Implantación de un proyecto de humanización en una Unidad de Cuidados Intensivos / Humanization in healthcare arises from the need for a holistic approach to illness

La humanización en sanidad surge por la necesidad de acercarnos a una dimensión más holística de la enfermedad. El sufrimiento no solo es exclusivo de los pacientes y las familias, sino que el profesional se encuentra en el centro del proceso de despersonalización. El exceso de tecnificación y la colocación del proceso patológico en ocasiones como único objetivo de actuación, así como la hipertrofia del poder institucional que estamos viviendo en los últimos tiempos, hacen que en ocasiones el propio profesional sanitario sea el primero en demandar un cambio en el abordaje de la dinámica dentro de las instituciones sanitarias. Tras una reflexión inicial, desde el corazón de la medicina más tecnificada, como es la Medicina Intensiva, clásicamente aislada del resto del entorno hospitalario y de las familias, decidimos abordar un proyecto de integración, empatía y acercamiento a los pacientes y familiares de la Unidad de Cuidados Intensivos (UCI) del Hospital Infanta Margarita, en el que se pretendieron implementar herramientas para trabajar en los elementos más importantes de un plan de humanización (las familias, pacientes, profesionales, y nuestra comunidad), potenciando el dar a conocer el trabajo que se realiza en la UCI y que se desarrolló a lo largo de 12 meses, el proyecto: UCI Infanta Margarita, 1 año: 12 meses para 12 compromisos (AU)

Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments (AU)

Humanization in healthcare arises from the need for a holistic approach to illness. / Implantación de un proyecto de humanización en una Unidad de Cuidados Intensivos.

Suffering is not only exclusive to patients or their relatives, but also to the health professionals, who feel to be at the center of the depersonalization process. Over-technification and the fact that the disease process is sometimes the only focal point of our activities, together with the ever-increasing influence of institutional power seen in recent times, all cause the health professional to be the first in demanding a change in health institution dynamics. Following initial reflection from one of the most technified medical specialties (Intensive Care Medicine), classically isolated from the rest of the Hospital and from the community, we implemented a project aimed at securing integration and empathy in our approach to patients and their relatives in the Intensive Care Unit (ICU) of Infanta Margarita Hospital. The project was designed to incorporate tools for working on the most important elements of a humanization plan, i.e., the patients, their relatives, the health professionals and the community, attempting to disclose the work done in the ICU over a period of 12 months. This project is referred to as the Project ICU Infanta Margarita: 1 year: 12 months for 12 commitments.

Herbicides induce change in metabolic and genetic diversity of bacterial community from a cold oligotrophic lake.

Pristine cold oligotrophic lakes show unique physical and chemical characteristics with permanent fluctuation in temperature and carbon source availability. Incorporation of organic toxic matters to these ecosystems could alter the bacterial community composition. Our goal was to assess the effects of simazine (Sz) and 2,4 dichlorophenoxyacetic acid (2,4-D) upon the metabolic and genetic diversity of the bacterial community in sediment samples from a pristine cold oligotrophic lake. Sediment samples were collected in winter and summer season, and microcosms were prepared using a ration 1:10 (sediments:water). The microcosms were supplemented with 0.1 mM 2,4-D or 0.5 mM Sz and incubated for 20 days at 10 °C. Metabolic diversity was evaluated by using the Biolog Ecoplate™ system and genetic diversity by 16S rDNA amplification followed by denaturing gradient gel electrophoresis analysis. Total bacterial counts and live/dead ratio were determined by epifluorescence microscopy. The control microcosms showed no significant differences (P > 0.05) in both metabolic and genetic diversity between summer and winter samples. On the other hand, the addition of 2,4-D or Sz to microcosms induces statistical significant differences (P < 0.05) in metabolic and genetic diversity showing the prevalence of Actinobacteria group which are usually not detected in the sediments of these non-contaminated lacustrine systems. The obtained results suggest that contaminations of cold pristine lakes with organic toxic compounds of anthropic origin alter their homeostasis by inhibiting specific susceptible bacterial groups. The concomitant increase of usually low representative bacterial groups modifies the bacterial composition commonly found in this pristine lake.

