Development of burnout and moral distress in intensive care nurses: An integrative literature review.

AIMS: To describe, through an integrative literature review, the factors contributing to the development of burnout and moral distress in nursing professionals working in intensive care units and to identify the assessment tools used most frequently to assess burnout and moral distress. METHODS: An integrative literature review was carried out. PubMed, CINAHL, PsycINFO, SciELO, Dialnet, Web of Science, Scopus, and Cochrane databases were reviewed from January 2012 to February 2023. Additionally, snowball sampling was used. The results were analysed by using integrative synthesis, as proposed by Whittemore et al., the Critical Appraisal Skills Programme for literature reviews, the Strengthening the Reporting of Observational Studies in Epidemiology guidelines for quantitative observational studies, and the Joanna Briggs Institute checklist for qualitative research were used to evaluate evidence quality. RESULTS: Forty-one articles were selected for review: 36 were cross-sectional descriptive articles, and five were literature reviews. The articles were grouped into five-factor categories: 1) personal factors, 2) organisational factors, 3) labour relations factors, 4) end-of-life care factors, and 5) factors related to coronavirus disease 2019 (COVID-19). The Maslach Burnout Inventory-Human Services Survey and the Moral Distress Survey-Revised instruments were the most commonly used to measure burnout and moral distress. CONCLUSIONS: This review highlights the multiple personal, organisational, relational, situational, and end-of-life factors promoting burnout and moral distress among critical care nurses. Interventions in these areas are necessary to achieve nurses' job satisfaction and retention while improving nurses' quality of care.

[Dyadic self-care interventions in chronic heart failure in hospital settings: a systematic review].

Dyadic self-care in chronic heart failure (CHF) is key to ensure treatment continuity, reduce complications and readmissions, and minimise caregiver burden, but it requires specific strategies. The aim of the study was to identify dyadic self-management interventions in CHF in hospital settings by means of a systematic literature review conducted in the Pubmed, CINAHL and PsycInfo databases. Methodological quality was assessed according to CASPe and Joanna Briggs Institute tools. The main components of the interventions were identified: delivery format; dimensions and strategies used (cognitive-attitudinal, affective-emotional and behavioural); providers and recipients; measurement instruments used; and effectiveness. Most of the studies demonstrated improved outcomes, especially in depression and/or anxiety symptoms, adherence to treatment, diet and weight control. Innovative interventions that include components of the three dimensions identified and the use of valid, reliable and specific scales to measure outcomes are recommended.

[Level of empowerment of hospitalized chronic heart failure patient].

BACKGROUND: Establishing the level of chronic cardiac inpatient empowerment is essential. By doing so, it is possible to identify groups with a lower level. It also provides a basis for designing effective strategies to improve their control over decision making and the actions that affect their health and wellness. The shortage of studies of this phenomenon for this particular population and context suggests that such patients are not receiving proper care. METHODS: A prospective and descriptive study was carried out. A validated Spanish version of the Patient empowerment in long-term conditions scale was used. The survey has 47 items, grouped into three dimensions: Positive attitude and feeling of control, Knowledge in shared decision making, and Seeking information and sharing with other patients. It was distrib-uted 24 hours before hospital discharge. RESULTS: Twenty five questionnaires were collected (81%). The mean global empowerment score of the patients was 165.92 ± 20.9. The dimension Positive attitude and sense of control showed the lowest score, with a mean of 3.4 ± 0.5. An inverse weak relationship was found between the level of empowerment and age (rho = -0.240; p = 0.000) while a positive one was found with 10-year survival (rho = 0,316; p = 0.01). CONCLUSION: The level of empowerment of the patients in this study was medium-high. The strategies used to address the care of this population should focus on working on their attitude towards the disease and perceived control of the situation, and should be individualized according to age.

[Exploring the experience of living with a heart transplant: a systematic review of the literature]. / Explorando la experiencia de vivir con un trasplante cardíaco: una revisión sistemática de la literatura.

