Pain and Satisfaction Perceptions of Ultrasound-Guided Versus Conventional Peripheral Intravenous Catheterization: A Randomized Controlled Trial.

BACKGROUND: While many emergency department (ED) patients need peripheral vascular catheterization, diagnosis and treatment are often delayed by difficult intravenous access (DIVA). AIMS: This study of ED patients with DIVA was designed to evaluate ultrasound (US)-guided peripheral intravenous (IV) catheterization, compare it with conventional catheterization, and analyse patient pain and satisfaction regarding catheterization. DESIGN: Randomized controlled clinical trial. METHODS: Adult patients treated in the ED who scored >3 on the Adult-Difficult Venous Catheterization scale were randomly assigned to either US-guided or conventional peripheral IV catheterization. Data were collected from April to December 2016. Study variables were catheter insertion success, number of catheterization attempts, time required to perform the procedure, catheter length and calibre, puncture site, complications, and catheter functioning. Pain and patient satisfaction were also analysed for each group and the full sample. RESULTS: 120 and 138 patients were recruited for the US-guided and conventional peripheral IV catheterization groups, respectively. For the US-guided compared to the conventional procedure, insertion success was greater (91.75% versus 89.9%; p=0.04), the mean (SD) number of attempts was lower (1.29 (0.59) versus 1.81 (1.28); p<0.001), mean (SD) satisfaction was greater (7.59 (2.04) versus 6.69 (2.28); p=0.03), and the mean (SD) required time in minutes was greater (7.89 (7.13) versus 5.1 (3.69); p=0.045). Mean (SD) pain was moderate in both groups (4.6 (2.75) versus 4.33 (2.91) (p=0.32). Logistic regression for the full sample indicated that more attempts and greater pain were both associated with reduced satisfaction, while use of higher-calibre catheters was associated with greater satisfaction. CONCLUSION: US-guided compared to conventional peripheral IV catheterization in patients with DIVA was more successful, required fewer attempts, enabled use of longer and higher-calibre catheters, and led to greater patient satisfaction. Patients who underwent US-guided intravenous catheterization reported moderate pain, similar to that reported for the conventional procedure. CLINICAL IMPLICATIONS: US-guided peripheral intravenous catheterization improves ED patient care, as it requires fewer catheterization attempts. It is especially recommended for patients with DIVA.

Development, Diagnostic Sensitivity, and Prognostic Accuracy of the Adult-Difficult Venous Catheterization Scale for Emergency Departments.

INTRODUCTION: Difficulty in accessing peripheral veins in emergency departments increases patients' discomfort and impedes their diagnosis. The objective of this study was to develop and test the prognostic accuracy of an easily applied scale to measure difficult venous access to peripheral veins in emergency departments, called the Adult-Difficult Venous Catheterization scale. METHODS: This prospective observational study was conducted in adults from the hospital catchment area attending the emergency department. Using the Delphi technique, 5 experts reached a consensus regarding a 3-item scale scored from 0 to 5. Concurrent validity and predictive validity were analyzed using a numeric rating scale and the number of access attempts, respectively. Internal consistency and interobserver reliability for 3 independent observers were analyzed using Cronbach alpha and Cohen kappa, respectively. RESULTS: In 392 participants, the concurrent and predictive validity scores pointed to positive relationships with the numeric rating scale (r = 0.82; P < 0.001) and the number of access attempts (r = 0.5; P < 0.001), respectively. The odds ratio for 1 to 2 access attempts versus more than 2 access attempts in relation to the Adult-Difficult Venous Catheterization scale score was 2.76 (95% confidence interval 1.86, 4.08; P < 0.001). Sensitivity and specificity values for the Adult-Difficult Venous Catheterization scale were good, at 93.75% and 78.99%, respectively, as were internal consistency (Cronbach alpha 0.81) and interobserver reliability (Cohen kappa 0.75). DISCUSSION: The Adult-Difficult Venous Catheterization scale is a valid and reliable instrument for predicting difficult venous access in emergency departments.

The method matters. A comparative study of biologging and camera traps as data sources with which to describe wildlife habitat selection.

