Instruments to measure skills and knowledge of physicians and medical students in palliative care: A systematic review of psychometric properties.

PURPOSE: Palliative care is constantly increasing around the world. The knowledge and skills of future physicians in this area are crucial. This study evaluates the psychometric properties of knowledge and skills questionnaires used in palliative care, validated by physicians or medical students based on the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. METHODS: A systematic review was carried out in Cosmin Databases, Cochrane Library, PsycINFO, SciELO, Cinahl, and Medline up to September 2020 (updated June 2021), based on the COSMIN methodology and PRISMA recommendations. The psychometric properties of each included questionnaire were identified. Methodological quality, quality of results, and quality of evidence were evaluated. RESULTS: The search strategy yielded 12 questionnaires assessing the knowledge and skills of physicians or medical students. The Palliative Care Knowledge Questionnaire for PEACE (PEACE-Q) and Palliative Care Knowledge Test (PCKT) were the instruments with the highest scores for methodological quality, quality of results, and quality of evidence-based on the COSMIN methodology. CONCLUSIONS: PEACE-Q and PCKT should be the preferred choice to assess palliative care knowledge and skills in physicians. In-depth studies following COSMIN validation criteria are recommended to improve the psychometric properties and cross-cultural validation of the questionnaires.

[Risk of pneumococcal disease in elderly patients with and without previous vaccination]. / Riesgo de enfermedad neumocócica en pacientes ancianos con y sin vacunación previa.

OBJECTIVES: To know the pneumococcal vaccination coverage in patients≥65 years old, as well as the risk of pneumococcal disease according to whether or not they received such vaccination. DESIGN: Cross-sectional study, followed by historical cohort. LOCATION: Urban area. PARTICIPANTS: By systematic sampling, 2,805 people≥65 years from the city of Albacete were selected. MAIN MEASUREMENTS: Dependent variable: diagnosis of pneumococcal disease and date. INDEPENDENT VARIABLES: age, sex, chronic pathologies, medication, pneumococcal vaccination and date. The computerized medical records were reviewed, from 1-1-2009 to October-December 2015. A descriptive analysis was carried out, the relative risk of the onset of pneumococcal disease according to vaccination has been calculated, and survival analysis has been carried out, with the statistical program SPSS 17.0. RESULTS: Median age 71 years; 57.2% were women; 46% received polysaccharide vaccine (95% CI 44.1-47.8). Only 10 people received conjugated vaccine. Twenty-two people were diagnosed with invasive pneumococcal disease and 153 non-invasive. The relative risk of pneumococcal disease in vaccinated versus unvaccinated, respectively for invasive and non-invasive, was 1.59 (95% CI 0.69-3.68) and 1.84 (95% CI 1.33-2.54). Cox regression showed a higher risk of non-invasive disease for COPD (1.95; 95% CI 1.32-2.89), smoking (1.87; 95% CI 1.28-2.73), corticoid-therapy (1.73; 95% CI 1.08-2.79), polysaccharide vaccination (141.41; 95% CI 5.92-3,378.49) and age (1.11; 95% CI 1.08-1.14), with interaction between these 2 (0.94, 95% CI 0.91-0.98). CONCLUSIONS: There is an increased risk of pneumococcal disease in patients≥65 years vaccinated with polysaccharide, although with a protective effect in vaccinated older.

Palliative care knowledge test for nurses and physicians: validation and cross-cultural adaptation.

