Cristina Rivera-Picón

Background/Objectives: Arteriovenous fistulas are the preferred vascular access for hemodialysis, but difficult or unsuccessful cannulation may cause pain, complications, and access dysfunction. This review evaluated whether ultrasound-guided cannulation improves outcomes compared with standard cannulation. Methods: A systematic review was conducted according to PRISMA guidelines. PubMed, Web of Science, Scopus, CINAHL, Cochrane Library, and ClinicalTrials.gov were searched for randomized controlled trials comparing ultrasound-guided and standard arteriovenous fistula cannulation in hemodialysis patients. Findings were synthesized narratively. Risk of bias was assessed using RoB 2, and certainty of evidence using GRADE. Results: Of 1210 records identified, five randomized trials involving 142 patients were included. Some trials reported improved cannulation success or lower pain with ultrasound guidance, but findings varied across populations and outcome measures. Three of four trials reporting procedure time found longer durations with ultrasound guidance. A consistent reduction in complications or improvement in patient satisfaction was not established. Staff findings mainly concerned confidence and acceptability. The certainty of evidence was low. Conclusions: The effects of ultrasound-guided AVF cannulation on pain varied across trials. These uncertain findings should be interpreted alongside the longer procedure times reported in several trials. Larger randomized trials with clearly defined outcomes and analyses accounting for repeated observations are needed before recommending routine use.

Introduction: Diabetes mellitus (DM) significantly impacts emergency medical services (EMS) and complicates acute illness prognoses. This study aimed to evaluate the effect of DM on 2‐year mortality in patients admitted to emergency departments (EDs), compare diabetic and nondiabetic groups, and identify key mortality predictors. Methods: A prospective cohort study in Spain (2019–2022) included adults with acute illnesses transported by the EMS. Diabetic patients were grouped by the presence of complications. The primary outcome was 2‐year mortality; secondary outcomes included ICU and ward admissions. Survival and mortality predictors were assessed via Kaplan–Meier and Cox regression analyses. Results: Among 5963 patients, 25.4% ( n = 1513) died within a 2‐year period. Mortality was significantly greater in diabetic patients with complications (41.5%) than in diabetic patients without complications (27.6%) and nondiabetic patients (21.8%) ( p < 0.001). The main risk factors for mortality include advanced age and elevated lactate, leukocyte, and bilirubin levels in diabetic patients with complications. The protective factors were higher Glasgow Coma Scale (GCS) scores and hemoglobin levels. Survival curves revealed a sharp decline in the group of diabetic patients with complications during the acute phase. Conclusion: Diabetes, particularly complications, significantly increases short‐ and medium‐term mortality in patients with acute illnesses treated with emergency services. The results of this study highlight the need for a more thorough and early risk assessment in these patients, as the factors influencing their prognosis differ significantly from those in nondiabetic patients. This differential approach could improve clinical management and long‐term outcomes.

Background/Objectives: Differences between rural and urban settings, as well as between emergency medical service (EMS) systems, may influence short-term mortality among patients attended in the prehospital setting. The aim of this study was to determine the associations of rurality and the US and Spanish EMS health systems with patient mortality. Methods: This was a multicenter, EMS-based, observational study involving a prospective dataset, the Salud de Castilla y Leon dataset (SACYL) from Spain, and a retrospective dataset, the National Emergency Medical Services Information System (NEMSIS) from the US. All consecutive EMS activations of adult patients (≥18 years) requiring high-priority transport to emergency departments were included in the analysis. The collected variables included demographic characteristics, EMS transport characteristics, case characteristics, and rural or urban origin. The primary outcome was 2-day, short-term mortality. Results: A total of 54,981 EMS activations were considered from both datasets. The mortality rate was 8.47% for rural areas and 11.8% for urban areas (p < 0.001). Multivariable analyses showed that mortality patterns differed according to geographic setting and EMS system. Male sex and the use of advanced life support were associated with higher odds of mortality in several models, while prehospital time intervals and call characteristics showed context- and system-dependent associations, including protective effects in specific subgroups. Conclusions: Short-term mortality differed between rural and urban settings, with heterogeneous patterns across EMS systems. These findings highlight the importance of considering both geographic context and system-level organizational characteristics when evaluating prehospital care and mortality outcomes.