Habitat use is a virtually universal activity among animals and is highly relevant as regards designing wildlife management and conservation actions. This has led to the development of a great variety of methods to study it, of which resource selection functions combined with biologging-derived data (RSF) is the most widely used for this purpose. However this approach has some constraints, such as its invasiveness and high costs. Analytical approaches taking into consideration imperfect detection coupled with camera trap data (IDM) have, therefore, emerged as a non-invasive cost-effective alternative. However, despite the fact that both approaches (RSF and IDM) have been used in habitat selection studies, they should also be comparatively assessed. The objective of this work is consequently to assess them from two perspectives: explanatory and predictive. This has been done by analyzing data obtained from camera traps (60 sampling sites) and biologging (17 animals monitored: 7 red deer Cervus elaphus, 6 fallow deer Dama dama and 4 wild boar Sus scrofa) in the same periods using IDM and RSF, respectively, in Doñana National Park (southern Spain) in order to explain and predict habitat use patterns for three studied species. Our results showed discrepancies between the two approaches, as they identified different predictors as being the most relevant to determine species intensity of use, and they predicted spatial patterns of habitat use with a contrasted level of concordance, depending on species and scale. Given these results and the characteristics of each approach, we suggested that although partly comparable interpretations can be obtained with both approaches, they are not equivalent but rather complementary. The combination of data from biologging and camera traps would, therefore, appear to be suitable for the development of an analytical framework with which to describe and characterise the habitat use processes of wildlife.

Using species distribution modeling to generate relative abundance information in socio-politically unstable territories: Conservation of Felidae in the central-western region of Mexico.

The distribution range and population abundance of species provide fundamental information on the species-habitat relationship required for management and conservation. Abundance inherently provides more information about the ecology of species than do occurrence data. However, information on abundance is scarce for most species, mainly at large spatial scales. The objective of this work was, therefore, to provide information regarding the population status of six wild felids inhabiting territories in Mexico that are inaccessible or politically unstable. This was done using species distribution models derived from occurrence data. We used distribution data at a continental scale for the wild felids inhabiting Mexico: jaguar (Panthera onca), bobcat (Lynx rufus), ocelot (Leopardus pardalis), cougar (Puma concolor), margay (Leopardus wiedii), and jaguarundi (Herpailurus yagouaroundi) to predict environmental suitability (estimated by both Maxent and the distance to niche centroid, DNC). Suitability was then examined by relating to a capture rate-based index, in a well-monitored area in central western Mexico in order to assess their performance as proxies of relative abundance. Our results indicate that the environmental suitability patterns predicted by both algorithms were comparable. However, the strength of the relationship between the suitability and relative abundance of local populations differed across species and between algorithms, with the bobcat and DNC, respectively, having the best fit, although the relationship was not consistent in all the models. This paper presents the potential of implementing species distribution models in order to predict the relative abundance of wild felids in Mexico and offers guidance for the proper interpretation of the relationship between suitability and population abundance. The results obtained provide a robust information base on which to outline specific conservation actions and on which to examine the potential status of endangered species inhabiting remote or politically unstable territories in which on-field monitoring programs are not feasible.

A Qualitative Approach to Exploring the Impact of the Gay Identity Formation Process.

Background: Most gay men experience difficulty in coming to terms with their sexual orientation, with their health, wellbeing, and quality of life potentially affected by unpleasant experiences often associated with the formation of their gay identity. It is therefore important for nurses to understand the needs of gay men so that they can accompany them and provide quality care during and after the identity formation process. Objective: The aim of the study was to explore and describe the identity formation and coming out experiences of gay men. Methods: A qualitative design with a constructivist naturalist approach was used. Data were collected through in-depth semi-structured interviews with five gay men with experience of the gay identity formation process, and data were analyzed using a thematic analysis method. Results: The results show that the men needed support, as they reported feeling different and alone during the identity formation and coming out process, and that their mental health was affected. Fear of rejection, negative reactions, and disappointing people were the reasons that led the men not to disclose their sexual orientation to family, while those who had come out defined a feeling of liberation. Conclusions: The gay identity formation process has potential impacts on health, wellbeing, and quality of life. Nurses need cultural competence training to be able to understand the needs of gay men, accompany them in the identity formation process, and provide individualized and non-heteronormative care. Nurses also need to participate in dismantling a heterosexist social structure.

