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Pedreira-Robles G, Garcimartín P, Sevilla-Guerra S, Bach-Pascual A, García-Martínez M, Morín-Fraile V. Nurse-led clinical activity in kidney transplantation care in Spain: A cross-sectional observational study. J Ren Care 2024; 50:168-175. [PMID: 36906846 DOI: 10.1111/jorc.12463] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/11/2023] [Accepted: 02/25/2023] [Indexed: 03/13/2023]
Abstract
OBJECTIVES To explore the presence of specialist outpatient nursing activity in care for kidney transplant recipients in Spain and to determine the level of competence development of this activity according to the Advanced Practice Nurse model. DESIGN Descriptive, cross-sectional study. PARTICIPANTS AND MEASUREMENTS All outpatient nurses specialising in renal transplantation in the 39 transplant hospitals in Spain were included. To fulfil the study objectives, an ad hoc questionnaire and the 'Advanced Practice Nurse Role Definition Instrument (IDREPA)' were administered to assess the nurses' level of competence development. RESULTS Of the facilities included in the study, 25 (64.1%) had posttransplant nursing activity, 13 (33.3%) had pretransplant nursing activity and 11 (28.2%) had nursing activity involving kidney donor candidates. Twenty-seven specialist nurse's offices were identified. The results of the IDREPA reflect the presence of advanced practice in the domains of 'expert care planning' and 'comprehensive care'. Three (11.1%) nurses met all criteria for advanced nursing practice. CONCLUSION The results on specialised outpatient nursing activity at the 39 transplantation facilities in Spain indicate a low presence of this type of activity, with an even lower presence of advanced practice nurses. IMPLICATIONS FOR CLINICAL PRACTICE Management teams should consider investing in the quality of care provided by advanced nurse practice to ensure that suitable treatment is provided and better clinical outcomes are obtained.
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Affiliation(s)
- Guillermo Pedreira-Robles
- Nephrology Department, Hospital del Mar, Barcelona, Spain
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra affiliated, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Nursing and Health PhD Programme, University of Barcelona, Barcelona, Spain
| | - Paloma Garcimartín
- Nursing direction, Hospital del Mar, Barcelona, Spain
- Department of Biomedical Research in Heart Diseases, Hospital del Mar Institute for Medical Research (IMIM), Barcelona, Spain
| | - Sonia Sevilla-Guerra
- Gerència de Processos Integrats de Salut, Àrea Assistencial, Catalan Health System, Barcelona, Spain
| | | | | | - Victoria Morín-Fraile
- Department of Public Health, Mental and Maternal and Child Health, Nursing School, University of Barcelona, Barcelona, Spain
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Guerrero-Menéndez R, Fontán-Vinagre G, Cobos-Serrano JL, Ayuso-Murillo D. The advancement of critical care nursing as a response to the current demands. ENFERMERIA INTENSIVA 2024:S2529-9840(24)00017-X. [PMID: 38806311 DOI: 10.1016/j.enfie.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/22/2024] [Indexed: 05/30/2024]
Abstract
The current demand on health services requires that nurses play a key role, by adapting their competencies to different fields and complexity levels. The approach of situations presented by critically ill patients underpins the need for development of specialised competencies in specific areas such as patient safety, prevention and control of healthcare-associated infections, performance of specific techniques and interventions, autonomous medication management or the use of technology, among others. Spain relies on a specialist training programme that is unique worldwide. Training admission is managed through a contract as a "Resident Nurse Intern" (EIR, Enfermera Interna Residente), provided by regional healthcare services. Only 6 specialities have been established and developed, in an uneven manner and with a short provision of places, annually. Given that the specialization in critical care nursing does not exist, nurses usually self-fund their postgraduate training to enhance their opportunities career development. The development of a speciality for critical care nursing is a priority. The models proposed advocate for creating nursing roles that could cover the systemic gaps through the expansion of their competencies and the introduction of procedures that fit nursing into advanced practice, which could be achieved through Advanced Accreditation Diplomas. Simultaneously, it would be convenient to analyse how and why such a dynamic discipline in some countries became stuck in anachronistic models of the Spanish healthcare system. This analysis might contribute to move forward on the development of areas of improvement in terms of service access and quality of care.
