What is essential remains invisible to the eyes? Blood pressure cuffs colonized by bacterial diversity.

Using sphygmomanometers to measure blood pressure is a common practice in the healthcare context. The disinfection and maintenance of these devices is essential in clinical practice to prevent the proliferation of microorganisms. The aim of this study was to determine the presence of pathogenic microorganisms in sphygmomanometer cuffs in the clinical setting. A cross-sectional study was carried out. Five types of healthcare centers, selected through convenience sampling, participated in this study. Samples were collected from the inside of sphygmomanometer cuffs, and labeled and delivered to the laboratory for analysis. The samples were incubated in an oven at 35.5 °C for 24 h. A total CFU count was carried out on the plates that were cataloged as positive. Colonies that showed growth were identified using the matrix-assisted laser desorption/ionization-mass spectrometry technology. Of the total sample, (N = 372), 69.1% were positive and were isolated. In 30.9% (n = 115), no bacterial development was found within 48 h. A total of 257 microorganisms were found. The mean number of colony-forming units was 29.62 (SD = 32.33). The socio-health centers had the highest amount of bacterial contamination in the cuffs. In regards to the type of microorganisms, 31.5% (n = 81) found were Bacillus cereus, followed by 26.8% (n = 69) of Staphylococcus hominis and 9.7% (n = 25) were Pantoea agglomerans, among others. Statistically significant differences were found between the type of microorganism and the hours elapsed since the last disinfection (X2(19) = 44.582; p = 0.001). Statistically significant differences were found between the time elapsed since the last disinfection and the type of sphygmomanometer (X2 (2) = 117.752; p = 0.000). Despite the fact that most hospitals and health centers have established infection control policies and protocols, the results of this study indicate the presence of pathogenic microorganisms in blood pressure cuffs in the clinical setting.

Self-Efficacy in the Cannulation Technique for Intraosseous Access in Pediatric Cardiac Arrest: Egg Versus Bone.

OBJECTIVES: The use of intraosseous (IO) access is recommended in cardiac arrest when peripheral venous access is not accessible. Various methodologies exist that are used for teaching and learning about cannulation of the IO route both in education and in research. The purpose of the present study was to compare self-efficacy in the cannulation technique for IO access through different techniques. METHODS: A randomized comparative study was conducted. A total of 118 nursing students participated. The participants were randomly distributed into 2 intervention groups: chicken bone and egg. A checklist was used for data collection to evaluate the IO cannulation technique in nursing students and another to analyze self-efficacy. RESULTS: The average total score of self-efficacy for all participants was 8.84 (standard deviation (SD) = 0.98). No statistically significant differences were found when comparing the total self-efficacy score and the intervention group ( U = 1604.500; z = -0.733; P = 0.463). No statistically significant differences were found between both groups for the average total score of the procedure ( U = 6916.500; z = -0.939; P = 0.348). The egg group carried out the IO cannulation procedure in a significantly less amount of time (M = 126.88, SD = 82.18) than the chicken bone group (M = 183.77, SD = 108.28), finding statistically significant differences ( U = 4983.500; z = -5.326; P < 0.001). CONCLUSIONS: Using an egg to teach and learn about IO access could be considered a methodology that is equally effective as using a chicken bone, with the advantage of achieving IO access in a lesser amount of time.

Implementation of a neonatal donation protocol in the neonatal intensive care unit: A single-center experience.

BACKGROUND: Lack of specific protocols for neonatal donation contributes to the rarity of neonatal donors. In this study, we evaluate the impact of the implementation of a neonatal donation protocol in our NICU. METHODS: In this single-center study, we conducted a retrospective chart review of neonatal deaths in our NICU from January 2013 to January 2022. The study was divided into two periods: before and after the implementation of a neonatal donation protocol. The referral rates of potential neonatal donors to the OPO in the two periods were compared using the chi-square test. A p value < .05 was considered statistically significant. RESULTS: Sixty-four infants were reviewed. Seven (10.9%) met the inclusion criteria for potential neonatal donors after DCC. The referral rate of potential neonatal donors increased from 2.5% to 16.7% after the implementation of this protocol (p = .041), and one infant (4.1%) became an effective heart-valve donor. CONCLUSION: The implementation of a local neonatal donation protocol could have contributed to increase the referral rate of potential neonatal donors in our NICU. Following the implementation of a local neonatal donation protocol, we were able to perform a heart-valve donation for the first time in our unit.