The influence of COVID-19 on the mental health of final-year nursing students: comparing the situation before and during the pandemic.

The COVID-19 pandemic has had an important impact on the academic world. It is known that university studies can influence the mental health of students, and especially those studying health sciences. In this study, we therefore sought to analyse whether the current pandemic has affected the mental well-being of final-year nursing students. This was a multi-centre study, with a descriptive, longitudinal, and prospective design. Mental well-being was evaluated using the General Health Questionnaire. A total of 305 participants were included in the study, of whom 52.1% had experienced the COVID-19 pandemic. Statistically significant differences were found between the two groups analysed in terms of age, access to university, average marks, mental well-being self-esteem, emotional exhaustion, and sense of coherence. In the case of mental well-being, a direct association was found with both the pandemic situation (OR = 2.32, P = 0.010) and emotional exhaustion scores (OR = 1.20, P < 0.001), while an inverse association was found with sense of coherence scores (OR = 0.45, P < 0.001). This study shows that the mental health of students is a significant factor and one that must be taken into consideration when training nursing staff at university. There is a need to promote healthy habits and provide appropriate coping strategies. It is also important to train and prepare students for pandemic situations as these can have an important impact on the mental health of both the members of the public who will be treated by these future nursing professionals and the students themselves.

Psychological Well-Being in Nursing Students: A Multicentric, Cross-Sectional Study.

In addition to complying with strict academic standards, nursing students must acquire relevant knowledge and skills, and learn how to carry themselves in different and often stressful professional settings. These obligations could severely affect their mental health. The purpose of this study was to examine the mental health status of undergraduate nursing students and related factors. A total of 1368 nursing students from different universities in Spain and Chile were included in this study, which took place over the 2018-2019 academic year. We assessed their levels of stress related to specific learning methodologies and determined their mental health status using the General Health Questionnaire (GHQ-28). The results revealed that the more advanced the course was, the lower the total GHQ-28 score. The stress generated by different types of training activities had a significant effect on the total GHQ-28 score. These results suggest that nursing education could act as a protective factor against mental health disorders. Although a heavy academic workload could lead to higher levels of stress, overall, it seems that mental health is better in more advanced courses than in initial academic years.

Alcohol Use and Sexual Violence among Nursing Students in Catalonia, Spain: A Multicentre Cross-Sectional Study.

(1) Background: Sexual violence (SV) has become common in universities for reasons related to unwanted social/peer pressures regarding alcohol/drug use and sexual activities. Objectives: To identify perceptions of SV and alcohol use and estimate prevalence among nursing students in Catalonia, Spain. (2) Methods: Observational descriptive cross-sectional study of a convenience sample of nursing students attending public universities. (3) Results: We recruited 686 students (86.11% women), who reported as follows: 68.7% had consumed alcohol, 65.6% had been drunk at least once in the previous year, 62.65% had experienced blackouts and 25.55% had felt pressured to consume alcohol. Drunkenness and blackouts were related (p < 0.000). Of the 15.6% of respondents who had experienced SV, 47.7% experienced SV while under the influence of alcohol and were insufficiently alert to stop what was happening, while 3.06% reported rape. SV was more likely to be experienced by women (OR: 2.770; CI 95%: 1.229-6.242; p = 0.014), individuals reporting a drunk episode in the previous year (OR: 2.839; 95% CI: 1.551-5.197; p = 0.001) and individuals pressured to consume alcohol (OR: 2.091; 95% CI: 1.332-3.281; p = 0.001). (4) Conclusions: Nursing instructors need to raise student awareness of both the effects of alcohol use and SV, so as to equip these future health professionals with the knowledge and skills necessary to deal with SV among young people.