Alcohol consumption in university students is a public health problem that is especially relevant nursing students because of their role as future health p

Background/Objectives: Emergency medical services (EMSs) are essential for reducing mortality among critically ill patients. This study aims to evaluate the influence of temporal factors, such as time of day, day of the week, month, and year, on mortality in EMS activations, comparing health systems in the U.S. and Spain. Methods: This multicenter observational study, which is based on two databases (Spain’s Sacyl and the U.S.’s NEMSIS), analyzed EMS activation in high-priority adult patients (>18 years) between 2018 and 2023. Demographic variables, transport characteristics, and response times were included. Short-term mortality was the primary outcome. Results: A total of 54,981 EMS activations (11,713 from the Sacyl dataset and 43,268 from the NEMSIS dataset) were analyzed. Mortality was higher among older patients and males, with significant increases during shifts from 06:00 to 12:00 and from 18:00 to 24:00. Mortality also varied by year, with higher rates in 2022 and 2023 than in 2018. Notable differences were observed between the U.S. and Spain, especially in shifts and months, with higher mortality during the 12:00 to 18:00 shift and in October in the NEMSIS cohort. Conclusions: These findings have direct implications for emergency medical service operations, suggesting that resource allocation, staffing models, and clinical protocols should be strategically optimized based on temporal risk patterns to improve patient outcomes during identified high-risk periods.

Background/Objectives: This study aimed to determine the effects of weight gain and fatigue on nursing students performing high-fidelity cardiopulmonary resuscitation (CPR) simulation. Methods: A simulation-based research study (with or without a vest) was performed at the Faculty of Health Sciences, University of Castilla la Mancha (Spain), with volunteer nursing students. Vital signs, pain scale, pupillary sizes, analytical parameters, and lifestyle habits were evaluated before, during, and after CPR. The differences between groups were assessed by ANOVA for time and group factors. Results: A total of 31 participants met the inclusion criteria, 15 subjects without a vest and 16 subjects with a vest. The ANOVA results revealed that all the variables presented statistically significant time effects, except for glucose. For the group effect, heart rate, lactate, and cortisol presented statistically significant differences between subjects with and without vests. Conclusions: Vital signs and physiological variables increased during CPR with vests. This could negatively impact the CPR procedure. The implementation of physical training programs aimed at improving the performance of future health professionals during CPR should be studied.

Background/Objective: One of the life stages that affects the consolidation of habits and health is the university stage. This transition to adulthood is associated with a decrease in physical activity, increasing the risk of cardiovascular disease. This study describes lifestyle habits related to physical activity level, diet quality, and body composition in nursing students and analyzes cardiovascular risk using the ABSI-z index. Methods: We conducted a cross-sectional study with 296 students from the Faculty of Nursing of Albacete (Spain). Physical activity was assessed via the IPAQ-SF. Body composition was measured by bioimpedance, from which BMI and ABSI-z scores were obtained as indicators of cardiovascular risk. The eating patterns of the participants were analyzed. Results/Discussion: The active students had significantly better body composition, with greater fat-free mass and muscle mass than the sedentary students, both in men (p = 0.037 and p = 0.046, respectively) and in women (p = 0.002 and p = 0.007). These findings corroborate evidence of the protective role of physical activity in maintaining metabolic health. The analysis of the ABSI-z score revealed different patterns in the distribution of body fat. High ABSI values were associated with greater abdominal girth (p < 0.001) and visceral fat (p < 0.001) in women, confirming its usefulness as an early marker of cardiovascular risk in university students. In contrast, the fulfillment of healthy dietary criteria was low, especially in the consumption of legumes (19%) and fish (25.9%). Conclusions: Regular physical activity is a determining factor in the body composition of university students, and ABSI is a good indicator of cardiovascular risk.

Background/Objectives: University students frequently engage in risky alcohol consumption, making them a priority population for targeted interventions. Motivational interventions (MIs) have been widely implemented to address this issue, but evidence of their effectiveness remains heterogeneous. This study aimed to evaluate the efficacy of MIs in reducing alcohol consumption and related harm among university students through a systematic review and meta-analysis. Methods: A systematic search was conducted in PubMed, Scopus, and BVS Library, including randomized controlled trials (RCTs) published up to April 2025. The PRISMA and RoB-2 tools guided reporting and risk of bias assessment. Random-effects models were applied to pool effect sizes for changes in alcohol consumption patterns and related consequences. Results: Fifteen RCTs were included. MIs significantly reduced daily alcohol intake (−0.55 drinks/day; 95% CI: −0.78 to −0.32), with additional reductions in weekly consumption and binge drinking episodes, though these were not statistically significant. Positive effects were also observed in reducing alcohol-related consequences and blood alcohol concentration levels. Short, single-session formats (45–90 min) showed consistent efficacy across studies, with effects sustained at 2–3 months and, in some cases, up to one year post-intervention. Conclusions: MIs are effective, brief, and adaptable strategies for reducing harmful alcohol use and associated negative outcomes among university students. Their simplicity, feasibility, and sustained effects make them valuable tools for university health programs. Future research should focus on optimizing intervention components and evaluating their effectiveness in diverse cultural and socioeconomic contexts.