Efficacy and safety of biological treatment for inflammatory bowel disease in elderly patients: Results from a GETECCU cohort.

INTRODUCTION: Biological therapies used for the treatment of inflammatory bowel disease (IBD) have shown to be effective and safe, although these results were obtained from studies involving mostly a young population, who are generally included in clinical trials. The aim of our study was to determine the efficacy and safety of the different biological treatments in the elderly population. METHODS: Multicenter study was carried out in the GETECCU group. Patients diagnosed with IBD and aged over 65 years at the time of initiating biological therapy (infliximab, adalimumab, golimumab, ustekinumab or vedolizumab) were retrospectively included. Among the patients included, clinical response was assessed after drug induction (12 weeks of treatment) and at 52 weeks. Patients' colonoscopy data in week 52 were assessment, where available. Regarding complications, development of oncological events during follow-up and infectious processes occurring during biological treatment were collected (excluding bowel infection by cytomegalovirus). RESULTS: A total of 1090 patients were included. After induction, at approximately 12-14 weeks of treatment, 419 patients (39.6%) were in clinical remission, 502 patients (47.4%) had responded without remission and 137 patients (12.9%) had no response. At 52 weeks of treatment 442 patients (57.1%) had achieved clinical remission, 249 patients had responded without remission (32.2%) and 53 patients had no response to the treatment (6.8%). Before 52 weeks, 129 patients (14.8%) had discontinued treatment due to inefficacy, this being significantly higher (p<0.0001) for Golimumab - 9 patients (37.5%) - compared to the other biological treatments analyzed. With respect to tumor development, an oncological event was observed in 74 patients (6.9%): 30 patients (8%) on infliximab, 23 (7.14%) on adalimumab, 3 (11.1%) on golimumab, 10 (6.4%) on ustekinumab, and 8 (3.8%) on vedolizumab. The incidence was significantly lower (p=0.04) for the vedolizumab group compared to other treatments. As regards infections, these occurred in 160 patients during treatment (14.9%), with no differences between the different biologicals used (p=0.61): 61 patients (19.4%) on infliximab, 39 (12.5%) on adalimumab, 5 (17.8%) on golimumab, 22 (14.1%) on ustekinumab, and 34 (16.5%) on vedolizumab. CONCLUSIONS: Biological drug therapies have response rates in elderly patients similar to those described in the general population, Golimumab was the drug that was discontinued most frequently due to inefficacy. In our experience, tumor development was more frequent in patients who used anti-TNF therapies compared to other targets, although its incidence was generally low and that this is in line with younger patients based on previous literature.

Artificial intelligence-assisted identification and retrieval of chronic hepatitis C patients lost to follow-up in the health area of Pontevedra and O Salnés (Spain).

OBJECTIVE: Direct-acting antivirals (DAAs) to treat hepatitis C virus (HCV) infection offer an opportunity to eliminate the disease. This study aimed to identify and relink to care HCV patients previously lost to medical follow-up in the health area of Pontevedra and O Salnés (Spain) using an artificial intelligence-assisted system. PATIENTS AND METHODS: Active retrospective search of previously diagnosed HCV cases recorded in the Galician Health Service proprietary health information exchange database using the Herramientas para la EXplotación de la INformación (HEXIN) application. RESULTS AND CONCLUSIONS: Out of 99 lost patients identified, 64 (64.6%) were retrieved. Of these, 62 (96.88%) initiated DAA treatment and 54 patients (87.1%) achieved a sustained virological response. Mean time from HCV diagnosis was over 10 years. Main reasons for loss to follow-up were fear of possible adverse effects of treatment (30%) and mobility impediments (21%). Among the retrieved patients, almost one in three presented advanced liver fibrosis (F3) or cirrhosis (F4) at evaluation. In sum, HCV patients lost to follow-up can be retrieved by screening past laboratory records. This strategy promotes the achievement of HCV elimination goals.

[Predictive validity of Clinical Risk Groups in chronic patients in primary healthcare]. / Validez predictiva del Clinical Risk Groups en pacientes crónicos en el ambito de la atencion primaria.