[Less pain during puncture by a peripheral venous catheter; a bibliographical review on adults]. / Menos dolor en la punción de un catéter venoso periférico. Una revisión bibliográfica en población adulta.

Canalizing veins is a habitual technique carried out by nurses. Inserting a catheter in a peripheral vein causes pain. The importance of fine quality in nursing treatment implicitly bears on a person's well-being. In daily practice, health professionals do not use any method to reduce pain when inserting a catheter. The authors observations led them to believe in the need to carry out a bibliographical review whose objective was to discover all the methods used to reduce pain caused by puncturing a peripheral vein. Six randomly assigned clinical tests and a meta-analysis evaluate the effectiveness of: The use of Valsalva, an analgesic cream which contains two local amino-amide anesthetics; lidocaine and prylocaine (EMLA) compared to another analgesic cream, Myolaxin; a meta-analysis of twenty studies evaluates the degree by which pain is diminished by one such method: an EMLA cream; an anti-inflammatory skin dressing (diclofenaco), a diclofenaco dressing versus an EMLA anesthetic dressing, 0.25 ml subcutaneous injection of 1% mepivaína, an amida type local anesthetic; and direct photography moments before puncture occurs to use the effects of a flash of light. All these methods studied proved effective in reducing pain. Creams and dressing prove to be unaggressive methods but require some time for application prior to puncture. Using a camera flash, subcutaneous injection of mepivacaine and the application of Valsalva can be effective alternatives to reduce pain when puncturing veins in patients who require emergency care.

Sociodemographic and Clinical Characteristics Associated with Suicidal Behaviour and Relationship with a Nurse-Led Suicide Prevention Programme.

Suicidal behaviour is a major public health problem that needs to be tackled by all health agents including mental health nurses. AIMS: The purpose of this study was to analyse the relationship between demographic and clinical characteristics and different kinds of suicidal behaviour with a nurse-led suicide prevention programme. METHODS: The design was a cross-sectional study, performed in the region of Osona (Catalonia) in the five-year period 2013-2017. Suicidal behaviour was classified as suicidal ideation, interrupted self-directed violence, suicide attempt or completed suicide. RESULTS: The sample included 753 patients (of whom 53 completed suicide) who experienced 931 suicidal behaviour episodes. Men represented only 38.4% of the sample but 81.1% of completed suicides. Mental disorders were associated with suicidal behaviour in 75.4% of the sample. Two thirds (66.4%) of the individuals (0.8% (n = 4) of whom completed suicide) were participants in a nurse-led suicidal behaviour case management programme. CONCLUSION: The main risk factors were being a woman for suicidal behaviour and being a man and being older for completed suicide. Mental disorders, widowhood and retirement were also associated with completed suicide. The completed suicide rate was lower among participants in the nurse-led programme.

Healthy Ageing in Place: Enablers and Barriers from the Perspective of the Elderly. A Qualitative Study.

BACKGROUND: Most elderly people wish to grow old at their own homes. The sociodemographic characteristics; home and neighbourhood conditions; and the social services support and networks are determinants in the possibility of "ageing in place". The present study aimed to explore the ageing in place phenomenon, as well as the enablers and barriers that interact in a healthy ageing from the perspective of the elderly connected to local entities. METHODS: A generic qualitative design was proposed in the Health Region of Girona in Catalonia (Spain). Seventy-one elderly people were purposefully selected. Six focus groups were conducted, and data were thematically analysed. RESULTS: Three key themes were generated: (1) Participants experienced ageing differently. The physical and mental health, the family environment and financial stability were key elements for life quality. (2) The perception of the elderly's role in the community depended on their age, health status and attitude towards life. (3) The participants identified several enablers and barriers to healthy ageing in place. CONCLUSIONS: The promotion of older people's autonomy and wellbeing, together with the creation of an active network of health and social services, may improve the possibility for elderly to age at home and avoid or delay institutionalisation.

[Adolescent use of helmets moped riders in the city of Gerona, Spain, 2006]. / Uso del casco en adolescentes usuarios de ciclomotores en la ciudad de Gerona, 2006.