Time out! Pauses during advanced life support in high-fidelity simulation: A cross-sectional study.

BACKGROUND: Prolonged preshock pauses are associated with negative effects on patient outcomes and survival. A greater understanding of these pauses may help to improve the quality of advanced life support (ALS) and clinical outcomes. OBJECTIVE: The objective of this study was to identify the pauses that occur during ALS situations in high-fidelity simulation scenarios and the frequency and duration of these pauses. METHODS: One hundred forty-two nursing students participated in this cross-sectional study, involving high-fidelity simulation scenario of cardiorespiratory arrest in a simulated hospital room. Pauses were assessed using an observation checklist. RESULTS: Students performed the scenario in an average time of 8.32 (standard deviation = 1.13) minutes. Pauses between chest compressions were longer than recommended (mean = 0.36, standard deviation = 1.14). A strong positive correlation was found between the identification of the arrhythmia and the initiation of countershock (rs = 0.613, p < 0.001). CONCLUSIONS: Nursing students generally performed ALS within the time limits recommended by resuscitation guidelines. Early identification of shockable rhythms may lead to early nurse-initiated defibrillation. Strategies to speed up the identification of arrhythmias should be put in place to minimise preshock pauses and improve ALS outcomes.

Large vessel vasculitis secondary to granulocyte-colony stimulating factor.

Aortitis is a rare entity that may cause fever of unknown origin. This entity has a wide various etiologies, which main cause is rheumatologic, but not only. Iatrogenia has also been described, including chemotherapy and supporting treatment (like granulocyte-colony stimulating factor in oncological patients. The evidence in favour of this pharmacological link is growing. The differential diagnosis of fever, in febrile neutropenia setting, can be difficult to itemize.

Using a Mobile Phone Application Versus Telephone Assistance During Cardiopulmonary Resuscitation: A Randomized Comparative Study.

INTRODUCTION: In recent years, the way CPR instructions are given has changed because of the development of new technology that allows bystanders who witness a cardiac arrest to be guided in performing CPR. This study aimed to compare the effectiveness of using a mobile phone application (app) versus telephone operator assistance in performing cardiopulmonary resuscitation (CPR) techniques in simulated settings. METHODS: A comparative study was performed with 2 intervention groups: (1) mobile phone app and (2) telephone assistance. A total of 128 students participated and were distributed randomly into each intervention group. A CPR observation checklist and standard CPR quality parameter measurements were used for data collection. RESULTS: The group that used the app obtained better results than the group that had telephone assistance on 5 items during CPR observation: checking if the area is secure (X2(1) = 26.81; P < 0.05), asking for help (X2(1) = 66.07; P < 0.05), opening of airways (X2(1) = 12.03; P < 0.05), checking for breathing (X2(1) = 6.10; P < 0.05), and contacting emergency services (X2(1) = 12.41; P < 0.05). Regarding the skill level of CPR, no statistically significant differences were found when comparing the 2 intervention groups (X2(1) = 0.91; P = 0.33). As for the parameters measured, there were only statistically significant differences found in the item compression fraction (U = 1,593.00; Z = -2.16; P < 0.05), with the group that used the app obtaining better results. DISCUSSION: Better outcomes were observed in recognizing if the area was safe, asking for help, opening up the airways, checking for breathing, and calling emergency services in the mobile phone app group. However, the results indicated that there were no differences in the CPR parameters, except compression fraction, when the app was used as opposed to being guided by telephone.

Surveillance of transmitted drug resistance to integrase inhibitors in Spain: implications for clinical practice.