OBJECTIVE: To analyse a prediction model for admissions and hospital emergencies based on Clinical Risk Groups, in a population of complex chronic patients demanding primary care. DESIGN: A multicentric retrospective observational study, of a cohort of chronic patients with comorbidity, from January until December 2013. PLACE: The study population was assigned to the Santa Pola and Raval health centres from the Health Department of Elche. PARTICIPANTS: Cohort of chronic patients with comorbidity, from January to December 2013. INTERVENTIONS: Data about the number of admissions, reasons and complexity level associated with the admission were collected by the review of medical records. MAIN MEASURES: To determine the level of complexity, the classification included in the chronicity strategy of the Valencian Community based on Clinical Risk Groups was used. RESULTS: Five hundred and four patients were recruited with a high complexity degree (N3) and 272 with moderate/low complexity (N1-N2). A higher comorbidity was observed in N3 patients with high complexity [Charlson 2.9 (DE 1.8) vs. 1.9 (DE 1.3); P<.001], and higher dependence degree for basic diary activities [Barthel 16.1 (n=81) vs. 7.3 (n=20); P<.001]. Association between the number of admissions [0.4 (DE 0.8) vs. 0.1 (DE 0.5); P<.001] and emergency visits [0.8 (DE 1.5) vs. 0.3 (DE 0.8), P<.001] was significatively higher in patients from N3 group than N1-N2 groups. CONCLUSIONS: The predictive capacity of CRG grouper showed high sensibility for the patient classification with a high degree of complexity. Its specificity and positive predictive value were lower for the association of the N3 complexity stratum.

Impact of the multiplex molecular FilmArray Respiratory Panel on antibiotic prescription and clinical management of immunocompromised adults with suspected acute respiratory tract infections: A retrospective before-after study.

This study aimed to assess the impact of the implementation of a rapid multiplex molecular FilmArray Respiratory Panel (FRP) on the medical management of immunocompromised patients from a community general hospital. We conducted a single-center, retrospective, and before-after study. Two periods were evaluated: before the implementation of the FRP (pre-FRP) from April 2017 to May 2018 and after the implementation of the FRP (post-FRP) from January to July 2019. The inclusion criteria were immunocompromised patients over 18 years of age with suspected acute respiratory illness tested by conventional diagnostic methods (pre-FRP) or the FilmArray™ Respiratory Panel v1.7 (post-FRP). A total of 142 patients were included, 64 patients in the pre-FRP and 78 patients in the post-FRP. The positive detection rate was significantly higher in the post-FRP (63% vs. 10%, p<0.01). There were more patients receiving antimicrobial treatment in the pre-FRP compared with the post-FRP period (94% vs. 68%, p<0.01). A decrease in beta-lactam (89% vs. 61%, p<0.01) and macrolide (44% vs. 13%, p<0.01) prescriptions were observed in the post-FRP. No differences were observed in oseltamivir use (22% vs. 13%, p=0.14), changes in antimicrobial treatment, hospital admission rate, days-reduction in droplet isolation precautions, hospital length of stay (LOS), admission to intensive care unit (ICU), LOS in ICU, treatment failure and 30-day mortality. The implementation of the FRP impacted patient care by improving diagnostic yield and optimizing antimicrobial treatment in immunocompromised adult patients.

Potentially inappropriate prescriptions in geriatric patients hospitalized in the internal medicine department of a referral hospital in Mexico.

BACKGROUND: Potentially inappropriate prescription (PIP) constitutes a risk for the development of adverse effects of a drug that outweigh its benefits, which can be considered inappropriate medication use. OBJECTIVE: To describe the prevalence of PIP in geriatric patients hospitalized at the internal medicine department of a referral hospital in Mexico. MATERIAL AND METHODS: Cross-sectional, descriptive design, with simple allocation of medical records from patients older than 65 years hospitalized between January 2016 and August 2017. The STOPP/START criteria were applied to identify the number of PIPs, the number of prescribed medications, number and type of comorbidities, as well as days of hospital stay. RESULTS: A prevalence of PIP of 73.3% was identified, with main comorbidities being hypertension and type 2 diabetes mellitus. A total of 1,885 prescribed medications were quantified; mean hospital stay was 6.3 days. CONCLUSIONS: A high prevalence of PIP was identified in hospitalized geriatric patients, hence the importance of applying the STOPP/START criteria and of the role of the pharmacist for validating the prescription prior to drug administration.