BACKGROUND: Cerebral injuries as a result of craniocerebral trauma are the most frequent cause of death in traffic collisions involving two-wheeled vehicles. In spite of the proven effectiveness of the use of the head protective devices to prevent injuries in the event of traffic collisions, some teenagers and youngsters do not use it. The main goal of this research is to identify the best predictors of helmet use among adolescents. METHOD: Transversal study of a population of 874 young students of Secondary Education during the academic year 2005-06. The population object of study were students of 3rd and 4th year of the 6 public secondary schools of Gerona and only those present in class in the day of the data capture participated in the study. The participation was 74.6%. The data capture was carried out by means of a self-devised survey. An analysis of hierarchical logistical regression was also carried out. RESULTS: Predictable variables of helmet use in motorcycle drivers: age (OR=0.56), safety as main reason for its use (OR=0.02), possession of driving license (OR=0.17), peer influence (OR=0.23) and family influence (OR=0.17). In passengers: age (OR=0.46), peer influence (OR=0.35) and safety as main reason for its use (OR=0.38). CONCLUSIONS: The variables that predict the use of the helmet in the motorcycles users are: age, being in possession of the license to drive motorcycles, wearing the helmet as a safety device and social reinforcement (friends and family).

Measuring self-directed learning readiness in health science undergraduates: A cross-sectional study.

BACKGROUND: The European Higher Education Area places students at the centre of the teacher-guided learning process and requires them to participate more in their education and to be responsible for acquiring the professional competences relevant to their career. Self-directed learning is a key means for developing the skills necessary for professional careers. OBJECTIVE: To measure self-directed learning readiness in health science undergraduates. METHOD: Observational descriptive cross-sectional study of a convenience sample drawn from the total health science (medicine, nursing, physiotherapy and psychology) undergraduate population (n = 1699) at the University of Girona (Spain). The data collection instrument was a self-directed learning readiness scale with 38 items administered to the 1134 undergraduates who agreed to participate. RESULTS: Just over three quarters of the sample (n = 865; 76.27%) completed the full questionnaire. Self-directed learning readiness was indicated by an overall mean (standard deviation) score of 143.65 (11.76) points. Nursing undergraduates obtained the highest mean (SD) score - 145.08 (14.13) - in the overall scale. Associations were observed between degree course and self-directed learning readiness in the learning planning, desire for learning, self-confidence, self-management and self-evaluation subscales. Women scored better than men (p < 0.13) and scores progressively improved with each additional academic year. CONCLUSION: The sampled students exhibited good self-directed learning readiness. Training students in self-directed learning skills is a necessary part of the teaching-learning process. This kind of training in universities needs to be reinforced to develop learning autonomy, promote lifelong learning and prepare competent future health professionals.

Scale for the study of nursing students' perception of intimate partner violence: Adaptation and validation.

BACKGROUND: Intimate partner violence (IPV) is one of the most important challenges facing today's society. Health professionals, and nurses in particular, play a leading role in addressing this problem. Having an instrument to study Nursing students' perception of this type of violence may enable appropriate and necessary educational strategies for their pre-service training and help them identify and address IPV in their future careers. OBJECTIVES: To adapt and validate the IPV scale of Beccaria et al. (2011) in order to study nursing students' perception of IPV. METHOD: The original instrument (63 items) underwent back-translation. Statistical and metrical analysis in a sample of 1064 students of the four-year Nursing degree program at four public universities in Catalonia (Spain) were based on their responses to the Spanish version. RESULTS: The results of the exploratory factorial analysis and subsequent confirmatory analysis showed that the data had an adequate fit for a four-factor model. The reliability analysis showed adequate internal consistency for each subscale in the instrument: Education (0.83); Identification of the Victim (0.72); Nursing Role and Values (0.78), and Identification of the Perpetrator (0.66). CONCLUSION: The translation, cultural adaptation and validation process of the original IPV scale resulted in a Spanish-language instrument (IPV scale Spanish version) with 32 items in four subscales. We concluded that the Spanish version of the instrument is reliable and valid, and that its implementation would enable the assessment of nursing students' perception of IPV situations.

