[Comparison of colon-cleansing methods in preparation for colonoscopy-comparative of solutions of mannitol and sodium picosulfate]. / Estudio comparativo entre el uso de manitol y el picosulfato sódico como preparación para colonoscopía.

OBJECTIVES: The purpose of the present study is to compare intestinal preparation with mannitol and sodium picosulphate, assessing patient's acceptance, side effects and cleaning capacity. MATERIAL AND METHODS: This is a prospective, nom randomized, blind study, in which the evaluator had no information about the preparation applied. The sample obtained was divided into two groups according to the bowel preparation applied, with 153 patients prepared with 10% mannitol and 84 patients with sodium picosulfate. The evaluation of colon preparation was done using the Boston Scale (Boston Bowel Preparation Scale - BBP) through a three-point scoring system for each of the three regions of the colon: right, left and transverse colon. RESULTS: Of the 237 patients that were evaluated, 146 (61.60%) were female and 91 (38.4%) were male. Regarding the group that used mannitol, 98 were female (64.05%) and 55 were male (35.95%). Among the patients who used sodium picosulfate, 48 were female (57.14%) and 36 were male (42.86%), with no statistical differences between both groups (p> 0.32). Considering that an adequate preparation scores ≥ 6 in the Boston Scale, the bowel cleansing preparation was satisfactory in both groups. 93% of the patients who used mannitol and 81% of the patients who used sodium picosulfate had adequate preparation (score of ≥ 6). Moreover, we consider that the average score in the preparation with Mannitol was 9, while the sodium picosulfate score was 7. There were no significant differences between the two groups. CONCLUSION: There is consensus among authors who state that colonoscopy's safety and success are highly related to the cleansing outcome, regardless of the method used. The same can be observed in the present study, on which both preparations were proved safe and effective for bowel cleansing, according to the Boston scale, as well as accepted by patients and free of complications.

Current dilemmas in the assessment of suffering in palliative care.

OBJECTIVE: Although relief from suffering is essential in healthcare and palliative care, few efforts have aimed at defining, operationalizing, and developing standards for its detection, assessment, and relief. In order to accurately explore and identify factors that contribute to suffering, more attention needs to be focused on quality assessment and measurement, not only for assessment purposes but also to test the effectiveness of interventions in relieving suffering. The scope of the present paper is to discuss the strategies that aid in the detection and assessment of the suffering experience in patients with chronic illnesses and/or in palliative care settings, and the dilemmas commonly encountered regarding the quality of available assessment measures. METHOD: A general description of instruments available for suffering assessment is provided. Matters regarding the accuracy of the measures are discussed. Finally, some dilemmas regarding the quality of the measures to screen for and assess suffering are presented. RESULTS: There have been some achievements toward adequate suffering assessment. However, a more robust theoretical background is needed, and empirical evidence aimed at supporting it is required. In addition, further examination of the psychometric characteristics of instruments in different populations and cultural contexts is needed. SIGNIFICANCE OF RESULTS: An interesting number of assessment measures are now available for use in the palliative care setting, employing innovative approaches. However, further examination and validation in different contexts is required to find high-quality tools for detection of suffering and assessment of the results of intervention.

Predictors of suffering in advanced cancer.

CONTEXT: Suffering is a complex experience. Identifying its predictors is useful to signal at-risk patients. OBJECTIVE: To identify suffering predictors in patients with advanced cancer in palliative care. METHODS: A total of 98 patients participated in the study. A semistructured interview examining suffering levels and physical, psychological, social, and spiritual aspects was used. Instruments included Pictorial Representation of Illness and Self Measure (PRISM), Edmonton Symptom Assessment System (ESAS), Detection of emotional distress (DED), and Structured Interview of Symptoms and Concern (SISC). Variance-based structural equation model was used for the data analysis. RESULTS: All measures were valid and reliable. The structural model explained 64% of the variance. Suffering levels were directly determined by psychological and adjustment problems and indirectly determined by physical, psychological, and spiritual aspects and coping strategies. CONCLUSION: Our study supports the proposed theoretical model and signals the important mediating effect of psychological and spiritual variables between physical symptoms and suffering.

Estudio comparativo entre el uso de manitol y el picosulfato sódico como preparación para colonoscopía / Comparison of colon-cleansing methods in preparation for colonoscopy- comparative of solutions of mannitol and sodium picosulfate