ANTECEDENTES: Una prescripción potencialmente inapropiada (PPI) constituye un riesgo de presentar efectos adversos por un fármaco que superan los beneficios de este, pudiendo considerarse como uso inadecuado de medicamentos. OBJETIVO: Describir la prevalencia de prescripciones potencialmente inapropiadas en pacientes geriátricos hospitalizados en el servicio de medicina interna de un hospital de referencia en México. MATERIAL Y MÉTODOS: Diseño descriptivo transversal, con asignación simple de expedientes clínicos de pacientes hospitalizados mayores de 65 años, entre enero de 2016 y agosto de 2017. Se aplicaron los criterios STOPP y START para identificar el número de PPI, cantidad de medicamentos prescritos, presencia, cantidad y tipo de comorbilidades, así como días de estancia hospitalaria. RESULTADOS: Se encontró una prevalencia de 73.3 % de PPI y las principales comorbilidades fueron hipertensión arterial y diabetes mellitus tipo 2. Se cuantificaron 1885 medicamentos prescritos; la estancia hospitalaria media fue de 6.3 días. CONCLUSIONES: Se identificó alta prevalencia de PPI en los pacientes geriátricos hospitalizados, de ahí la importancia de aplicar los criterios STOPP y START y del papel del farmacéutico en la validación de la prescripción antes de la administración de medicamentos.

Spanish Version of the RECAP Questionnaire to Assess Control of Atopic Eczema: Translation, Cultural Adaptation, Validation, and Correlations with Other Patient-Reported Outcome Measures. / Traducción, adaptación transcultural, correlación con otros PRO y validación del cuestionario RECAP sobre el grado de control de la dermatitis atópica.

BACKGROUND: The 7-item RECAP (Recap of Atopic Eczema) questionnaire is used to assess the control of different degrees of eczema severity in patients of all ages. Long-term control of eczema is one of the 4 core outcome domains to be assessed in clinical trials of eczema therapies. After the RECAP was developed in the United Kingdom, it was translated into Chinese, German, Dutch, and French. OBJECTIVES: To produce a validated Spanish version of the RECAP questionnaire and, secondarily, to test its content validity in a group of Spanish patients with atopic eczema. MATERIAL AND METHODS: In a 7-step process we produced 2forward translations and 1back translation of the RECAP questionnaire. Experts then held two meetings to reach consensus and draft a Spanish version of the questionnaire. Fifteen adult patients with atopic eczema were interviewed to evaluate the comprehensibility, comprehensiveness, and relevance of the drafted items. These patients also completed the Atopic Dermatitis Control Tool (ADCT), the Dermatology Life Quality Index (DLQI), and the Patient-Oriented Eczema Measure (POEM). Stata software (version 16) was then used to explore the correlations between the patients' scores on these tools and the RECAP. RESULTS: The patients found the Spanish version of the RECAP to be comprehensible and easy to answer. We observed a strong correlation between results on the Spanish RECAP and the ADCT, and highly significant correlations between the RECAP and the DLQI and POEM tools. CONCLUSIONS: The culturally adapted Spanish version of the RECAP is linguistically equivalent to the original version of the questionnaire. RECAP scores correlate highly with other patient-reported outcome measures.

Translation into Spanish and validation of a short questionnaire to measure the control of inflammatory bowel disease from the patient's perspective: IBD-Control, EII-Control. / Traducción al español y validación de un cuestionario breve de medida del control de la enfermedad inflamatoria intestinal desde la perspectiva del paciente: IBD-Control, EII-Control.

OBJECTIVE: Measurement of patient-perceived outcomes in inflammatory bowel disease (IBD) care is becoming increasingly important. A simple and validated tool exists in English for this purpose, the "IBD-Control". Our aim is to translate it into Spanish, adapt and validate it. PATIENTS AND METHODS: The IBD-Control was translated into the Spanish instrument "EII-Control" and prospectively validated. Patients completed the EII-Control and other questionnaires that served as baseline comparators. The gastroenterologist performed a global assessment of the disease, calculated activity indices and recorded treatment. A subgroup of patients repeated the entire assessment at a second visit. The usefulness of IBD-Control summary scales (IBD-Control-8 and IBD-Control-VAS) was also analysed. RESULTS: A total of 249 IBD patients were included (101 repeated the second visit). Psychometric standards of the test: internal consistency: Cronbach's α for EII-Control 0.83 with strong correlation between EII-Control-8 and EII-Control-EVA (r=0.5); reproducibility: intra-class correlation 0.70 for EII-Control; construct validity: moderate to strong correlations between IBD-Control, IBD-Control-8 and IBD-Control-VAS versus comparators; discriminant validity: P<.001; sensitivity to change: same response as quality of life index. Sensitivity and specificity at cut-off point 14 of 0.696 and 0.903, respectively, to determine quiescent status. CONCLUSIONS: The IBD-Control is a valid instrument to measure IBD-Control from the patient's perspective in our environment and culture. Its simplicity makes it a useful tool to support care.

[Post-traumatic stress and quality of life of post-COVID-19 patients in primary care]. / Trastorno de estrés postraumático y calidad de vida del paciente post-COVID-19 en Atención Primaria.