BACKGROUND: Integrase strand-transfer inhibitors (INSTIs) constitute at present one of the pillars of first-line ART. OBJECTIVES: To study the prevalence of and the trend in transmitted drug resistance (TDR) to INSTIs in ART-naive patients in Spain. METHODS: During the period 2012-17, 1109 patients from CoRIS were analysed. The Stanford algorithm v8.7 was used to evaluate TDR and transmission of clinically relevant resistance. To describe individual mutations/polymorphisms, the most recent IAS list (for INSTIs) and the 2009 WHO list update (for the backbone NRTIs used in combination with INSTIs in first-line treatment) were used. RESULTS: Clinically relevant resistance to the INSTI class was 0.2%: T66I, 0.1%, resistance to elvitegravir and intermediate resistance to raltegravir; and G163K, 0.1%, intermediate resistance to raltegravir and elvitegravir. No clinical resistance to dolutegravir or bictegravir was observed. The prevalence of INSTI TDR following the IAS-USA INSTI mutation list was 2.6%, with no trend towards changes in the prevalence throughout the study period. The overall prevalence of NRTI WHO mutations was 4.3%, whereas clinically relevant resistance to tenofovir, abacavir and emtricitabine/lamivudine was 1.7%, 1.9% and 0.7%, respectively. CONCLUSIONS: Given the low prevalence of clinically relevant resistance to INSTIs and first-line NRTIs in Spain, it is very unlikely that a newly diagnosed patient will present with clinical resistance to a first-line INSTI-based regimen. These patients may not benefit from INSTI and NRTI baseline resistance testing.

Cytomegalovirus reactivation in liver transplant recipients due to hepatitis C cirrhosis is associated with higher cardiovascular risk - an observational, retrospective study.

The association between cytomegalovirus (CMV) reactivation and cardiovascular risk has been reported in solid organ transplant populations; however, it has yet to be assessed in liver transplantation (LT). We aim to evaluate whether CMV reactivation is associated with cardiovascular events (CVE) in HCV-LT patients. LT patients (2010 and 2014) due to HCV cirrhosis were included. Clinically significant CMV (CS-CMV) was defined as viral load (VL) >5000 copies/ml, need of therapy or CMV disease. Baseline variables and endpoint measures (CVE, survival, severe recurrent hepatitis C, de novo tumors, and diabetes) were collected. One hundred and forty patients were included. At LT, a history of AHT was present in 23%, diabetes 22%, tobacco use 45%, obesity 20%, and renal impairment (eGFR < 60 ml/min) in 26.5%. CS-CMV reactivation occurred in 25% of patients. Twenty-six patients (18.5%) developed a CVE. Cox regression analysis revealed two factors significantly associated with CVE: Pre-LT DM [HR = 4.6 95% CI (1.6, 13), P = 0.004] and CS-CMV [HR = 4.7 95% CI (1.8, 12.5), P = 0.002]. CS-CMV was not independently associated with the remaining endpoints except for survival (P = 0.03). In our series, CS-CMV reactivation was associated with a greater risk of developing CVE, thus confirming data from other solid organ transplant populations and emphasizing the need for adequate CMV control.

Prevalence, Incidence, and Sex Ratio of Transsexualism in the Autonomous Region of Madrid (Spain) According to Healthcare Demand.

In recent years, different studies have provided estimates of the prevalence of transsexualism with very diverse results. The purpose of this study was to ascertain the prevalence, incidence, and sex ratio of transsexualism in the autonomous region of Madrid (Spain). A total of 1234 patients who attended from 2007 to the end of 2015 in the only Gender Identity Unit (GIU) in Madrid were analyzed. Sixty-three patients were excluded for various reasons; thus, 1171 could be included: 803 male-to-female (MtF) and 368 female-to-male (FtM) transsexual patients. Transsexualism was diagnosed based on the ICD-10, World Health Organization, 1992, and/or gender identity disorder based on the DSM-IV-TR, American Psychiatric Association, 2000. The demographic statistics were calculated on the basis of the population over 15 years old of Madrid. Based on healthcare demand, the prevalence of transsexualism was 22.1 in 100,000 inhabitants: 31.2 for MtF and 12.9 for FtM, making the MtF/FtM ratio approximately 2.2:1. The incidence rate was 2.5 in 100,000 inhabitants, representing an annual average of 130 demands. Although transsexualism occurs in all countries with different rates of prevalence, in our area, this prevalence was higher than reported from other European countries. We believe that two main circumstances might influence this high prevalence: the easy accessibility and the absence of a waiting list to the GIU, and the permissive social and legal climate and openness of Spain, especially in Madrid.

Disseminated infection due to Saksenaea vasiformis secondary to cutaneous mucormycosis.