The focus of healthcare professionals is shifting from illness to health and the individual experience of each person. However, current health care continues to focus on the prevention and treatment of medical complications, leaving aside other important aspects of the experience of cardiac transplant patients. The aim of this systematic review of the literature was to explore how living with a transplanted heart affects their lives. We searched the databases Pubmed, Cinahl, Scielo, Scopus, Dialnet, Cuiden and PsyINFO, and specialized journals. Twenty-five articles were included for study. The analysis and interpretation of the results was based on the methodology by Dixon-Woods et al and by Evans. The results were grouped into seven categories: spiritual repercussions, psychological repercussions, social repercussions, relationship with the donor and the organ, repercussions in the physical environment and quality of life, coping strategies, and feelings towards the healthcare professionals. The results confirm the need for a change in the care given to cardiac transplant patients given that, although transplantation has been shown to improve the quality and quantity of life, it has multiple psychosocial implications that affect the well-being and day-to-day life of these patients.

[The severity of rheumatoid arthritis as a timely predictor of instability in the asymptomatic cervical spine]. / La severidad de la artritis reumatoide como predictor oportuno de inestabilidad de la columna cervical asintomática.

INTRODUCTION: Cervical spine involvement is common in patients with RA, risk factors such as disease activity may be related to asymptomatic cervical instability. OBJECTIVE: To determine the associated factors for asymptomatic cervical spine instability in patients with rheumatoid arthritis. MATERIAL AND METHODS: Case and control study from the external spine and rheumatology consultation of a level II trauma center to identify all patients diagnosed with rheumatoid arthritis (RA) and asymptomatic cervical instability. With simple X-rays of the cervical spine, carrying out radiographic measurements, the diagnosis of cervical instability was performed, risk factors such as the presence of rheumatoid factor (FR), previous articular surgeries, elevations of the C-reactive protein (PCR) values were evaluated. The severity and activity of the disease measured in the activity index of 28 articulations (DAS 28) in addition to the index of activity of the simplified disease (SDAI). RESULTS: We assessed 32 patients, nine patients (28.1%) met the criteria for instability of the anterior cervical spine atlantoaxial subluxation (SAAa) (100%), also one patient with SAAa presented vertical subluxation (SV), risk factors more relevant: DAS 28 with an OR = 3.54, SDA with an OR = 2.34 and finally the PCR 1.0 its OR = 2.88. CONCLUSION: The risk factors associated opportunely in our population are the severity of the activity of the disease that we can see in the DAS and SDAI when applied in patients and PCR 1.0.

INTRODUCCIÓN: La afectación de la columna cervical es común en pacientes con artritis reumatoide (AR), factores de riesgo como la actividad de la enfermedad puede estar relacionada con inestabilidad cervical asintomática. OBJETIVO: Determinar los factores asociados a la inestabilidad de la columna cervical asintomáticos en pacientes con artritis reumatoide. MATERIAL Y MÉTODOS: Estudio de casos y controles provenientes de la consulta externa de reumatología y columna de un centro de trauma de nivel II para identificar a todos los pacientes diagnosticados con AR e inestabilidad cervical asintomáticos. Con radiografías simples de la columna cervical que hacen mediciones radiográficas, se realizó el diagnóstico de inestabilidad cervical, se evaluaron los factores de riesgo como la presencia de factor reumatoide (FR), cirugías articulares previas, las elevaciones de los valores de proteína C reactiva (PCR), la severidad y actividad de la enfermedad medida en el índice de actividad de la enfermedad de 28 articulaciones (DAS 28), además del índice de actividad de la enfermedad simplificada (SDAI). RESULTADOS: Se evaluaron 32 pacientes, nueve (28.1%) cumplieron con los criterios para inestabilidad de la columna cervical con subluxación atlantoaxial anterior (SAAa) (100%), también un paciente con SAAa presentaba subluxación vertical (SV), los factores de riesgo más relevantes: el DAS 28 con un OR = 3.54, SDA con un OR = 2.34 y por último el PCR 1.0 su OR = 2.88. CONCLUSIÓN: Los factores de riesgo asociados oportunamente en nuestra población son la severidad de la actividad de la enfermedad que podemos observar en el DAS y SDAI al aplicarlos en los pacientes y PCR 1.0.