The evaluation of reflective learning from the nursing student's point of view: A mixed method approach.

BACKGROUND: Adapting university programmes to European Higher Education Area criteria has required substantial changes in curricula and teaching methodologies. Reflective learning (RL) has attracted growing interest and occupies an important place in the scientific literature on theoretical and methodological aspects of university instruction. However, fewer studies have focused on evaluating the RL methodology from the point of view of nursing students. OBJECTIVES: To assess nursing students' perceptions of the usefulness and challenges of RL methodology. DESIGN: Mixed method design, using a cross-sectional questionnaire and focus group discussion. METHODS: The research was conducted via self-reported reflective learning questionnaire complemented by focus group discussion. RESULTS: Students provided a positive overall evaluation of RL, highlighting the method's capacity to help them better understand themselves, engage in self-reflection about the learning process, optimize their strengths and discover additional training needs, along with searching for continuous improvement. Nonetheless, RL does not help them as much to plan their learning or identify areas of weakness or needed improvement in knowledge, skills and attitudes. Among the difficulties or challenges, students reported low motivation and lack of familiarity with this type of learning, along with concerns about the privacy of their reflective journals and about the grading criteria. CONCLUSIONS: In general, students evaluated RL positively. The results suggest areas of needed improvement related to unfamiliarity with the methodology, ethical aspects of developing a reflective journal and the need for clear evaluation criteria.

Nursing student and professor perceptions and assessments of the achievement of practicum competencies: A mixed method approach.

Within the context of the European Higher Education Area's requirement of competency-based assessments, the objective of the present study was to evaluate the Nursing Degree Practicum experience at the University of Girona (Spain) and ascertain student and faculty perceptions of the degree of competency achieved as a result of the practicum. This cross-sectional, descriptive, study combined quantitative analysis of a questionnaire and qualitative analysis of focus group comments. In the quantitative part of the study, 163 fourth-year nursing students completed the questionnaire; the qualitative analysis was derived from a focus group of 5 students and 5 professors. On the questionnaire, overall practicum evaluation was 8.39 on a 10-point Likert scale; scores evaluating the nurse mentor/instructor and nursing professor were 8.43 and 7.98, respectively. The geriatrics practicum experience received the lowest overall score (7.81), while the surgical practicum received the lowest score on the adequacy of knowledge acquired in the classroom in previous courses (5.54). The best scores were earned by the mental health and intensive/emergency care practicum experiences (a mean of 9.05 and 8.70, respectively). Students and professors in the focus group agreed that the practicum met the Nursing degree program's competency goals, highlighting practical activity as the best methodology to evaluate competencies. Participants highlighted the importance of reflective practice and the role of the nurse mentor/instructor in student learning, and indicated that it is essential for the university and the health care centers where students take practicum courses to maintain a strong relationship and good communication. Finally, feedback from the nurse mentor/instructor and Nursing professor was very important to students, both to motivate them and to help them learn.

Perception of nursing students about couples' violence: knowledge, beliefs and professional role.

OBJECTIVES: to analyse the knowledge, beliefs and perception of the professional role that nursing students have, about exerted violence against women in relationships. METHOD: a descriptive qualitative study following the ecological model through 16 focus groups realized with 112 students from four nursing courses of four Spanish universities. RESULTS: the analytical categories were: knowledge, professional role, and beliefs about ones behaviour before the victim and the abuser. Students are unfamiliar with the characteristics of abuse, guidelines, protocols and screening questions and demand patterns for specific intervention. They do not identify their own professional role, be it delegated or specialized. Beliefs regarding their behaviour with the victim, not guided by professional criteria, perceive violence as a specific situation and disassociate the prevention of health care. They perceive the abuser as mentally ill, justifying the tolerance or delegation of performances. CONCLUSIONS: students define preconceived ideas about couples' violence. Speeches reproduce and reinforce stereotypical myths, values indicative of inadequate training for nursing studies which raises the need to fortify the competencies in relation to intimate couples' violence in the curriculum.

Influence of deviation from guidelines on the outcome of community-acquired pneumonia.

