Psychological Therapy in Chronic Pain: Differential Efficacy between Mindfulness-Based Cognitive Therapy and Cognitive Behavioral Therapy.

The objective of this study is to evaluate the differential efficacy between Mindfulness-Based Cognitive Therapy (MBCT) and Cognitive Behavioral Therapy (CBT). A quasi-experimental design of repeated measures before and after the test (n = 57) was used with a non-equivalent control group from a previous cohort treated with CBT (n = 105). The t-test revealed significant differences in subjective quality of life for the MBCT group, and in quantity, optimum, and adequate sleep for the CBT group. The pre-post effect size comparison mostly showed slightly larger effect sizes in the MBCT group. CBT and MBCT had comparable efficacies, although a slight trend towards larger effect sizes in MBCT was found. Likewise, CBT seemed to improve sleep-related variables, while MBCT was associated with improvements in pain and quality of life.

Effects of Mindfulness-Based Cognitive Therapy for Chronic Pain: A Multicenter Study.

The prevalence of chronic pain in Spain is 15%. The objective of this study was to evaluate the efficacy of mindfulness-based cognitive therapy on patients with chronic pain. A quasi-experimental design of repeated measures pre- and post-test (N = 57) was carried out at three hospitals from the province of Alicante. Self-reported assessment measurements of pain intensity, anxiety-depression symptoms, perception of health status, interference of pain on sleep, self-efficacy in pain, acceptance, and mindfulness attitude were included. The T-test indicates significant differences in intensity of present pain, mental quality of life, and depression (medium effect sizes), as well as in self-efficacy: total score, symptom management and pain control (medium effect sizes), sleep disturbances and quantity of sleep (large effect sizes). MBCT is effective in reducing many symptoms in patients with chronic pain, although its maintenance needs to be further investigated.

Barriers Perceived by Managers and Clinical Professionals Related to the Implementation of Clinical Practice Guidelines for Breastfeeding through the Best Practice Spotlight Organization Program.

International institutions facilitate the contact of health professionals to evidence-based recommendations for promoting exclusive breast feeding (BF). However, the achievement of good rates of exclusive BF is still far from the optimum. The intention of the present work is to determine the barriers identified by managers and health professionals involved in the implementation and sustainability of Clinical Practice Guidelines (CPG) for breastfeeding under the auspices of the Best Practice Spotlight Organization program. A qualitative research study was carried out. The participants were managers, healthcare assistants, nurses, midwives, pediatricians and gynecologists. Semi-structured interviews were conducted which were transcribed and analyzed using the six steps of thematic analysis. Twenty interviews were conducted, which defined four major themes: (1) Lack of resources and their adaptation; (2) Where, Who and How; (3) Dissemination and reach of the project to the professionals; and (4) The mother and her surroundings. This research identifies the barriers perceived by the health professionals involved in the implementation, with the addition of the managers as well. Novel barriers appeared such as the ambivalent role of the midwives and the fact that this CPG is about promoting health. The efforts for promoting the implementation program should be continuous, and the services should be extended to primary care.

The nurse work environment in Spanish nurses following an economic recession: From 2009 to 2014.

AIM: To detect possible changes in perception of the nurse work environment, job satisfaction and burnout between the years 2009 and 2014 among nurses working in the Spanish National Health System. BACKGROUND: The global economic crisis has had a great impact on nurses in the Spanish National Health Service: tougher working conditions, lower pay and a reduction in social benefits. It is not known whether these changes affect the nurses' work environment, job satisfaction and burnout. METHOD: Comparative, cross-sectional study performed in seven hospitals in the Spanish National Health System between 2009 and 2014, through 1,454 surveys of nurses working in internal medicine, surgery and intensive care. RESULTS: Nurses participating in the second period (2012-2014) were more satisfied with their current job (p = 0.001), perceived their work environment to be more favourable (p < 0.001) and had lower levels of burnout (p < 0.01). Professional factors as 'autonomy at work,' 'opportunities for advancement,' 'professional status' and 'nursing foundations for quality care,' as well as 'collegial nurse-physician relations' and 'nurse participation in hospital affairs' were the most important variables associated with these topics. CONCLUSIONS: Professional factors may influence these changes more than labour conditions and remuneration aspects. IMPLICATIONS FOR NURSING MANAGEMENT: In times of economic recession, encouraging interpersonal relationships, autonomy and participation in decision-making may improve the work environment, satisfaction and burnout of nurses.

Oleanolic acid induces migration in Mv1Lu and MDA-MB-231 epithelial cells involving EGF receptor and MAP kinases activation.