OBJECTIVE: To determine the association between post-traumatic stress disorder (PTSD) symptoms and health-related quality of life (HRQoL) of post-COVID-19 patients in primary care. DESIGN: Cross-sectional, multicenter, random probability sampling study. LOCATION: Primary care centers in Ica-Peru. PARTICIPANTS: Six hundred and thirty-six patients with previous diagnosis of COVID-19. MAIN MEASURES: The variable PTSD symptoms was measured with the COVID-19-PTSD questionnaire and HRQOL with the EuroQol scale (EQ-5D). Sociodemographic and health factors including post-COVID-19 syndrome were analyzed. A descriptive analysis was performed and crude and adjusted prevalence ratios (PR) were calculated using generalized linear models of the Poisson family to search for associations between variables. RESULTS: Of the participants, 21.4% presented symptoms of PTSD; 33.6% symptoms of dysphoric and anxious arousal; 22.3% intrusion, avoidance and negative affect; 22.6% anhedonia; and 23.6% externalizing behavior. 50.3% revealed at least one component of HRQoL affected; 35.5% problems linked to anxiety/depression; 34.9% pain/discomfort; 11% daily activity; 10.7% mobility and 6.6% self-care. The presence of PTSD symptoms was associated with the HRQoL affected (PR=2.46: 95% CI: 2.19-2.78). Also, certain sociodemographic and health variables were associated with PTSD symptoms and affected HRQoL. CONCLUSIONS: PTSD symptoms, increase the probability of affecting the patient's HRQoL post COVID-19. There are potentially modifiable sociodemographic and health variables that could decrease PTSD symptoms and improve HRQoL.

"Should WE Stand Together?": A systematic review and meta-analysis of the effectiveness of family-based interventions for adults with chronic physical diseases.

Family support has been identified as an important factor for the psychological adjustment of patients with chronic physical conditions. This study aimed to systematically review and conduct a meta-analysis of studies comparing the effectiveness of family-based versus patient-oriented interventions for chronic physical conditions. The search was performed between April 12 and April 29, 2021, on Web of Science (all databases included), Scopus, PsycINFO, and CENTRAL. Thirteen RCTs were included. The results favored family-based interventions for various patient outcomes related to pain, distress, self-efficacy, social and emotional function, coping, the welfare of the domestic environment, capacity to mobilize social support, and sexual relationships with medium to large effect sizes (Cohen's d range: 0.45-0.90). This type of intervention also decreased family members' anxiety, depression, sleep problems, and distress, improving search and presence of meaning in life, social support, the support provided to the patient, and sexual relationships with medium to very large effect sizes (Cohen's d range: 0.58-2.76). The meta-analytical findings suggested that the patients' (k = 12, d = 0.34; 95% CI = 0.13-0.55, I2  = 74%, p < 0.01) and family members' (k = 4, d = 0.68; 95% CI = 0.08-1.27, I2  = 88%, p < 0.01) psychosocial outcomes significantly improved with family-based interventions compared with patient-oriented interventions. The meta-analysis of patients' self-efficacy showed a medium-size effect (d = 0.64; k = 3; I2  = 19%). The results suggest a trend toward the beneficial effects of family-based interventions, but more research is needed with higher quality RCTs to confirm this hypothesis.

El apoyo familiar se ha reconocido como un factor importante para la adaptación psicológica de los pacientes con enfermedades físicas crónicas. El presente estudio tuvo como finalidad analizar sistemáticamente y realizar un metaanálisis de estudios que comparan la eficacia de las intervenciones familiares y de las orientadas al paciente en las enfermedades físicas crónicas. La búsqueda se realizó entre el 12 de abril y el 29 de abril de 2021 en Web of Science (se incluyeron todas las bases de datos), Scopus, PsycInfo, y CENTRAL. Se incorporaron trece ensayos clínicos aleatorizados y controlados. Los resultados favorecieron las intervenciones familiares en los casos de diferentes desenlaces de los pacientes relacionados con el dolor, el distrés, la autoeficacia, la función social y emocional, el afrontamiento, el bienestar del entorno doméstico, la capacidad de movilizar el apoyo social, y las relaciones sexuales con tamaños del efecto entre medianos y grandes (rango de la d de Cohen: entre 0.45 y 0.90). Este tipo de intervención también disminuyó la ansiedad, la depresión, los problemas de sueño y el distrés de los miembros de la familia, mejoró la búsqueda y la presencia del significado en la vida, el apoyo social, el apoyo brindado al paciente y las relaciones sexuales con tamaños del efecto entre medianos y muy grandes (rango de la d de Cohen: entre 0.58 y 2.76). Los resultados metaanalíticos sugirieron que los resultados psicosociales de los pacientes (k = 12, d = 0.34; 95 % CI = 0.13­0.55, I2 = 74 %, p<.01) y de los familiares (k = 4, d = 0.68; 95 % CI = 0.08­1.27, I2=88 %, p<.01) mejoraron considerablemente con las intervenciones familiares en comparación con las intervenciones orientadas a los pacientes. El metaanálisis de la autoeficacia de los pacientes demostró un efecto de tamaño mediano (d = 0.64; k = 3; I2 = 19 %). Los resultados sugieren una tendencia hacia los efectos beneficiosos de las intervenciones familiares, pero se necesitan más investigaciones con ensayos controlados aleatorizados de mayor calidad para confirmar esta hipótesis.