BACKGROUND: Palliative care knowledge is essential in primary healthcare due to the increasing number of patients who require attention in the final stage of their life. Health professionals (physicians and nurses) need to acquire specific knowledge and abilities to provide high-quality palliative care. The development of education programmes in palliative care is necessary. The Palliative Care Knowledge Test (PCKT) is a questionnaire that evaluates the basic knowledge about palliative care, but it has not been adapted into Spanish, and its effectiveness and utility for Spanish culture have not been analysed. OBJECTIVE: The aim of this study was to report the translation into Spanish and a psychometric analysis of the PCKT. METHODS: The questionnaire survey was validated with a group of 561 physicians and nurses. The PCKT Spanish Version (PCKT-SV) was obtained from a process, including translation, back translation and revision by experts and a pilot study. The content validity and reliability of the questionnaire were analysed. RESULTS: The results showed internal consistency and reliability indexes similar to those obtained by the original version of PCKT. CONCLUSION: The PCKT-SV is a useful instrument for measuring Spanish-speaking physician and nurse knowledge of palliative care, and it is suitable to evaluate the effectiveness of training activities in palliative care.

Physicians' and Nurses' Knowledge in Palliative Care: Multidimensional Regression Models.

The increase in life expectancy has led to a growth in the number of people in need of palliative care. Health professionals must possess appropriate knowledge and skills. This study aimed to assess knowledge in palliative care through the Palliative Care Knowledge Test Spanish Version (PCKT-SV)®. A cross-sectional analytical study was conducted in 40 primary care health services. A total of 600 PCKT-SV questionnaires were distributed among health professionals; 561 of them (226 nurses and 335 physicians) were properly filled up. Sociodemographic information, education, and work experience were also recorded. A total of 34.41% of the nurses and 67.40% of the physicians showed good or excellent knowledge of palliative care. Physicians' scores for pain, dyspnea, and psychiatric disorders were higher than those of the nurses. Nurses scored significantly better in philosophy. Professionals with continuous training in palliative care showed a higher level of knowledge. Age and work experience of physicians and undergraduate training in nurses had significant weight in knowledge. Developing continuous training and enhancing undergraduate training in palliative care will lead to improved patient care at the end of life.

Palliative care undergraduate education: Do medical and nursing students need more skills in ethical and legal issues?

This study aimed to analyze the schools that teach ethical and legal aspects within the subject of palliative care in the degrees of medicine and nursing in Spain. MATERIAL AND METHODS: Descriptive Analysis of the palliative care subject and their ethical and legal curricular competencies in the Spanish Nursing and Physicians undergraduate. The training received in legal ethical aspects related to palliative care was compared with the criteria established by the European Association for Palliative Care (EAPC). DATA SOURCES: The National Conference of Nursing Deans, The National Conference of Spanish Medical Faculty Deans and The Ministry of Science, Innovation, and Universities databases were searched. RESULTS: Twenty-one universities have an undergraduate in medicine with palliative care in their curricular training explicitly. The degree in nursing is present in fifty-six universities, palliative care is present in 62.5% of the cases. The degrees of nursing and medicine receive approximately the same level of training in ethical and legal aspects of palliative care. CONCLUSION: The specific training received in ethical and legal issues of palliative care must be improved in medical and nursing to meet the EAPC levels.

Cell interactions with hierarchically structured nano-patterned adhesive surfaces.

The activation of well-defined numbers of integrin molecules in predefined areas by adhesion of tissue cells to biofunctionalized micro-nanopatterned surfaces was used to determine the minimum number of activated integrins necessary to stimulate focal adhesion formation. This was realized by combining micellar and conventional e-beam lithography, which enabled deposition of 6 nm large gold nanoparticles on predefined geometries. Patterns with a lateral spacing of 58 nm and a number of gold nanoparticles, ranging from 6 to 3000 per adhesive patch, were used. For α(v) ß(3)-integrin activation, gold nanoparticles were coated with c(-RGDfK-)-thiol peptides, and the remaining glass surface was passivated to prevent non-specific protein adsorption and cell adhesion. Results show that focal adhesion formation is dictated by the underlying hierarchical nanopattern. Adhesive patches with side lengths of 3000 nm and separated by 3000 nm, or with side lengths of 1000 nm and separated by 1000 nm, containing approximately 3007 ± 193 or 335 ± 65 adhesive gold nanoparticles, respectively, induced the formation of actin-associated, paxillin-rich focal adhesions, comparable in size and shape to classical focal adhesions. In contrast, adhesive patches with side lengths of 500, 250 or 100 nm, and separated from adjacent adhesive patches by their respective side lengths, containing 83 ± 11, 30 ± 4, or 6 ± 1 adhesive gold nanoparticles, respectively, showed a significant increase in paxillin domain length, caused by bridging the pattern gap through an actin bundle in order to mechanically, synergistically strengthen each single adhesion site. Neither paxillin accumulation nor adhesion formation was induced if less than 6 c(-RGDfK-)-thiol functionalised gold nanoparticles per adhesion site were presented to cells.

