an increased workload for nurses and organisational and structural changes, which have been necessary to meet the needs of inpatients in isolation. AIM: To describe the impact of the COVID-19 pandemic on levels of adherence to the completion of nursing records that document the risk of developing pressure ulcers, falling, and social vulnerability among hospitalised patients in isolation. METHODS: Observational pre-post comparison study. Comparison between nursing records (the Braden, Downton, and Gijón scales) belonging to 1205 inpatients took place in two phases. Phase 1: 568 patients admitted in February 2020, prior to the COVID-19 pandemic, vs. phase 2: 637 patients hospitalised with COVID-19 in March-April 2020, during the peak of the first wave of the pandemic. This research adheres to the STROBE guidelines for the reporting of observational studies. RESULTS: The degree of completion of the Braden, Downton, and Gijón scales decreased significantly in phase 2 vs. phase 1 (p < 0.001). The mean Downton and Gijón scale scores for patients admitted in phase 1 were higher compared to those of patients admitted in phase 2 (p < 0.001). The mean Braden scale score in phase 2 was higher than in phase 1 (p < 0.05). CONCLUSION: During the COVID-19 pandemic, there was a decrease in the completion of nursing records in the clinical records of patients in isolation. The levels of risk of developing PUs, falling, and social vulnerability of patients admitted to hospital were lower during the first wave of the pandemic.

Development of critical thinking skills of undergraduate students throughout the 4 years of nursing degree at a public university in Spain: a descriptive study.

OBJECTIVE: To analyse the critical thinking skills of students enrolled in the four academic years of the nursing degree at a public university belonging to the European Higher Education Area. DESIGN: Cross-sectional, quantitative, descriptive study. Using the Critical Thinking Questionnaire to analyse the critical thinking skills in their substantive and dialogic dimension. SETTING: Faculty of Nursing, Valladolid Public University in Spain, belonging to the European Higher Education Area. PARTICIPANTS: The sample consisted of 215 first-year, second-year, third-year and fourth-year undergraduate nursing students. MAIN OUTCOMES: The students of the four academic years were positively disposed towards critical thinking. The students of the final courses obtained higher average scores. RESULTS: The study sample was 215 students, 19.1% men/80.9% women. The average score in the substantive dimension (3.81±0.53 points) was higher than that in the dialogic dimension (3.48±0.51 points) (p<0.001). They had a greater ability in listening and speaking (3.77±0.61 points) with respect to writing (3.65±0.61 points) and reading (3.52±0.43 points) (p<0.001). There are significant differences in the critical thinking average scores across academic years. CONCLUSIONS: Nursing students displayed a greater critical thinking ability in its substantive dimension compared with the dialogic one. This reflects a greater ability in actions related to provide reasons and evidence that support their point of view. Identifying critical thinking skills in nursing students will help establish specific teaching methodologies focused on improving these skills.

Analysis of Burnout Syndrome and Resilience in Nurses throughout the COVID-19 Pandemic: A Cross-Sectional Study.

BACKGROUND: The COVID-19 pandemic has contributed to the occurrence of work-related stress on nursing staff. Being resilience an essential element to countering adversity. The aim of the study was to assess burnout syndrome as well as resilience in hospital-care nurses during the first outbreak of the COVID-19 pandemic. METHODS: A cross-sectional descriptive study of burnout syndrome and resilience of 101 nurses during the first COVID-19 outbreak. The Maslach Burnout Inventory and the Scale of Resilience of Connor-Davidson were used. RESULTS: The burnout average score was 74.35 ± 12.78 points, and resilience was 27.94 ± 5.84. Temporary nurses reached a lower average score for the emotional fatigue dimension (23.80 ± 10.39 points) p < 0.05. The emotional fatigue dimension correlated adversely with the average score of resilience (r = -0.271; p < 0.001). CONCLUSIONS: The level of burnout in nurses was high, being higher on those who took care of COVID-19 patients. Resilient nurses were able to better cope with stressful situations.

Prevalence, pain management and registration in Internal Medicine units. / Prevalencia, manejo y registro del dolor en unidades de Medicina Interna.

OBJECTIVE: To analyze the prevalence and management of pain episodes, their evaluation and recording in internal medicine hospitalization units in a third level public hospital of the regional health service of Castilla y León. METHOD: A descriptive cross-sectional study. The study population comprised patients hospitalized in internal medicine units. Pain prevalence was detected by the Brief Pain Inventory questionnaire. The management of pain episodes was analyzed as recorded in the clinical records. RESULTS: 83 patients were included, 73.5% of them reported pain and 67.2% did not know their analgesia regimen. More episodes of pain were identified in the women (P=.006) than in the men. The pharmacological administration was recorded in all cases; however, nurses recorded the episode in the clinical history of 29.5% of the patients. In no case, was the pain intensity or degree of relief recorded using the visual analogical scale. CONCLUSIONS: There is evidence of a high prevalence of pain in hospitalized patients and deficiencies in the management of pain episodes by nurses, both in evaluation and recording. This implies the need for pain control protocols and the implementation of evidence-based best practice guidelines to provide nurses with the means and support for adequate pain management.

The impact of an educational intervention on nursing students' critical thinking skills: A quasi-experimental study.