Mucormycosis is an uncommon opportunistic fungal infection caused by Zygomycetes. It usually affects immunocompromised, diabetic and trauma patients with infected wounds. We report a case of disseminated infection secondary to facial cutaneous mucormycosis caused by Saksenaea vasiformis in a diabetic patient who had a farming accident causing him severe head injury. The patient was treated with a combination of surgical debridement and antifungal therapy with liposomal amphotericin B, but he had a slow and fatal outcome. In cases of tissue necrosis following trauma involving wound contact with soil (i.e., potential fungal contamination), testing for the presence of Zygomycetes fungi such as S. vasiformis in both immunocompetent and immunocompromised patients is crucial. The reason is that this infection usually has a rapid progression and may be fatal if appropriate treatment is not administered.

Guess it (SVUAL): An app designed to help nursing students acquire and retain knowledge about basic and advanced life support techniques.

To design an app that helps nursing students to acquire and retain knowledge of Basic and Advanced Life Support techniques, as well as analyze the students' gamification experience. The study had two phases: 1) App design and development and 2) experimental study. A total of 184 students participated, with 92 in the experimental group and 92 in the control group. The instruments used were the Guess it (SVUAL) app, a test on knowledge and the Gameful Experience Scale. The app was deemed to have a suitable level of content and user-friendliness of 97%. The experimental group obtained a higher average score on the knowledge test than the control group (U = 2835.500; Z = -3.968; p < 0.05). On the re-test, the experimental group also obtained a higher average score than the control group. As for the experience within the game, all the dimensions scored higher than average, except the absence of negative effects dimension, which indicates that the app had very few negative consequences on the participants. The developed app has proven to have a good level of content and to be user-friendly, improving knowledge levels and retention of information in nursing students.

The Influence of Gamification on Decision Making in Nursing Students.

BACKGROUND: Gamification provides nursing students with a setting in which they can practice clinical reasoning and decision making in a realistic and secure way. The purpose of this study was to determine the influence of gamification on decision making in nursing students. METHOD: A quasi-experimental study was performed with a control group and an experimental group. A convenience sample was used to select the participants. A total of 191 nursing students participated. Participants were randomly assigned to one of the groups. RESULTS: On comparing the control group and experimental group, statistically significant differences were found in the following patterns: vigilance, buck passing, and procrastination. CONCLUSION: Using gamification as part of nursing education increases satisfaction, creative thinking, and control, among other aspects, with little to no negative effects throughout the experience, which has a significant impact on decision making. [J Nurs Educ. 2019;58(12):718-722.].

How to measure gamification experiences in nursing? Adaptation and validation of the Gameful Experience Scale [GAMEX].

BACKGROUND: There has been an increasing amount of research in the last few years on the use of gamification in nursing. However, there is not yet a suitable measuring instrument that fully captures the emotional qualities that arise with the use of gamification. OBJECTIVES: To culturally adapt and validate the Gameful Experience Scale used among nursing students as well as understand their game experience. DESIGN: The study was divided into two phases 1) cross-cultural adaptation and 2) validation of the scale and cross-sectional descriptive study. SETTINGS: Faculty of Health Sciences at the University of Almeria, Spain. PARTICIPANTS: 226 students studying an undergraduate nursing degree. METHODS: In the first phase, a cross-cultural adaptation was carried out using a forward-back translation, with the collaboration of a panel of experts. In the second phase, the corresponding analyses were performed, to measure the reliability and the validity of the instrument. RESULTS: The Kaiser-Meyer-Olkin test that measures the appropriateness of the sample had a result of 0.875. Bartlett's sphericity test was significant (X2(351) = 3755.142, p < 0.05). A structure of 6 factors was confirmed. The total Chronbach α value was 0.855. In the analysis of the test-retest reliability, a correlation level of 0.89 was obtained (p < 0.05). The participants showed high scores in all the dimensions, except that of absence of negative effects. CONCLUSIONS: The adapted version of the scale showed good results in regards to reliability and validity, which indicates that it is an effective tool to be used to measure the game experience in nursing students' training.

Porosity Effect on Thermal Properties of Al-12 wt % Si/Graphite Composites.