[Validation of the living with osteoarthritis in Spanish population]. / Validación de la escala de convivencia con artrosis en la población española.

OBJECTIVE: Present the psychometric results of the Living with Osteoarthritis (LW-OA) in Spanish population. DESIGN: Observational, cross-sectional and multicenter study, with retest on a fraction of the sample. LOCATION: Public and private centres of primary and secondary healthcare, as well as patient associations from Navarra, La Rioja, Madrid, Valencia and Malaga. PARTICIPANTS: The sample was composed by 291 patients with OA with a medical diagnosis in every stage of the disease from primary or secondary healthcare, Spanish nationality and not hospitalized. INTERVENTIONS: In addition to LW-OA, a sociodemographic questionnaire was included, as well as scales to evaluate social support perceived from the patient (DUFSS), quality of life (WHOQOL-BREF) and satisfaction with life. MAIN MEASUREMENTS: Psychometric properties of the LW-OA were measured, as viability and acceptability, reliability (internal consistency and reproducibility), precision and construct validity (convergent, internal and known-groups). RESULTS: 100% of the data were computable. Excellent data quality was obtained. Cronbach's alpha for the scale total was 0.87 and the homogeneity index 0.22. ICC for the scale total was 0.88. As for precision, the SEM was 5.18 (<½DE=7.47). CONCLUSIONS: The LW-OA is a valid and feasible measure to evaluate the process of living with OA in Spain.

[Evaluation of a training model for health professionals in the care of critical patients: AIPCAP Study]. / Evaluación de un modelo formativo para profesionales sanitarios en la atención del paciente crítico: Estudio AIPCAP.

OBJECTIVE: To evaluate the validity, acceptability, and impact on the level of knowledge and skills of Primary Care health professionals of a training model aimed at improving the care of critical patients. DESIGN: A quasi-experimental interventional, multicentre study. LOCATION: Eight health care teams in Barcelona. PARTICIPANTS: A total of 272 professionals. INTERVENTIONS: A training program consisting of 48 simulations of acute myocardial infarction and stroke. MAIN MEASUREMENTS: A checklist was used to evaluate critical patient skills, effect of training on the knowledge of the participants, and a satisfaction survey. The training was carried out after 2 series of simulations (AMI+Stroke). In the second series, 3evaluations were made: in situ, one week after, and at 3weeks. Concordance and reliability were measured. The differences in means were analysed using the Student t test for paired data. RESULTS: A total of 449 knowledge tests were answered, with a higher score being obtained at the end of each simulation (3.89 -SD 1.01 vs. 3.21 -SD 1.09). Doctors obtained better medical scores than nurses (3.81 - SD 0.87 vs. 3.32 - SD 1.15), and professionals with a specialty completed scored more than those in training (MIR) (3.6 - SD 1.08 vs. 3.4 - SD 1.18). The mean score was 7.7 points (SD 1.56) in the first evaluation, and improved to 9.1 points (SD 0.78). The kappa index was greater than 0.40 in all cases. CONCLUSIONS: A training methodology in the management of emergencies in Primary Care based on simulations is valid, reliable and well accepted, achieving an improvement in the level of knowledge and skills of the participating professionals.

Which surgical patients require shared care? / ¿Qué pacientes quirúrgicos necesitan asistencia compartida?

Most hospitalized surgical patients have significant medical comorbidity and are treated with a considerable number of drugs and/or experience significant complications. Shared care (SC) is the shared responsibility and authority in managing hospitalized patients. In this article, we discuss whether patients should be selected for SC or not. The various selection criteria are not an exact science nor are they easy to apply. Furthermore, they may leave out many patients who may be good candidates for SC. Perioperative management is essential for preventing postoperative mortality. Failure to rescue (in-hospital mortality secondary to postoperative complications) is the main factor linked to in-hospital surgical mortality and can affect any patient regardless of age, comorbidity, or type of surgery. The component that most reduces failure to rescue is the presence of internists in surgical wards. We believe that all patients hospitalized in surgery departments should receive SC.