At what stage in the undergraduate curriculum is it best to train in family medicine? A study from two medical schools in Spain.

BACKGROUND: A course in family medicine (FM) could dispel the possibility of negative stereotyping about this speciality, and instil in students a greater interest. However, when is it preferable: at the beginning or at the end of undergraduate training? OBJECTIVES: To determine changes in knowledge and attitudes towards FM by medical students completing a course in primary care at the beginning or the end of the undergraduate training and whether those changes anticipate the choice of speciality. METHODS: Students from Albacete and Seville medical schools (primary care course in second and sixth years, respectively) were asked to respond to the 'valuation of attitudes towards and knowledge of family medicine questionnaire' (CAMF). Students from Albacete answered before and after the course, and in Seville second-year students answered at the end of the first trimester. All students were invited to respond again at the end of their undergraduate training. Afterwards, we investigated the score on the speciality exam (order for the election from highest to lowest score) and their choice of speciality. The outcome measures were the MIR exam score, the number in the ranking, the chosen speciality and the result of the CAMF. RESULTS: In Albacete 88 and 64 and in Seville 50 and 98 students responded in their second and sixth years, respectively. In Albacete, mean CAMF scores were 15.4, 22.7 before and after the course, and 21.8 at the end while in Seville, 13.9 in the second year, and 23.5 in the sixth year. Logistic regression analysis showed an association of the choice of FM only with the score on the speciality exam (OR: 0.667; 95%CI: 0.553-0.806). CONCLUSION: There were no significant differences between CAMF scores at the end of undergraduate training. Only the score on the speciality exam predicts FM choice: the higher the score, the lower the probability of choosing FM.

Cooperativity in adhesion cluster formation during initial cell adhesion.

We have studied the initial phase of cell adhesion as a function of the lateral organization of individual integrin molecules with single-cell force microscopy. Nanostructures, consisting of hexagonally ordered gold dots, were prepared with diblock-copolymer micelle lithography and functionalized with arginine- glycine-aspartate peptides, thus defining integrin position with nanometer resolution. Adhesion strength was characterized with an atomic force microscope and both cell detachment forces and work of detachment showed a reinforcement of adhesion if the distance between integrin molecules was <70 nm. This reinforcement had already occurred at cell-substrate contact times <5 min. We believe our results show quantitatively the relevance of the distance between adjacent integrin binding sites rather than their density. Furthermore, we propose a model describing the cooperative stabilization of early integrin clusters as a function of receptor patterning at the nanoscale.

Cell adhesion and polarisation on molecularly defined spacing gradient surfaces of cyclic RGDfK peptide patches.

In vivo cell migration and location are orchestrally guided by soluble and bound chemical gradients. Here, gradients of extracellular matrix molecules are formed synthetically by the combination of a surface nanopatterning technique called block copolymer nanolithography (BCN) and a biofunctionalisation technique. A modified substrate dip-coating process of BCN allows for the formation of precise molecular gradients of cyclic RGDfK peptide patches at interfaces, which are presented to cells for testing cell adhesion and polarisation. Surfaces formed by BCN consist of hexagonally ordered gold dot patterns with a gradient in particle spacing. Each dot serves as a chemical anchor for the binding of cyclic RGDfK peptides, which are specifically recognised by alpha(v)beta(3) integrins. Due to steric hindrance only up to one integrin binds to one functionalised gold dot which forms a peptide patch spacing. We demonstrate how cell morphology, adhesion area, actin and vinculin distribution as well as cell body polarisation are influenced by the peptide patch spacing gradient. As a consequence, these gradients of adhesive ligands induce cell orientation towards smaller particle spacing when the gradient strength is 15nm/mm at least. This implicates that an adherent cell's sensitivity to differentiate between ligand patch spacing is approximately 1nm across the cell body.