During wound healing, skin function is restored by the action of several cell types that undergo differentiation, migration, proliferation and/or apoptosis. These dynamics are tightly regulated by the evolution of the extra cellular matrix (ECM) contents along the process. Pharmacologically active flavonoids have shown to exhibit useful physiological properties interesting in pathological states. Among them, oleanolic acid (OA), a pentacyclic triterpene, shows promising properties over wound healing, as increased cell migration in vitro and improved wound resolution in vivo. In this paper, we pursued to disclose the molecular mechanisms underlying those effects, by using an in vitro scratch assay in two epithelial cell lines of different linage: non-malignant mink lung epithelial cells, Mv1Lu; and human breast cancer cells, MDA-MB-231. In every case, we observed that OA clearly enhanced cell migration for in vitro scratch closure. This correlated with the stimulation of molecular pathways related to mitogen-activated protein (MAP) kinases, as ERK1,2 and Jun N-terminal kinase (JNK) 1,2 activation and c-Jun phosphorylation. Moreover, MDA-MB-231 cells treated with OA displayed an altered gene expression profile affecting transcription factor genes (c-JUN) as well as proteins involved in migration and ECM dynamics (PAI1), in line with the development of an epithelial to mesenchymal transition (EMT) status. Strikingly, upon OA treatment, we observed changes in the epidermal growth factor receptor (EGFR) subcellular localization, while interfering with its signalling completely prevented migration effects. This data provides a physiological framework supporting the notion that lipophilic plant extracts used in traditional medicine, might modulate wound healing processes in vivo through its OA contents. The molecular implications of these observations are discussed.

[Surgery in children and adolescents]. / Cirugía en el niño y el adolescente.

The authors explain in a standardized model of nursing care for children and adolescents durning pre-operative phase, the first part in the global surgical process. This phase commences at the moment a surgical intervention is deemed necessary and finalizes when the child/adolescent is transported to the operating room. The authors perform a systematic and holistic evaluation, using the Gordon Functional Health Patterns. Special emphasis is given to aspects such as the perception-management health pattern, the nutritional-metabolic pattern, the elimination pattern, the exercise-activity pattern, the dream-rest pattern, the self-perception pattern and the adaptation-stress tolerance pattern. They evaluate the perception and responses children of varying ages provide to being separated from parents. They highlight the cultural factors which must be born in mind in order to achieve an adequate evaluation and individualized care. The authors select the Nursing Diagnoses of NANDA, the North American Nursing Diagnosis Association, which most frequently appear in this pre-operative phase: fear/anxiety, risk of aspiration, risk of an alteration in health maintenance, and risk of infection. Finally, the authors describe the nursinginterventions related with these diagnoses.

Cirugía en el niño y el adolescente / Surgery for children and adolescents. Intra-operative phase

Se expone la segunda fase del proceso quirúrgico, conocida como intraoperatorio, desarrollando un modelo estandarizado de la atención de enfermería al niño y adolescente durante la fase intraoperatoria. Transcurre en la sala de operaciones desde el momento en el que el niño / adolescente llega procedente de la unidad de hospitalización hasta que es trasladado a la unidad de reanimación. Se efectúa una valoración sistemática y holística utilizando los Patrones Funcionales de Salud de Gordon. Se seleccionan los Diagnósticos de Enfermería de la NANDA (North American Nursing Diagnosis Association) que con mayor frecuencia se presentan en esta fase intraoperatoria: riesgo de lesión, riesgo de infección, riesgo de hipotermia y riesgo de asfixia. También se mencionan las complicaciones potenciales que pueden aparecer durante la intervención según la edad del niño, el tipo de anestesia, la técnica quirúrgica y el estado general previo. Finalmente, describimos las intervenciones enfermeras relacionadas con las complicaciones potenciales y los diagnósticos enfermeros reseñados (AU)

Cirugía en el niño y el adolescente. Preoperativo / Surgery for children and adolescents pre-operative phase

Se expone un modelo estandarizado de la atención de enfermería al niño y adolescente durante la fase preoperatoria, la primera parte del proceso quirúrgico global. Comienza en el momento en el que se decide realizar la intervención y finaliza cuando se traslada al niño/adolescente al quirófano. Se efectúa una valoración sistemática y holística utilizando los Patrones Funcionales de Salud de Gordon. Se incide especialmente en aspectos como el patrón percepción-manejo de la salud, el patrón nutricional-metabólico, el patrón de eliminación, el patrón actividad-ejercicio, el patrón sueño-descanso, el patrón autopercepción y el patrón adaptación-tolerancia al estrés. Se evalúa la percepción y respuestas del niño con diferentes edades a la separación de los padres. Se resaltan los factores culturales que se han de tener presentes para lograr una adecuada valoración y unos cuidados individualizados. Se seleccionan los Diagnósticos de Enfermería de la NANDA (North American Nursing Diagnosis Association) que con mayor frecuencia se presentan en esta fase preoperatoria: temor/ansiedad, riesgo de aspiración, riesgo de alteración en el mantenimiento de la salud y riesgo de infección. Finalmente, se describen las intervenciones enfermeras relacionadas con estos diagnósticos (AU)

[Surgery in children and adolescents]. / Cirugía en el niño y el adolescente.

The authors explain the second phase in surgery procedure which is known as intra-operative, developing a standardized model of nursing care for children and adolescents during the intra-operative phase. This phase commences in the operating room from the moment the child/adolescent arrives after being brought from a hospital ward and lasts until the child/adolescent is transferred to the recovery room. The authors perform a systematic and holistic evaluation, using the Gordon Functional Health Patterns. The authors select the Nursing Diagnoses of NANDA, the North American Nursing Diagnosis Association, which most frequently appear in this intra-operative phase: risk of lesion, risk of infection, risk of hypothermia, and risk of asphyxiation. The authors also mention the potential complications which could appear during an operation according to the age of the child, the type of anesthesia used, the surgical technique used, and the overall health of the patient prior to surgery. Finally, the authors describe the nursing treatments related to the potential complications and the outlined nursing diagnoses.