Relationship between Mental Health and Burden among Primary Caregivers of Outpatients with Schizophrenia.

There is growing recognition that caring for a patient with schizophrenia often results in high levels of perceived burden and poorer overall mental health for caregivers. A quantitative cross-sectional design and standardized instruments were used to collect data from 355 primary caregivers of adults in outpatient care with schizophrenia in China. Structural equation modeling was used to examine the association between caregiver burden and mental health among primary caregivers and whether this association is influenced by personality, coping style, and family functioning, based on a diathesis-stress perspective. Goodness-of-fit indices (χ2 /df = 1.406, GFI = 0.919, CFI = 0.957, etc.) confirmed that the modified model fit the data well. In line with the diathesis-stress model, and with this study's hypotheses, we found that caregiver burden was significantly related to mental health outcomes directly. The final model showed that personality traits, coping style, and family function influenced the relationship between caregiver burden and mental health. The neuroticism personality traits have a direct effect on caregiver burden and family functioning in this sample. Coping style had a direct effect on the caregiver burden, and family functioning had a direct effect on the caregiver burden. Our final model about primary caregivers can be applied clinically to predict mental health outcomes from caregiver burden.

Cada vez se reconce más que cuidar a un paciente con esquizofrenia generalmente resulta en niveles altos de sobrecarga percibida y en una peor salud mental general para los cuidadores. Se utilizó un diseño transversal cuantitativo e instrumentos estandarizados para recopilar datos de 355 cuidadores principales de adultos con esquizofrenia en atención extrahospitalaria en China. Se utilizaron modelos de ecuaciones estructurales para analizar la asociación de la sobrecarga del cuidador y la salud mental entre cuidadores principales, y si esta asociación está influenciada por la personalidad, el estilo de afrontamiento y el desempeño familiar sobre la base de una perspectiva diátesis-estrés. Los índices de bondad de ajuste (χ2 /df = 1.406, GFI = 0.919, CFI = 0.957, etc.) confirmaron que el modelo modificado se ajustó bien a los datos. De acuerdo con el modelo de diátesis-estrés y con las hipótesis de este estudio, descubrimos que la sobrecarga del cuidador estuvo considerablemente relacionada con las consecuencias en la salud mental directamente. El modelo definitivo demostró que los rasgos de la personalidad, el estilo de afrontamiento y el desempeño familiar influyeron en la relación entre la sobrecarga del cuidador y la salud mental. Los rasgos de personalidad de neuroticismo tienen un efecto directo en la sobrecarga del cuidador y el desempeño familiar en esta muestra. El estilo de afrontamiento tuvo un efecto directo en la sobrecarga del cuidador y el desempeño familiar tuvo un efecto directo en la sobrecarga del cuidador. Nuestro modelo definitivo acerca de los cuidadores principales puede aplicarse clínicamente para predecir las consecuencias de la sobrecarga del cuidador en su salud mental.

The Dynamic Interplay Between Satisfaction With Intimate Relationship Functioning and Daily Mood in Low-Income Outpatients.

Substantial research supports bidirectional links between intimate relationship discord and individual psychopathology, including depressive symptoms. However, few studies have utilized daily diary methods to capture the micro-level processes underlying the association between couple discord and depression, particularly among populations that are at elevated risk for both interpersonal and individual dysfunction. To address this gap, we examined whether daily changes in satisfaction with relationship functioning were associated with daily changes in negative affect and positive affect over the span of 2 weeks among mental health outpatients of low socioeconomic status. Participants were 53 low-income outpatients from community mental health clinics who completed a semi-structured interview about the quality of their intimate relationships followed by 14 daily reports of positive and negative mood and satisfaction with relationship functioning across several domains. Growth curve analytic techniques revealed the hypothesized bidirectional relations. Decline in satisfaction with relationship functioning predicted escalation in negative affect and deterioration in positive affect over 2 weeks, and deterioration of mood predicted declining satisfaction with relationship functioning. This study extends existing knowledge about couple dysfunction and individual psychopathology by highlighting the immediate nature of this dynamic process as it unfolds over time.