Isothiocyanate-functionalized RGD peptides for tailoring cell-adhesive surface patterns.

With the advances made in surface patterning by micro- and nanotechnology, alternative methods to immobilize biomolecules for different purposes are highly desired. RGD peptides are commonly used to create cell-attractive surfaces for cell-biological and also medical applications. We have developed a fast, one-step method to bind RGD peptides covalently to surfaces by thiourea formation, which can be applied to structured and unstructured materials. RGD peptides were fused to an isothiocyanate anchor during synthesis and directly immobilized on amino-terminated surfaces. The spreading behavior of fibroblasts and the formation of focal contacts served to prove the applicability of the coupling method. Two different linear peptides and one cyclic peptide were compared. All the peptides induced spreading behavior and the formation of focal contacts in murine fibroblasts. Adhesion was specific as cells neither recognized the corresponding negative control peptides nor spread in the presence of soluble H-RGDS-OH peptide. We successfully applied our coupling method to functionalize surface patterns created by microcontact printing (microCP) and chemical etching. Cells recognize areas selectively coated with RGD-containing peptides, proliferate and maintain this preference during long-term cultivation. Our method significantly facilitates surface modification with any kind of peptide - even for the preparation of peptide-functionalized small surface areas.

Specific integrin labeling in living cells using functionalized nanocrystals.

We present an integrin labeling method using functionalized quantum dots (QDs). Cyclic Arg-Gly-Asp (RGD) peptides and a biotin-streptavidin linkage are used to specifically couple individual QDs to integrins of living cells. The spacer distance between the RGD sequence and the QD surface is a crucial parameter to ensure specific binding to individual alpha(v)beta(3) integrins of osteoblast cells. Despite blinking, the position of single QDs is tracked with nanometer precision and localized diffusive behavior is observed. We show that blinking events do not prevent the acquisition of quantitative parameters from the QD trajectories.

Protein repellent properties of covalently attached PEG coatings on nanostructured SiO(2)-based interfaces.

In this study, we report the systematic comparison of different poly(ethylene glycol) (PEG) self-assembled monolayers on glass with respect to their protein adsorption and cell adhesion resistance. Combining PEGylation with micellar nanolithography allowed the formation of gold nanoparticle arrays on glass and selective coverage of the free glass area by PEG. The gold nanoparticles serve as anchor points for the attachment of individual proteins and peptides such as the cell-matrix adhesion promoting cyclic RGDfK motif or the kinesin motor protein Eg5. The capability of the motor protein to bind microtubules remained unaffected by the immobilization. It was shown that the film thickness of a water swollen PEG layer is crucial to maximize the interaction between proteins and peptides with the nanostructures. Non-specific interaction between cells or microtubules and the surface was minimized. The optimum PEG layer thickness correlated with the size of gold nanoparticles which was approximately 5 nm.

Frequency and characteristics of Internet use by Spanish teenagers. A cross-sectional study.