Objetivos: El objetivo del presente estudio es comparar la preparación adecuada del colon con manitol y picosulfato sódico. Evaluar la aceptación de los pacientes, los efectos secundarios y la capacidad de limpieza. Materiales y métodos: Este es un estudio no aleatorio, prospectivo, ciego, en que el evaluador no tenía información sobre la preparación aplicada. La muestra obtenida se dividió en dos grupos de acuerdo con la preparación adecuada del colon, con 153 pacientes preparados con manitol al 10% y 84 pacientes con picosulfato sódico. La evaluación de la preparación se realizó usando la Escala de Boston (Boston Bowel Preparation Scale - BBP) a través de un sistema de puntuación para cada región del colon puntuada con 3 puntos: derecha, izquierda y colon transverso. Resultados: De los 237 pacientes que fueron evaluados, 146 (61,60%) eran mujeres y 91 (38,4%) eran hombres. En el grupo que utilizó manitol, 98 (64,05%) eran mujeres y 55 (35,95%) eran varones. Entre los pacientes que utilizaron picosulfato sódico, 48 (57,14%)eran mujeres y 36 (42,86%) eran hombres, sin diferencias estadísticas de ambos grupos (p>0,32). Teniendo en cuenta que con la adecuada preparación del colon y con puntuación de 6 puntos en la Escala de Boston, la preparación intestinal fue satisfactoria en ambos grupos. El 93% de los pacientes que utilizaron manitol y el 81% de los pacientes que utilizaron picosulfato sódico tenían preparación adecuada (puntuación de 6). La puntuación media en la preparación con manitol fue de 9 y en la preparación con picosulfato sódico fue de 7. No hubo diferencias significativas entre ambos grupos. Conclusión: Ambas preparaciones, demostraron ser seguras y eficaces para la limpieza del intestino, de acuerdo con la Escala de Boston, así como, la aceptabilidad de los pacientes y libre de complicaciones

Objectives: The purpose of the present study is to compare intestinal preparation with mannitol and sodium picosulphate, assessing patient’s acceptance, side effects and cleaning capacity. Material and methods: This is a prospective, nom randomized, blind study, in which the evaluator had no information about the preparation applied. The sample obtained was divided into two groups according to the bowel preparation applied, with 153 patients prepared with 10% mannitol and 84 patients with sodium picosulfate. The evaluation of colon preparation was done using the Boston Scale (Boston Bowel Preparation Scale - BBP) through a three-point scoring system for each of the three regions of the colon: right, left and transverse colon. Results: Of the 237 patients that were evaluated, 146 (61.60%) were female and 91 (38.4%) were male. Regarding the group that used mannitol, 98 were female (64.05%) and 55 were male (35.95%). Among the patients who used sodium picosulfate, 48 were female (57.14%) and 36 were male (42.86%), with no statistical differences between both groups (p> 0.32). Considering that an adequate preparation scores ≥ 6 in the Boston Scale, the bowel cleansing preparation was satisfactory in both groups. 93% of the patients who used mannitol and 81% of the patients who used sodium picosulfate had adequate preparation (score of ≥ 6). Moreover, we consider that the average score in the preparation with Mannitol was 9, while the sodium picosulfate score was 7. There were no significant differences between the two groups. Conclusion: There is consensus among authors who state that colonoscopy’s safety and success are highly related to the cleansing outcome, regardless of the method used. The same can be observed in the present study, on which both preparations were proved safe and effective for bowel cleansing, according to the Boston scale, as well as accepted by patients and free of complications

Validez factorial del Maslach Burnout Inventory Human Services (MBI-HSS) en profesionales chilenos / Factorial validity of Maslach Burnout Inventory Human Services (MBI-HSS) on Chilean professionals

El objetivo de este estudio fue analizar la validez factorial y la consistencia interna de las subescalas del “MBI-Human Services Survey (MBI-HSS). La muestra la formaron 957 profesionales de servicios chilenos de diferentes unidades laborales. Los datos fueron analizados mediante análisis factorial, con el método de Componentes principales y rotación Varimax. En el análisis factorial exploratorio se evidenció la extracción de tres factores. Los ítems de Agotamiento emocional se agruparon en el Factor I, los ítems de Realización personal en el trabajo cargaron en el Factor II y los ítems de Despersonalización en el Factor III. Los resultados presentaron una estructura factorial consistente con la estructura original. Sin embargo, dos ítems cargaron al igual que en sus respectivas dimensiones (determinadas originalmente por el instrumento), en otros factores anexos, con menores cargas factoriales (ítem 13 e ítem 12), y el ítem 14 no satura en el factor esperado (Agotamiento emocional), presentando una carga factorial de 0,57 en Despersonalización. Se concluye que los resultados del estudio apoyan la validez factorial del MBI-HSS, y la consistencia interna adecuada de sus dimensiones, por lo que es un instrumento adecuado para evaluar el Síndrome de Quemarse por el Trabajo (SQT) (burnout en denominación anglosajona) en profesionales de servicios humanos chilenos.

The purpose of this study was to examine the factorial validity and internal consistency of the subscales of “MBI Human Services Survey (MBI-HSS)”. The sample was formed by 957 professionals of Chilean services from different labour units. The information was analyzed by means of factorial analysis, using the method of principal Components and Varimax rotation. Exploratory factorial analysis revealed the three factors extraction. Items of Emotional Exhaustion were grouped in Factor I, items of Personal Accomplishment at work loaded in Factor II, and items of Depersonalisation in the Factor III. The results showed a factorial structure consistent with the original one. Nevertheless, two items were loaded as in their respective dimensions (originally determined by the instrument), in other attached factors, with less factorials loads (item 13 and item 12), and the items 14 does not saturate in the expected factor (Emotional Exhaustion), presenting a factorial load of 0,57 in Depersonalisation. We conclude that the study results support the factorial validity of the MBI-HSS, and the internal suitable consistency of their dimensions, making it a suitable instrument to evaluate the Syndrome of Burning for the Work (SQT) (burnout in Anglo-Saxon denomination) in professionals of human Chilean services.