The effect of porosity on the thermal conductivity and the coefficient of thermal expansion of composites obtained by infiltration of Al-12 wt % Si alloy into graphite particulate preforms has been determined. Highly irregular graphite particles were used to fabricate the preforms. The thermal conductivity of these composites gradually increases with the applied infiltration pressure given the inherent reduction in porosity. A simple application of the Hasselman-Johnson model in a two-step procedure (that accounts for the presence of both graphite particles and voids randomly dispersed in a metallic matrix) offers a good estimation of the experimental results. As concerns the coefficient of thermal expansion, the results show a slight increase with saturation being approximately in the range 14.6-15.2 × 10-6 K-1 for a saturation varying from 86% up to 100%. Results lie within the standard Hashin-Strikman bounds.

Nosocomial fungemia by Candida auris: First four reported cases in continental Europe.

BACKGROUND: Candida auris is an emerging multidrug-resistant yeast that can cause invasive infections and is associated with high mortality. It is typically resistant to fluconazole and voriconazole and, some cases, also to echinocandins and amphotericin B. This species, phylogenetically related to Candida haemulonii, is frequently misidentified by commercial identification techniques in clinical laboratories; therefore, the real prevalence of C. auris infections may be underestimated. AIMS: To describe the clinical and microbiological features of the first four cases of C. auris fungemia episodes observed in the European continent. METHODS: The four patients were hospitalized in the adult surgical intensive care unit. A total of 8 isolates (two per patient) from blood and catheter tip were analyzed. RESULTS: All isolates were misidentified as Saccharomyces cerevisiae by AuxaColor 2, and as Candida sake by API ID20C. VITEK MS technology misidentified one isolate as Candida lusitaniae, another as C. haemulonii and could not identify the other six. C. auris identification was confirmed by ITS rDNA sequencing. All isolates were fluconazole (MIC >256mg/l) and voriconazole (MIC 2mg/l) resistant and susceptible to posaconazole, itraconazole, echinocandins and amphotericin B. CONCLUSIONS: C. auris should be regarded as an emerging pathogen, which requires molecular methods for definitive identification. Our isolates were highly resistant to fluconazole and resistant to voriconazole, but susceptible to the other antifungals tested, which emphasizes the importance of accurately identifying this species to avoid therapeutic failures.

Body image in persons with gender dysphoria.

BACKGROUND: For subjects with gender dysphoria, body image is an important aspect of their condition. These people sometimes exhibit a strong desire to change their primary and secondary sexual characteristics. In addition, idealization of beauty has grown in importance and it may increase body dissatisfaction. The aim of this paper is to analyze whether body dissatisfaction in people with gender dysphoria is similar to that in clinical population or if it is more similar to that which may appear in general population. We also looked at gender differences in body dissatisfaction. METHODS: A set of questionnaires was administered to patients with gender dysphoria: Eating Attitudes Test (EAT- 26), body dissatisfaction sub-scale of Eating disorder inventory-two (EDI-2) and IMAGEN questionnaire. RESULTS: In the case of body dissatisfaction subscale of Eating disorder inventory-two with a cut-off 11; body dissatisfaction in our sample was close to the level presented in clinical population. However, using cut-off points 14 and 16, they exhibited a body dissatisfaction level that was similar to the general population. The same occurred for the IMAGEN questionnaire. No gender differences were found when looking at the level of dissatisfaction. CONCLUSIONS: The data seem to indicate that people with gender dysphoria would be at an intermediate point in relation to body dissatisfaction between general population and clinical population; in both female and male transsexuals. It seems that some level of body dissatisfaction may be perceived in relation to the ideal of beauty, but this dissatisfaction is significantly lower than in clinical populations.

INTRODUCCIÓN : Para las personas con disforia de género, la imagen corporal es un aspecto fundamental en su condición. Estas personas a veces manifiestan un fuerte deseo de cambiar sus caracteres sexuales primarios y secundarios. Además, socialmente el ideal de belleza ha ido cobrando cada vez más importancia pudiendo incrementar la insatisfacción corporal. El objetivo de este trabajo es analizar si la insatisfacción corporal en personas con disforia de género es similar a la que presenta la población clínica o si está más cerca de la que pudiera presentar la población general, así como la diferencia por géneros. MÉTODOS: Se administraron a personas con disforia de género una batería de cuestionarios en los que se incluyeron el Test de Actitudes hacia la Alimentación, la subescala de insatisfacción corporal del Inventario para los Trastornos de Alimentación y el cuestionario IMAGEN. RESULTADOS: En el caso de la subescala de insatisfacción corporal del Inventario para los Trastornos de Alimentación, con un punto de corte 11 la insatisfacción corporal de nuestra muestra estaría cercana al nivel de la población clínica. Sin embargo, usando los puntos de corte 14 y 16 si presentarían una insatisfacción corporal cercana a la población general, lo mismo para el IMAGEN. No se encontraron diferencias por géneros respecto al nivel de insatisfacción. CONCLUSIONES: Los datos parecen apuntar a que las personas con disforia de género estarían en un punto intermedio en lo que se refiere a insatisfacción corporal entre la población general y la población clínica, tanto transexuales femeninas como masculinos. Parece ser que hay cierta insatisfacción corporal que pueden percibir en relación al ideal de belleza pero esta insatisfacción es bastante menor que la que pueden tener poblaciones clínicas.