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Affiliation(s)
- R Guerrero-Menéndez
- Instituto Español de Investigación Enfermera, Consejo General de Colegios Oficiales de Enfermería de España, Madrid, Spain.
| | - G Fontán-Vinagre
- Instituto Español de Investigación Enfermera, Consejo General de Colegios Oficiales de Enfermería de España, Madrid, Spain
| | - J L Cobos-Serrano
- Consejo General de Colegios Oficiales de Enfermería de España, Madrid, Spain
| | - D Ayuso-Murillo
- Consejo General de Colegios Oficiales de Enfermería de España, Madrid, Spain
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Muñoz-Villaverde S, Martínez-García M, Serrano-Oviedo L, Sobrado-Sobrado AM, Cidoncha-Moreno MÁ, Garcimartin P. Professional competencies of oncology nurses: Recognizing advanced practice in nursing. ENFERMERIA CLINICA (ENGLISH EDITION) 2023; 33:338-345. [PMID: 37543360 DOI: 10.1016/j.enfcle.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 06/30/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVE To identify the competency profile of advanced practice nurses involved in the care process of cancer patients. METHODS Cross-sectional and descriptive study. The study included all nurses involved in the cancer patient care process in a tertiary hospital in Barcelona. Competence profile data were collected using the instrument for defining the role of the advanced practice nurse (APRD), as well as sociodemographic and occupational variables. Sociodemographic and occupational data were compared against the performance of advanced practice activities. RESULTS A total of 29 (82.9%) nurses participated with a mean age of 42.6±12.54 years. 9 (31%) nurses were identified as meeting the standard in all 6 domains on the APRD scale to be considered advanced practice nurses. Of these 9 (31%) nurses, 7 (24.1%) met the training standards required by the International Council of Nurses (ICN) with an official master's degree and 2 (6.9%) with a PhD. CONCLUSIONS There are nurses who carry out their activity in the oncology field of the hospital analyzed with the EPA profile. The identification of advanced practice nurses (APNs) in our health system is essential to be able to recognize the competencies of these professionals and create specific positions that help to address chronicity, patients' quality of life, their survival, and the optimization of health resources. Our study highlights the importance of chronicity and cancer as areas for the development of the APNs.
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Affiliation(s)
- Sergio Muñoz-Villaverde
- Unidad de ensayos clínicos de oncología, Hospital del Mar, Barcelona, Spain; Programa de investigación en cáncer, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain; Centro de Atención Primaria Casc Antic, Instituto Catalán de Salud, Gerencia territorial de Barcelona, Barcelona, Spain.
| | - María Martínez-García
- Unidad de ensayos clínicos de oncología, Hospital del Mar, Barcelona, Spain; Programa de investigación en cáncer, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain; Departamento de oncología médica, Hospital del Mar, Barcelona, Spain
| | - Leticia Serrano-Oviedo
- Unidad de Investigación Traslacional, Hospital General Universitario de Ciudad Real, Servicio de Salud de Castilla-La Mancha (SESCAM), Ciudad Real, Spain
| | | | | | - Paloma Garcimartin
- Dirección Enfermera, Hospital del Mar, Barcelona, Spain; Grupo de Investigación en Cuidados de Enfermería, IMIM (Instituto Hospital del Mar de Investigaciones Médicas), Barcelona, Spain
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Pedreira-Robles G, Morín-Fraile V, Bach-Pascual A, Redondo-Pachón D, Pérez-Sáez MJ, Crespo M, Falcó-Pegueroles A, Garcimartín P. The role of Advanced Practice Nurses in creating the Kidney Transplant candidate care map (APN-preKT): a convergent-parallel mixed methods research protocol. BMC Nurs 2023; 22:44. [PMID: 36797711 PMCID: PMC9936119 DOI: 10.1186/s12912-023-01193-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Waiting time for kidney transplants (KT) is an important health determinant for patients with chronic kidney disease (CKD). During this time, ongoing evaluation and participation is necessary in order to guarantee the quality and suitability of the proposed treatment. There is no existing literature on the potential impact of inclusion of an Advanced Practice Nurse (APN) role in the hospital setting on care for CKD patients who are candidates for KT. The main objectives of this protocol are: to analyse outpatient nursing activity in the care of individuals with KT in Spain; to identify the needs of individuals who are KT candidates; and to measure the impact of the APN role through patient outcomes and experiences. These objectives are fulfilled through 5 specific related substudies. METHODS A convergent parallel mixed methods approach will be conducted between July 2021 and April 2024. Quantitative and qualitative data will be collected and analysed separately to ascertain whether the findings confirm or contradict one another. Each of the 5 substudies of the project require a specific design, sampling method, and data collection procedure in order to meet the overall objectives for the project. DISCUSSION The results of the project are expected to inform the design of future nursing roles and contribute to future improvements in the quality of care provided. The data that may be obtained from this protocol are limited to the specific context of the study facility and may be extrapolated but not compared to other settings due to the variability of care pathways for KT candidates internationally. TRIAL REGISTRATION This project was approved by the Clinical Research Ethics Committee (no.2020/9418/I). The study was supported by the "Strategic Plan for Health Research and Innovation" from the Generalitat de Catalunya, registration number SLT017/20/000001, with a contribution of 57,239 euros.