Gran cantidad de investigaciones respaldan las conexiones bidreccionales entre los desacuerdos en las relaciones afectivas y la psicopatología individual, incluidos los síntomas depresivos. Sin embargo, pocos estudios han utilizado los métodos de registro diario para captar los procesos a pequeñísima escala que subyacen a la asociación entre el desacuerdo entre las parejas y la depresión, particularmente entre poblaciones que tienen un riesgo elevado de disfunción interpersonal e individual. Para abordar esta brecha, analizamos si los cambios diarios en la satisfacción con el funcionamiento de la relación estuvieron asociados con los cambios diarios en el afecto negativo y el afecto positivo durante el periodo de dos semanas entre los pacientes ambulatorios de salud mental de bajo nivel socioeconómico. Los participantes fueron 53 pacientes ambulatorios de bajos ingresos de clínicas comunitarias de salud mental que se sometieron a una entrevista semiestructurada acerca de la calidad de sus relaciones afectivas seguida de 14 informes diarios de estado de ánimo positivo y negativo y de satisfacción con el funcionamiento de la relación en varias áreas. Las técnicas analíticas de la curva de crecimiento revelaron las relaciones bidireccionales planteadas como hipótesis. La disminución de la satisfacción con el funcionamiento de la relación predijo un aumento del afecto negativo y un deterioro del afecto positivo durante dos semanas, y el deterioro del estado de ánimo predijo una disminución de la satisfacción con el funcionamiento de la relación. Conclusiones: Este estudio amplía el conocimiento existente sobre la disfunción en la pareja y la psicopatología individual destacando la índole inmediata de este proceso dinámico a medida que se desarrolla poco a poco con el tiempo.

The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice.

Systematic client feedback (SCF) is increasingly employed in mental health services worldwide. While research supports its efficacy over treatment as usual, clinicians, especially those who highly value relational practices, may be concerned that routine data collection detracts from clinical process. This article describes one SCF system, the Partners for Change Outcome Management System (PCOMS), along a normative (standardized measurement) to communicative (conversational) continuum, highlighting PCOMS' origins in everyday clinical practice. The authors contend that PCOMS represents "both/and," providing a valid signal of client progress while facilitating communicative process particularly prized by family therapists steeped in relational traditions. The article discusses application of PCOMS in systemic practice and describes how it actualizes time-honored family therapy approaches. The importance of giving voice to individualized client experience is emphasized.

Health-related quality of life in patients with spinocerebellar ataxia. / Calidad de vida relacionada con la salud en pacientes con ataxias espinocerebelosas.

INTRODUCTION: The progressive deterioration of patients with spinocerebellar ataxia (SCA) has a major impact on their health-related quality of life (HRQOL). This study evaluates HRQOL in a sample of patients diagnosed with SCA and aims to estimate the predictive ability of a set of sociodemographic variables for the different dimensions of the General Health Questionnaire. METHODS: A total of 80 patients diagnosed with SCA were assessed using a sociodemographic questionnaire and the SF-36 General Health Questionnaire. The sociodemographic variables studied were sex, age, presence of a carer, employment status, and time elapsed from diagnosis of the disease. RESULTS: The 8 subscales of the SF-36 show positive and significant correlations to one another. Mean scores obtained on each SF-36 subscale differ between women and men, although this difference is significant only on the general health subscale, with men scoring higher than women. We found significant age differences on the vitality and social function subscales, with higher scores among younger patients (< 34 years). The variable 'presence of a carer' accounts for most of the total variance of the questionnaire. CONCLUSIONS: The SF-36 is a valid and useful instrument for evaluating HRQOL in patients diagnosed with SCA. Presence of a carer seems to be a determinant of self-perceived quality of life in these patients.

[Transferring palliative-care patients from hospital to community care: A qualitative study]. / Transferencia de pacientes de cuidados paliativos desde el hospital hasta atención primaria: un estudio cualitativo.

AIM: To know the experience of case-manager nurses with regard to transferring palliative-care patients from the hospital to their homes. DESIGN: Qualitative phenomenological study carried out in 2014-2015. SETTING: Poniente and Almería health districts, which referral hospitals are Poniente Hospital and Torrecárdenas Hospital, respectively. PARTICIPANTS: A purposive sample comprised of 12 case-manager nurses was recruited from the aforementioned setting. METHOD: Theoretical data saturation was achieved after performing 7 in-depth individual interviews and 1 focus group. Data analysis was performed following Colaizzi's method. RESULTS: Three themes emerged: (1) 'Case-management nursing as a quality, patient-centred service' (2) 'Failures of the information systems', with the subthemes "patients" insufficient and inadequate previous information" and "ineffective between-levels communication channels for advanced nursing"; (3) 'Deficiencies in discharge planning', with the subthemes "deficient management of resources on admission", "uncertainty about discharge" and "insufficient human resources to coordinate the transfer". CONCLUSIONS: Case-manager nurses consider themselves a good-quality service. However, they think there are issues with coordination, information and discharge planning of palliative patients from hospital. It would be useful to review the communication pathways of both care and discharge reports, so that resources needed by palliative patients are effectively managed at the point of being transferred home.