Nutrición y cáncer / Nutrition and cáncer

La expresión máxima de desnutrición en el cáncer es la caquexia tumoral, que será responsable directa o indirecta de la muerte en un tercio de los pacientes con cáncer. En un Consenso Internacional se ha definido la Caquexia cancerosa como un síndrome multifactorial caracterizado por una pérdida de masa muscular esquelética (con o sin pérdida de masa grasa) que no puede ser completamente revertida con un soporte nutricional convencional y que lleva a un deterioro funcional progresivo. La fisiopatología se caracteriza por un balance proteico y energético negativo, debido a una combinación variable de ingesta reducida y un metabolismo alterado. Se clasifica la Caquexia Tumoral dentro de un continuum evolutivo, con tres estadios de relevancia clínica: Precaquexia, Caquexia, y Caquexia Refractaria; y se asocia con una disminución en la tolerancia al tratamiento oncológico, menor respuesta al mismo, y disminución de la calidad de vida y de la supervivencia del paciente. Para el Cribado nutricional del paciente con cáncer y siguiendo la Guía Clínica Multidisciplinar se recomienda el «Malnutrition Screening Toll» (MST) para los pacientes adultos con cáncer por su sencillez, fiabilidad y validez. Como método de valoración nutricional para enfermos con cáncer, debe mencionarse la Valoración Global Subjetiva (VGS), y sobre todo la VSG Generada por el Paciente. Al describir las causas de desnutrición en el paciente neoplásico las podemos concretar en: a) causas de desnutrición relacionadas con el tumor, b) con el paciente o c) con los tratamientos oncológicos, teniendo en cuenta que en muchas ocasiones todas las causas pueden estar presentes en un mismo paciente. La desnutrición en el paciente con cáncer se asocia, además de un aumento de morbilidad-mortalidad y aumento de estancias y de costes, a una peor evolución y tolerancia de los tratamientos oncológicos (quirúrgicos, radio y quimioterápicos). Los objetivos fundamentales de la intervención nutricional en el paciente oncológico son: Evitar la muerte precoz secundaria a la propia desnutrición; Disminuir las complicaciones y Mejorar la calidad de vida de los pacientes. Para lograr estos objetivos, la intervención nutricional engloba varias opciones que deben individualizarse para cada paciente. En todo caso la atención nutricional debe ser precoz y formar parte del tratamiento global de paciente oncológico. Si se clasifica el apoyo nutricional según su agresividad y complejidad, se incluyen las siguientes categorías: Recomendaciones nutricionales o consejo dietético; Nutrición artificial (Nutrición enteral oral o suplementación, Nutrición enteral por sonda, Nutrición parenteral) y Valoración de la posible adición de fármacos relacionados con la estimulación del apetito, la inhibición de citoquinas, con acción anabolizante, y otros (AU)

The highest expression of malnutrition in cancer is tumour cachexia, which directly or indirectly accounts for the deaths of one third of all the patients with cancer. In a formal international consensus process cancer cachexia was defined as a multifactorial syndrome defined by an ongoing loss of skeletal muscle mass (with or without loss of fat mass) that cannot be fully reversed by conventional nutritional support and leads to progressive functional impairment. Its pathophysiology is characterised by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. Tumour cachexia can be classified in three evolutionary stages of clinical relevance: precachexia, cachexia, and refractory cachexia, and it is associated with a decrease in treatment tolerance and responsiveness, and impairment of quality of life and survival in cancer patients. According to the Multidisciplinary Clinical Guide, the Malnutrition Screening Toll (MST) is a simple, reliable and valid instrument which can be useful for nutritional screening of adult patients with cancer. As a method of nutritional assessment for patients with cancer, the Subjective Global Assessment (SGA), and especially the Patient-Generated Subjective Global Assessment (PGSGA) should be also mentioned. The causes of malnutrition in cancer can be related to type of tumour, patient features or cancer treatment, taking into account that in many cases all causes may be present in the same patient. Malnutrition in patients with cancer is also associated to increased morbidity and mortality; longer hospital stays and higher medical care costs, and a worse outcome and tolerance of cancer treatments (surgery, radio- and chemotherapy). Key objectives of nutritional intervention in cancer patients include preventing early death secondary to underlying malnutrition, reducing complications and improving the quality of life of patients with cancer. To achieve these goals, nutritional intervention includes several options that should be individualized for each patient. In any case, nutritional care should be started early and be part of the overall treatment of cancer patients. Based on its aggressiveness and complexity nutritional support can be classified into the following categories: nutrition recommendations or dietary counseling; artificial nutrition (oral supplements, enteral and parenteral nutrition), and evaluation of possible addiction to appetite stimulants, anabolic agents, cytokine inhibitors and other drugs (AU)

Fish oil (n-3) polyunsaturated fatty acids beneficially affect biliary cholesterol nucleation time in obese women losing weight.

It has been reported that intake of (n-3) polyunsaturated fatty acids (PUFA) reduces the risk of coronary heart disease and decreases biliary cholesterol saturation in the bile of gallstone patients. We investigated the effect of n-3 PUFA on cholesterol saturation index (CSI) and nucleation time (NT) in obese subjects who were losing weight. This was a double-blind, placebo-controlled clinical trial. Obese women (n = 35) with a body mass index (BMI) > or = 30 kg/m(2), with no prior history of gallstones or cholecystectomy by ultrasound were first studied to ensure absence of stones or biliary sludge. The women were then assigned to a hypocaloric regimen [5.02 MJ (1200 kcal)/d] and to receive 1200 mg/d of ursodeoxycholic acid (UDCA), 11.3 g/d of (n-3) PUFA or a placebo for 6 wk. BMI, CSI and NT were recorded at baseline and at the end of the experimental period. BMI decreased 5.75 +/- 2.7%/mo (range, 1.5-12.42%/mo) during the experiment. The CSI did not change in any of the groups. Cholesterol NT decreased significantly in the UDCA and placebo groups, but not in the (n-3) PUFA group. None of the women had developed gallstones at 6 wk. These results suggest that (n-3) PUFA maintain the CSI and NT in obese women during rapid weight loss, which probably results in the prevention of cholesterol gallstone formation.