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Affiliation(s)
- Guillermo Pedreira-Robles
- grid.411142.30000 0004 1767 8811Nephrology Department, Hospital del Mar, Barcelona, Spain ,grid.418476.80000 0004 1767 8715ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra affiliated, Barcelona, Spain ,grid.411142.30000 0004 1767 8811SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain ,grid.5841.80000 0004 1937 0247PhD Candidate, Nursing and Health PhD Programme, University of Barcelona, Barcelona, Spain
| | - Victoria Morín-Fraile
- Department of Public Health, Mental Health, and Maternal and Child Health Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
| | - Anna Bach-Pascual
- grid.411142.30000 0004 1767 8811Nephrology Department, Hospital del Mar, Barcelona, Spain
| | - Dolores Redondo-Pachón
- grid.411142.30000 0004 1767 8811Nephrology Department, Hospital del Mar, Barcelona, Spain ,grid.20522.370000 0004 1767 9005Kidney Research Group (GREN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - María José Pérez-Sáez
- grid.411142.30000 0004 1767 8811Nephrology Department, Hospital del Mar, Barcelona, Spain ,grid.20522.370000 0004 1767 9005Kidney Research Group (GREN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Marta Crespo
- grid.411142.30000 0004 1767 8811Nephrology Department, Hospital del Mar, Barcelona, Spain ,grid.20522.370000 0004 1767 9005Kidney Research Group (GREN), Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
| | - Anna Falcó-Pegueroles
- grid.5841.80000 0004 1937 0247Department of Fundamental Care and Medical-Surgical Nursing, School of Nursing, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Paloma Garcimartín
- grid.411142.30000 0004 1767 8811Chief Nursing Officer, Hospital del Mar, Barcelona, Spain ,grid.20522.370000 0004 1767 9005Department of Biomedical Research in Heart Diseases, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
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Jokiniemi K, Tervo‐Heikkinen T, Peltokoski J, Mikkonen S. Construct validity of Advanced Practice Role Delineation tool: A confirmatory factor analysis. Int J Nurs Pract 2022; 28:e13064. [PMID: 35633049 PMCID: PMC9788128 DOI: 10.1111/ijn.13064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 04/25/2022] [Indexed: 12/30/2022]
Abstract
AIM To test the psychometric properties and latent structure of the modified Strong Model of Advanced Practice tool. BACKGROUND The Strong Model of Advanced Practice tool, developed in the United States in 1990s and its Australia modification, has been increasingly used to delineate nursing and advanced practice nursing roles. Few research-driven efforts to develop and validate these tools have taken place. DESIGN Psychometric testing of the modified Strong Model of Advanced Practice tool. METHODS A confirmatory factor analysis was undertaken to examine the factors of the modified Strong Model of Advanced Practice tool and compare the model to the Australian Advanced Practice Role Delineation tool. The data were collected in September 2020. RESULTS The analysis of the data provided construct validity evidence of the underlying theoretical structures of the five-factor modified Strong Model of Advanced Practice tool. The 45-item modified Strong Model of Advanced Practice tool demonstrated satisfactory, slightly better psychometric properties and construct validity than the 40-item Advanced Practice Role Delineation tool. CONCLUSIONS Psychometric properties of the scale were evaluated and reported. Based on the statistical analysis, we suggest the use of the 45-item modified Strong Model of Advanced Practice tool.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, Faculty of Health SciencesUniversity of Eastern FinlandKuopio
| | - Tarja Tervo‐Heikkinen
- Clinical Development, Education and Research Centre of NursingKuopio University HospitalKuopioFinland
| | | | - Santtu Mikkonen
- Department of Environmental and Biological Sciences and Department of Applied PhysicsUniversity of Eastern FinlandKuopioFinland
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Jokiniemi K, Chair SY, Wong FKY, Bryant-Lukosius D. Advanced Practice Role Delineation Within Hong Kong: A Cross-sectional Study. Nurs Health Sci 2022; 24:679-689. [PMID: 35699666 PMCID: PMC9545430 DOI: 10.1111/nhs.12964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/26/2022] [Accepted: 06/04/2022] [Indexed: 11/30/2022]
Abstract