Prevalence of hyperandrogenism and polycystic ovary syndrome in female to male transsexuals.

INTRODUCTION: Prevalence of hyperandrogenism (HA), including the polycystic ovary syndrome (PCOS), in female-to-male transsexuals (FMT) is high. This has been related to metabolic syndrome (MS), which appears to increase cardiovascular morbidity and mortality throughout cross-sex hormone (CSH) therapy. OBJECTIVES: To assess the prevalence of HA and PCOS in FMT patients before the start of CSH therapy, and their association to MS and its components, insulin resistance (IR) and other cardiovascular risk (CVR) factors. MATERIALS AND METHODS: Seventy-seven FMTs underwent clinical and biochemical assessment for HA before the start of CSH therapy. CVR, IR, and other MS parameters were also assessed. RESULTS: Prevalence of HA was 49.4% (73.7% were cases of PCOS [Rotterdam criteria]), and prevalence of PCOS in the overall sample was 36.4%. Prevalence of MS was 38.4% and 51.7% according to ATP-III and IDF criteria respectively). MS (according to ATP-III and IDF criteria respectively) was found in 36.8% and 57.9% as compared to 25.6% and 41% of patients with and without HA respectively (p<0.0001 and P<0.01 respectively). Of total patients, 54.5% had normal weight (body mass index [BMI] 18.5-24.9 kg.m(-2)), 26% were overweight (BMI 25-29.9 kg.m(-2)), and 19.5% were obese (BMI ≥ 30 kg.m(-2)). After adjusting for BMI, the comparison of hormonal, metabolic, and anthropometric parameters showed statistically significant differences in plasma glucose, HOMA-IR, and abdominal circumference (P<0.001 for all), as well as HDL cholesterol (HDL) (P=0.033), but not in total testosterone or calculated free testosterone levels. In the total sample, 27.3% had HDL levels less than 50mg/dL. CONCLUSIONS: Overall HA, and PCOS in particular, are highly prevalent in FMTs. HA and PCOS are related to early development of SM, IR, and other CVR factors with unknown consequences in adulthood.

[Automatic detection of bacterial and fungal infections in blood]. / Detección automática de bacterias y hongos en sangre.

Sepsis is one of the main causes of mortality and morbidity in hospitals. Early detection of pathogens using nucleic acid-based techniques speeds diagnosis of bacteremia and/or fungemia, aids the rapid application of appropriate antibiotics, reduces the use of unnecessary antibiotics, and lowers mortality. Two commercially available techniques that help to identify different sepsisproducing bacteria and fungi in a shorter time period are: LightCycler SeptiFast Test Mgrade (Roche Diagnostic SL) and GenoType Blood Culture (Hain Lifescience). We present the results of an initial in-house study using the LightCycler SeptiFast Test Mgrade. The study was carried out in 50 samples from 28 patients (1-3 samples per patient) with septic syndrome admitted to the intensive care unit by comparing the new technique with conventional blood culture. The concordance between the results of blood culture and SeptiFast was good, 79%, in the first trial and 89% in the second, after correcting for technical defects. We initially observed substantial inhibition of internal controls in Gram-negative bacilli, due to the presence of heparin in the blood used, and excess DNA because of the high number of leucocytes. To minimize these inhibitions, the second study used 24 samples at half the original volume (extracted DNA at 1/4 concentration). With these modifications, inhibitions were substantially reduced. SeptiFast is more effective than blood culture in discriminating between contamination by coagulase-negative staphylococci and species of streptococci.