INTRODUCTION: Internet has completely changed communication among people in today's world, especially among young users. The objective of this study is to establish the frequency of Internet use by teenagers, and most used apps. POPULATION AND METHODS: This was a crosssectional study. In November 2013, students attending two mandatory secondary schools in Albacete were invited to complete a self-administered questionnaire with close-ended and open questions. Questionnaires were completed in the classroom, either "online" or "with pen and paper". Answers were entered in a computer database using the SPSS 17.0 software. Statistical analysis included a comparison of proportions (χ² test) and mean/median values (Student's t test/non-parametric tests). RESULTS: Nine hundred and sixty-seven students participated; their mean age was 13.8 years old (range: 11-20); 53.5% were girls. Most students (70.9%) lived in the city. Most belonged to a middle (51.3%) and high (34.8%) socioeconomic status. Also most students went online on a daily basis (73.4%); only 0.9% indicated that they never did. The most frequently used apps included WhatsApp (77.1%), social networks (70.1%) and music apps (66.6%). Among girls, the most common Internet use was social networks (p= 0.004), WhatsApp (p < 0.0001), Instagram (p < 0.0001) and listening to music (p= 0.004). Boys most commonly used the Internet to browse the web (p < 0.0001), Skype (p=0.001), play (p < 0.0001) andwatchmovies or TV shows (p= 0.035). CONCLUSIONS: Internet takes up a large part of the time in adolescents' lives, especially as a means of communications, being WhatsApp and social networks the most commonly used apps.

INTRODUCCIÓN: Internet ha transformado la comunicación entre las personas en el mundo actual, especialmente en el caso de los más jóvenes. El objetivo de este estudio es determinar la frecuencia de uso de Internet por adolescentes, así como las aplicaciones utilizadas. POBLACIÓN Y MÉTODOS: Se trata de un estudio transversal. En noviembre de 2013, los estudiantes de la escuela secundaria obligatoria de dos institutos de Albacete fueron invitados a responder un cuestionario autoadministrable, con preguntas de respuesta abierta y cerrada. Contestaron en las aulas, "on line" o con "lápiz y papel". Las respuestas fueron introducidas en una base de datos informatizada, con el programa SPSS 17.0. El análisis estadístico ha incluido comparación de proporciones (chi cuadrado) y de medias/medianas (t de Student/pruebas no paramétricas). RESULTADOS: Participaron 967 estudiantes, con media de edad de 13,8 años (rango: 11-20); 53,5% de mujeres. La mayoría (70,9%) vivían en la ciudad. La clase social era mayoritariamente media (51,3%) y alta (34,8%). La mayoría se conectaba a Internet a diario (73,4%); solo 0,9% decía no conectarse nunca. Las aplicaciones más utilizadas eran WhatsApp (77,1%), redes sociales (70,1%) y relacionadas con música (66,6%). Se ha encontrado una mayor frecuencia de utilización por las mujeres de redes sociales (p= 0,004), WhatsApp (p <0,0001), Instagram (p <0,0001) y escuchar música (p= 0,004). Los varones navegaban más (p <0,0001), utilizaban Skype (p= 0,001), jugaban (p <0,0001) y veían películas o series (p= 0,035). CONCLUSIONES: Internet ocupa una gran parte del tiempo de los adolescentes, especialmente como medio de comunicación, y WhatsApp y las redes sociales son las aplicaciones que utilizan con más frecuencia.

Frecuencia y características de uso de Internet por adolescentes espanoles: Un estudio transversal / Frequency and characteristics of Internet use by Spanish teenagers: A cross-sectional study