STUDY OBJECTIVE: s: Consensus guidelines for the empirical treatment of community-acquired pneumonia (CAP) have been published. We investigated the following factors: (1) the degree of adherence to American Thoracic Society (ATS) and the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) guidelines; and (2) the influence of adhering to these guidelines on mortality and length of hospitalization. DESIGN: Prospective, observational study. SETTING: Tertiary-care teaching hospital. PATIENTS: Two hundred ninety-five patients with CAP who were consecutively admitted to the hospital and treated empirically. INTERVENTIONS: Patients were stratified according to the prognostic rule of Fine, and the antibiotic regimen prescribed in the first 24 h was evaluated as to whether or not it adhered to treatment guidelines. RESULTS: Adherence to SEPAR and ATS guidelines was 66% and 88%, respectively. There were no significant differences in mortality or duration of hospitalization between adherent and nonadherent regimens. However, mortality in severe CAP (Fine risk class V) was significantly higher in patients with nonadherent treatments (SEPAR: relative risk [RR], 2.6; 95% confidence interval [CI], 1.1 to 5.6; ATS: RR, 2.5; 95% CI, 1.1 to 5.8). In a multivariate analysis, adherence to ATS guidelines was independently associated with decreased mortality (RR, 0.3; 95% CI, 0.14 to 0.9) after adjusting for the Fine score. CONCLUSIONS: Adherence was higher to ATS guidelines than to SEPAR guidelines. Severe CAP had a significantly higher mortality when the guidelines (both ATS and SEPAR) were not followed. Length of hospitalization was similar irrespective of adherence to either set of guidelines.

Perception of nursing students about couples' violence: knowledge, beliefs and professional role / Percepção de estudantes de enfermagem sobre violência do parceiro: conhecimentos, crenças e função profissional / Percepción de los estudiantes de enfermería sobre violencia de pareja: conocimientos, creencias y rol profesional

to analyse the knowledge, beliefs and perception of the professional role that nursing students have, about exerted violence against women in relationships.

examinar os conhecimentos, crenças e a percepção da função profissional que têm os estudantes de enfermagem, sobre a violência contra as mulheres, nos relacionamentos íntimos.

analizar los conocimientos, las creencias y la percepción del rol profesional que tienen los estudiantes de Enfermería, acerca de la violencia ejercida contra las mujeres en las relaciones de pareja.

Assessment of analysis of urinary pneumococcal antigen by immunochromatography for etiologic diagnosis of community-acquired pneumonia in adults.

The limitations of conventional microbiologic methods (CMM) for etiologic diagnosis of community pneumococcal pneumonia have made faster diagnostic techniques necessary. Our aim was to evaluate the usefulness of the immunochromatography (ICT) technique for detecting urinary Streptococcus pneumoniae antigen in the etiologic diagnosis of community-acquired pneumonias (CAP). This was a prospective study on in-patients with CAP in a tertiary hospital conducted from October 2000 to March 2004. Apart from using CMM to reach an etiologic diagnosis, we determined pneumococcal antigen in concentrated urine by ICT. We also determined the urinary pneumococcal antigen (UPA) content in patients from two control groups to calculate the specificity of the technique. One group was comprised of in-patients diagnosed with chronic obstructive pulmonary disease (COPD) or asthma, with respiratory infection, and without pneumonia; the other group included fractures. We studied 959 pneumonia patients and determined UPA content in 911 (95%) of them. We diagnosed the etiology of 253 cases (28%) using CMM; S. pneumoniae was the most common etiologic agent (57 cases). ICT analysis was positive for 279 patients (31%). Using this technique, the percentage of diagnoses of pneumococcal pneumonias increased by 26%, while the overall etiologic diagnosis increased from 28 to 49%. The technique sensitivity was 81%; the specificity oscillated between 80% in CAP with nonpneumococcal etiology and 99% for patients with fractures without infections. Determination of UPA is a rapid, simple analysis with good sensitivity and specificity, which increased the percentage of etiologic diagnoses. Positive UPA may persist in COPD patients with probable pneumococcal colonization or recent pneumococcal infections.