A career ladder for nurses, including several levels of nursing practice and specific roles for advanced practice nurses, was introduced in Hong Kong around the turn of the century. To date no studies have distinguished the practices of advanced practice nurses in Hong Kong. This cross-sectional study, conducted between November 2020 and March 2021, aims to identify and differentiate the practice patterns of advanced practice nurses by utilizing the Advanced Practice Role Delineation tool. A total of 191 responses was obtained. Three roles were identified: nurse consultant, advanced practice nurse, and advanced practice nurse in management. From the advanced practice nursing domains, the nurses were most frequently involved in Education and Direct Comprehensive Care activities, while Research and Publication and Professional Leadership activities were the least utilized. Identifying activities in various nursing roles helps to differentiate their responsibilities and provides new insights for role utilization and support. Although the role characteristics are shaped by country contexts, research evidence on practice patterns may be used to support international discussion and efforts to promote role clarity and effective role introduction and optimization.
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Affiliation(s)
- Krista Jokiniemi
- Department of Nursing Science, Faculty of Health Sciences, University of Eastern Finland, Yliopistonranta 1, 70211, Kuopio, Finland
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong, SAR, China.,The Hong Kong Academy of Nursing, Lai Chi Kok, Kowloon, Hong Kong, SAR, China
| | - Frances Kam Yuet Wong
- Faculty of Health & Social Sciences, Chair Professor of Advanced Nursing Practice, School of Nursing, The Hong Kong Polytechnic University, Hunghum, Hong Kong, China SAR
| | - Denise Bryant-Lukosius
- School of Nursing, McMaster University, HSC-2J20, 1280 Main St. West, Hamilton, Ontario, Canada
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Sevilla Guerra S, Zabalegui A, Comellas Oliva M, Estrem Cuesta M, Martín-Baranera M, Ferrús Estopà L. Advanced practice nurses: Analysis of their role from a multicentre cross-sectional study. Int Nurs Rev 2021; 69:30-37. [PMID: 34402064 DOI: 10.1111/inr.12706] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 06/04/2021] [Accepted: 07/19/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Stronger healthcare models are increasingly sought to address new population needs, health workforce inefficiencies and nursing shortages. One strategy is to focus on employees' strengths to capitalize on their competencies and maximize their scope of practice. INTRODUCTION Globally, there is an exponential demand for advanced practice nursing services. This study aimed to identify the roles and positions of nurses who align with APN defining criteria at all levels of care in Catalonia, Spain. METHODS The first step of the study included the translation and validation to Catalan of the Advanced Practice Nurse Role Delineation Tool (IDREPA) and step 2 comprised a multicentre cross-sectional study, in which 126 healthcare centres participated: 1209 nurses were included in the study. The STROBE checklist was used to report this study. RESULTS Transcultural equivalence and validation of the instrument showed a content validity index of 0.958 and the reliability of the questionnaire. The instrument identified 269 nurses who align with international APN defined criteria. They worked in specialized care, mental healthcare and primary and community care, especially in chronic conditions, ageing and end-of-life care. DISCUSSION Most areas of Catalonia have access to nurses practicing at APN defining criteria. These nurses were developed as an optimal resource to respond to patient needs in the context of study. Both recognition and strategic implementation are necessary to apply their full competencies to solve healthcare problems. CONCLUSION Understanding the supply of services delivered by nurses practicing at an advanced level and their scope of practice may lay the foundations for effective workforce planning in a dynamic context. Nurses who align with APN defining criteria are working mainly in large acute services without regulation and recognition. IMPLICATIONS FOR NURSING Advanced practice nurses show the value of their role and activities in healthcare services. IMPLICATIONS FOR HEALTH POLICY Promoting the establishment of APN defining criteria that includes credentialing and a regulatory framework within international guidelines should be a priority to make an impact on healthcare policy.