AIM: In this study, we identified the impact of educational activities that focused on improving the competence and critical thinking skills of university nursing students. DESIGN: A prospective quasi-experimental study was conducted, and assessments were conducted before and after the educational intervention, which consisted of seminars, lectures, case studies, and problem-solving activities. METHODS: The Critical Thinking Questionnaire was used to collect data before and after the educational intervention between September 2017 and May 2018. The sample consisted of 112 first-year undergraduate students. To examine the data that were collected as a part of this quasi-experimental study, inferential statistics were used, and the results were tested against a significance level of P < 0.05. RESULTS: The students obtained higher scores on the substantive dimension than on the dialogic one, and women scored higher than men. The educational intervention led to an improvement in every critical thinking skill across both dimensions, except listening and speaking skills, whereby men demonstrated a greater change in average scores for critical thinking skills. CONCLUSIONS: The educational intervention improved the critical thinking skills of undergraduate students and had a greater impact on men than on women. This finding underscores the need for educational interventions that can enhance critical thinking skills. Developing these skills will improve future nurses' ability to make health care management decisions in a reflective, agile, and evidence-based manner.

Impact of Nursing Methodology Training Sessions on Completion of the Virginia Henderson Assessment Record.

The Virginia Henderson model, integrated in the computer application GACELA Care, helps to standardise the nursing assessment and establish precise and personalised nursing diagnoses. The aim was to determine the extent of completion of the initial patient assessment record after nurses following a training programme on nursing methodology. A quasi-experimental, retrospective, randomised, observational, single-group study was performed in two stages: pre-training and post-training. Voluntary training sessions were held for the nurses that work with GACELA Care. The completion of the initial patient assessment using the needs of Virginia Henderson and the Norton scale was evaluated before and after the training sessions. Completion of the needs of Virginia Henderson in the initial patient assessment increased from 94.2% to 100% (p = 0.014). Completion of "hygiene/skin" increased significantly from 83.3% to 95.8% (pre-training and post-training, respectively). The remaining needs did not show statistical significance. Recording of the Norton scale increased from 63.13% to 92.5% (p < 0.001). The training sessions on nursing methodology have improved the completion of records and inclusion of normal characteristics, defining characteristics and risk factors, and improving pressure ulcer risk assessment through the Norton scale.

Impact of educational games on academic outcomes of students in the Degree in Nursing.

OBJECTIVE: The aim of using the game-based tool Kahoot! was to evaluate and reinforce the contents taught in the subject of Management and Administration of Nursing, Ethics and Health Legislation Services included in the Degree in Nursing, during the 2016-2017 academic year. METHODS: A prospective quasi-experimental study was carried out on a sample of 116 students. 10 multiple-choice questions were designed, with only one possible correct answer and a 20-second-limited response time for each of the questions. Four of these questions previously answered in the classroom using this game were chosen (20% of the exam). Each one of them corresponded to one unit of the topics taught in the subject. In order to participate in the educational game, students needed their smartphones or electronic devices. After completing the game, the students' satisfaction level derived from its use was assessed. RESULTS: The correct answer rate in the educational game was greater than 50% for all questions except for one, in which the rate was 28.8% (P<0.05). Response time as related to score presented statistically significant differences, and higher scores for those questions with lower response time (P<0.001). The questions included in the final test which had been previously answered using Kahoot! showed a significantly higher difficulty index than the rest of the final exam questions (P<0.05). Question 3 was the easiest, while being the one in which the highest-scoring students obtained more wrong answers. For the students this tool was easy to use (89.6%) and they positively valued the content acquisition and comprehension, as well as the teacher-student interaction (P<0.05). CONCLUSION: The implementation of educational games which consider response time and correct answers favors competitiveness and motivates students to actively participate in their learning process.

Relationships of the woody Medicago species (section Dendrotelis) assessed by molecular cytogenetic analyses.

BACKGROUND AND AIMS: The organization of rDNA genes in the woody medic species from the agronomically important Medicago section Dendrotelis was analysed to gain insight into their taxonomic relationships, to assess the levels of infraspecific variation concerning ribosomal loci in a restricted and fragmented insular species (M. citrina) and to assess the nature of its polyploidy. METHODS: Fluorescence in situ hybridization (FISH) was used for physical mapping of 5S and 45S ribosomal DNA genes in the three species of section Dendrotelis (M. arborea, M. citrina, M. strasseri) and the related M. marina from section Medicago. Genomic in situ hybridization (GISH) was used to assess the genomic relationships of the polyploid M. citrina with the putatively related species from section Dendrotelis. KEY RESULTS: The diploid (2n = 16) M. marina has a single 45S and two 5S rDNA loci, a pattern usually detected in previous studies of Medicago diploid species. However, polyploid species from section Dendrotelis depart from expectations. The tetraploid species (2n = 32) M. arborea and M. strasseri have one 45S rDNA locus and two 5S rDNA loci, whereas in the hexaploid (2n = 48) M. citrina four 45S rDNA and five 5S rDNA loci have been detected. No single chromosome of M. citrina was uniformly labelled after using genomic probes from M. arborea and M. strasseri. Instead, cross-hybridization signals in M. citrina were restricted to terminal chromosome arms and NOR regions. CONCLUSIONS: FISH results support the close taxonomic interrelationship between M. arborea and M. strasseri. In these tetraploid species, NOR loci have experienced a diploidization event through physical loss of sequences, a cytogenetic feature so far not reported in other species of the genus. The high number of rDNA loci and GISH results support the specific status for the hexaploid M. citrina, and it is suggested that this species is not an autopolyploid derivative of M. arborea or M. strasseri. Further, molecular cytogenetic data do not suggest the hypothesis that M. arborea and M. strasseri were involved in the origin of M. citrina. FISH mapping can be used as an efficient tool to determine the genomic contribution of M. citrina in somatic hybrids with other medic species.