Patients' experience during weaning of invasive mechanical ventilation: A review of the literature. / Experiencias del paciente durante la retirada de la ventilación mecánica invasiva: una revisión de la literatura.

OBJECTIVE: Weaning from invasive mechanical ventilation (IMV) is influenced by physiological and psychological factors, the latter being the least studied. The aim was to identify, through the literature, patients' experiences during weaning from IMV and report its influencing factors. METHOD: The literature search was conducted using the Pubmed, CINAHL and PsycINFO databases. The search terms were: "patient", "experience" and "ventilator weaning". The research limits were: age (>19years) and language (English, Spanish and Finnish). RESULTS: Fifteen publications were analysed. The main results were grouped into three main categories according to patient's perceptions, feelings and experiences, influence of professionals' attention and determinants for successful weaning. Patients remember IMV weaning as a stressful process where they experience anxiety, frustration, despair or uncertainty. Nurses have a key role in improving communication with patients and foreseeing their needs. Family support and the care provided by the caregivers were shown as essential during the process. The patient's self-determination, self-motivation and confidence are identified as important factors to achieve successful IMV weaning. CONCLUSIONS: Psychological care, in addition to physical and technical care, is important at providing holistic care. Interventional studies are needed to improve the care during the weaning experience.

Satisfaction in the Intensive Care Unit (ICU). Patient opinion as a cornerstone. / Satisfacción en la Unidad de Cuidados Intensivos (UCI): la opinión del paciente como piedra angular.

OBJECTIVE: To study the agreement between the level of satisfaction of patients and their families referred to the care and attention received during admission to the ICU. DESIGN: A prospective, 5-month observational and descriptive study was carried out. SETTING: ICU of Marqués de Valdecilla University Hospital, Santander (Spain). SUBJECTS: Adult patients with an ICU stay longer than 24h, who were discharged to the ward during the period of the study, and their relatives. INTERVENTION: Instrument: FS-ICU 34 for assessing family satisfaction, and an adaptation of the FS-ICU 34 for patients. The Cohen kappa index was calculated to assess agreement between answers. RESULTS: An analysis was made of the questionnaires from one same family unit, obtaining 148 pairs of surveys (296 questionnaires). The kappa index ranged between 0.278-0.558, which is indicative of mild to moderate agreement. CONCLUSIONS: The families of patients admitted to the ICU cannot be regarded as good proxies, at least for competent patients. In such cases, we must refer to these patients in order to obtain first hand information on their feelings, perceptions and experiences during admission to the ICU. Only when patients are unable to actively participate in the care process should their relatives be consulted.

American vs. European Trauma Centers: A Comparison of Preventable Deaths. / Comparación de la mortalidad evitable de un trauma center americano vs. un centro de referencia europeo.

INTRODUCTION: The aim is comparing the quality of care at a typical American trauma center (USC) vs. an equivalent European referral center in Spain (SRC), through the analysis of preventable and potentially preventable deaths. METHODS: Comparative study that evaluated trauma patients older than 16 years old who died during their hospitalization. We cross-referenced these deaths and extracted all deaths that were classified as potentially preventable or preventable. All errors identified were then classified using the JC taxonomy. RESULTS: The rate of preventable and potentially preventable mortality was 7.7% and 13.8% in the USC and SRC respectively. According to the JC taxonomy, the main error type was clinical in both centers, due to errors in intervention (treatment). Errors occurred mostly in the emergency department and were caused by physicians. In the USC, 73% of errors were therapeutic as compared to 59% in the SRC (P=.06). The SRC had a 41% of diagnosis errors vs just 18% in the USC (P = .001). In both centers, the main cause of error was human. At the USC, the most frequent human cause was 'knowledge-based' (44%). In contrast, at the SRC center the most common errors were 'rule-based' (58%) (P<.001). CONCLUSIONS: The use of a common language of errors among centers is key in establishing benchmarking standards. Comparing the quality of care of an American trauma center and a Spanish referral center, we have detected remarkably similar avoidable errors. More diagnostic and 'ruled-based' errors have been found in the Spanish center.