Introducción: Internet ha transformado la comunicación entre las personas en el mundo actual, especialmente en el caso de los más jóvenes. El objetivo de este estudio es determinar la frecuencia de uso de Internet por adolescentes, así como las aplicaciones utilizadas. Población y métodos: Se trata de un estudio transversal. En noviembre de 2013, los estudiantes de la escuela secundaria obligatoria de dos institutos de Albacete fueron invitados a responder un cuestionario autoadministrable, con preguntas de respuesta abierta y cerrada. Contestaron en las aulas, "on line" o con "lápiz y papel". Las respuestas fueron introducidas en una base de datos informatizada, con el programa SPSS 17.0. El análisis estadístico ha incluido comparación de proporciones (chi cuadrado) y de medias/medianas (t de Student/pruebas no paramétricas). Resultados: Participaron 967 estudiantes, con media de edad de 13,8 años (rango: 11-20); 53,5% de mujeres. La mayoría (70,9%) vivían en la ciudad. La clase social era mayoritariamente media (51,3%) y alta (34,8%). La mayoría se conectaba a Internet a diario (73,4%); solo 0,9% decía no conectarse nunca. Las aplicaciones más utilizadas eran WhatsApp (77,1%), redes sociales (70,1%) y relacionadas con música (66,6%). Se ha encontrado una mayor frecuencia de utilización por las mujeres de redes sociales (p= 0,004), WhatsApp (p <0,0001), Instagram (p <0,0001) y escuchar música (p= 0,004). Los varones navegaban más (p <0,0001), utilizaban Skype (p= 0,001), jugaban (p <0,0001) y veían películas o series (p= 0,035). Conclusiones: Internet ocupa una gran parte del tiempo de los adolescentes, especialmente como medio de comunicación, y WhatsApp y las redes sociales son las aplicaciones que utilizan con más frecuencia.

Introduction. Internet has completely changed communication among people in today's world, especially among young users. The objective of this study is to establish the frequency of Internet use by teenagers, and most used apps. Population and methods. This was a crosssectional study. In November 2013, students attending two mandatory secondary schools in Albacete were invited to complete a self-administered questionnaire with close-ended and open questions. Questionnaires were completed in the classroom, either "online" or "with pen and paper". Answers were entered in a computer database using the SPSS 17.0 software. Statistical analysis included a comparison of proportions (χ2 test) and mean/median values (Student's t test/non-parametric tests). Results. Nine hundred and sixty-seven students participated; their mean age was 13.8 years old (range: 11-20); 53.5% were girls. Most students (70.9%) lived in the city. Most belonged to a middle (51.3%) and high (34.8%) socioeconomic status. Also most students went online on a daily basis (73.4%); only 0.9% indicated that they never did. The most frequently used apps included WhatsApp (77.1%), social networks (70.1%) and music apps (66.6%). Among girls, the most common Internet use was social networks (p= 0.004), WhatsApp (p < 0.0001), Instagram (p < 0.0001) and listening to music (p= 0.004). Boys most commonly used the Internet to browse the web (p < 0.0001), Skype (p=0.001), play (p < 0.0001) andwatchmovies or TV shows (p= 0.035). Conclusions. Internet takes up a large part of the time in adolescents' lives, especially as a means of communications, being WhatsApp and social networks the most commonly used apps.

Induction of cell polarization and migration by a gradient of nanoscale variations in adhesive ligand spacing.

Cell interactions with adhesive surfaces play a vital role in the regulation of cell proliferation, viability, and differentiation, and affect multiple biological processes. Since cell adhesion depends mainly on the nature and density of the adhesive ligand molecules, spatial molecular patterning, which enables the modulation of adhesion receptor clustering, might affect both the structural and the signaling activities of the adhesive interaction. We herein show that cells plated on surfaces that present a molecularly defined spacing gradient of an integrin RGD ligand can sense small but consistent differences in adhesive ligand spacing of about 1 nm across the cell diameter, which is approximately 61 mum when the spacing includes 70 nm. Consequently, these positional cues induce cell polarization and initiate cell migration and signaling. We propose that differential positional clustering of the integrin transmembrane receptors is used by cells for exploring and interpreting their environment, at high spatial sensitivity.

Mimicking cellular environments by nanostructured soft interfaces.

We present herein an innovative technique for decorating soft polymer surfaces with metallic nanostructures fabricated by diblock copolymer micelle nanolithography. Thus far, such nanolithography has been limited to plasma-resistant inorganic substrates such as glass. Our new development is based on the transfer of nanopatterns from glass to soft substrates. Special emphasis is given to hydrogel surfaces with respect to their properties for tailoring cell adhesion. Besides planar surfaces, periodic gold nanopatterns on curved surfaces have been fabricated, as demonstrated on the interior surface of a tubelike hydrogel, which potentially mimic situations of vessels in vivo.