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Affiliation(s)
| | | | - Montserrat Comellas Oliva
- University School of Nursing and Occupational Therapy (EUIT), Autonomous University of Barcelona (UAB), Barcelona, Spain
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Manzanares I, Sevilla Guerra S, Peña-Ceballos J, Carreño M, Palanca M, Lombraña M, Conde-Blanco E, Centeno M, Donaire A, Gil-Lopez F, Khawaja M, López Poyato M, Zabalegui A. The emerging role of the advanced practice epilepsy nurse: A comparative study between two countries. J Clin Nurs 2021; 30:1263-1272. [PMID: 33471366 DOI: 10.1111/jocn.15669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 12/11/2020] [Accepted: 01/07/2021] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES The aim of the study was to compare advanced practice in epilepsy nurses in Spain and United Kingdom, identifying differences in the domains of standard advanced practice. BACKGROUND Europe has recently faced the challenge of providing high-quality care for patients with epilepsy, a disease that generates many health demands. In some countries, such as the United Kingdom, advanced practice nursing is well established and could serve as a guide for implantation in countries where it is still in development, as is the case of Spain. DESIGN A multicentre cross-sectional descriptive cohort study compared differences in the roles of advanced practice nurses in Spain and the United Kingdom. METHODS The Advanced Practice Role Delineation Tool and its validated Spanish version were administered using an online questionnaire in a cohort of advanced practice epilepsy nurses in both countries. A convenience sample was recruited between January to December 2019. The study complied with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist. RESULTS Most United Kingdom nurses in our sample came from community environments, in contrast to Spanish nurses who worked in hospital. All domains analysed in the survey had significantly higher scores in the United Kingdom than in the Spanish cohort, especially in the research and leadership domains. CONCLUSIONS The advanced practice role in Spain is underdeveloped compared with the United Kingdom. Differences in the settings of advanced roles in epilepsy nurses may be explained by greater community practice in the United Kingdom and differences in organisational and health systems. RELEVANCE TO CLINICAL PRACTICE Our study showed the need to implement specific policies to develop advance practice nurse roles in Spain to improve the quality of care of patients with epilepsy.
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Affiliation(s)
- Isabel Manzanares
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Sonia Sevilla Guerra
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hospital Clínic de Barcelona, Barcelona, Spain
| | - Javier Peña-Ceballos
- Department of Basic & Clinical Neurosciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mar Carreño
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Palanca
- Refractory Epilepsy Unit, Department of Neurology, Hospital Universitari i Politècnic La Fe de Valencia, Valencia, Spain
| | - María Lombraña
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hospital Clínic de Barcelona, Barcelona, Spain
| | - Estefanía Conde-Blanco
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - María Centeno
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Antonio Donaire
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Francisco Gil-Lopez
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mariam Khawaja
- Epilepsy Unit, Department of Neurology, Hospital Clínic de Barcelona, Barcelona, Spain.,Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Mireia López Poyato
- Department of Nursing, Facultad de Medicina i Ciencias de la Salud, Universidad de Barcelona, Barcelona, Spain.,Primary Care Centre Les Corts, Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain
| | - Adelaida Zabalegui
- Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Hospital Clínic de Barcelona, Barcelona, Spain
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