Intervenciones de autocuidado diádico en la insuficiencia cardíacacrónica en el contexto hospitalario: una revisión sistemática / Dyadic self-care interventions in chronic heart failure in hospital settings: a systematic review

El autocuidado diádico en la insuficiencia cardiaca cró-nica (ICC) es clave para garantizar la continuidad del tra-tamiento, disminuir las complicaciones y los reingresos, yminimizar la sobrecarga del cuidador, pero demanda estra-tegias específicas. El objetivo fue identificar las intervencio-nes de autocuidado diádico en la ICC en el contexto hospi-talario mediante una revisión sistemática de la literatura enPubMed, CINAHL y PsycInfo; la calidad metodológica se valo-ró según las herramientas de CASPe y del Joanna Briggs Ins-titute. Se identificaron los principales componentes de lasintervenciones: formato de administración; dimensiones yestrategias utilizadas (cognitivo-actitudinal, afectiva-emo-cional y conductual); proveedores y receptores; instrumen-tos de medida utilizados; y efectividad. La mayoría de estu-dios mejoraron los resultados, especialmente síntomas dedepresión y/o ansiedad, adherencia al tratamiento, dieta ycontrol del peso. Se recomiendan intervenciones innova-doras que incluyan componentes de las tres dimensionesidentificadas y el uso de escalas válidas, fiables y específicaspara medir los resultados.(AU)

Dyadic self-care in chronic heart failure (CHF) is key toensure treatment continuity, reduce complications and re-admissions, and minimise caregiver burden, but it requiresspecific strategies. The aim of the study was to identify dy-adic self-management interventions in CHF in hospital set-tings by means of a systematic literature review conductedin the Pubmed, CINAHL and PsycInfo databases. Methodo-logical quality was assessed according to CASPe and JoannaBriggs Institute tools. The main components of the inter-ventions were identified: delivery format; dimensions andstrategies used (cognitive-attitudinal, affective-emotionaland behavioural); providers and recipients; measurementinstruments used; and effectiveness. Most of the studiesdemonstrated improved outcomes, especially in depressionand/or anxiety symptoms, adherence to treatment, diet andweight control. Innovative interventions that include com-ponents of the three dimensions identified and the use ofvalid, reliable and specific scales to measure outcomes arerecommended(AU)

The effect of supplementation with n-3 fatty acids on the physical performance in subjects with spinal cord injury.

A global physical evaluation was performed in 21 males with spinal cord injury (SCI), at the beginning and at three and six months of omega-3 fatty acid (FA) supplementation. A significant increase in the proportion of eicosapentaenoic acid and docosahexanoic acid in plasma was observed in response to the supplementation (p<0.05). After six months of FA supplementation, strength endurance time increased from 127.7+/-19.0 s to 215.2+/-45.6 s in the right arm, and from 139+/-27.6 s to 237.7+/-48.7 s, in the left arm. The time to perform 20 repetitions of 70% maximum workload showed a reduction of 41% between the first and the third test. The time taken to cover a 90 meter long track, with a 6% slope, was reduced from 66.9+/-8.0 s to 59.3+/-6.7 s, at the end of the study (p<0.05). In conclusion, omega-3 FA supplementation could contribute to improve the functional capabilities in SCI subjects.

The experience of family caregivers caring for a terminal patient at home: A research review.

INTRODUCTION: One of the key aspects of the care of terminal patients is care delivered in their own home. Increasingly, the process of dying is moving from hospitals to homes. Although this process is directly related to the support of the social health environment, the involvement of family caregivers is essential. Given the impact that caring for a terminally ill family member has on people's lives, it is necessary to comprehend their personal experience in a holistic way. OBJECTIVE: To reveal the experience of family caregivers who are caring for a terminal patient in their home. DESIGN: A qualitative systematic review of articles published from 2000 to 2015 was conducted between March and September of 2015. The following databases were consulted: CINAHL, PubMed, PsycINFO, Cochrane Library, SciELO and Dialnet. After applying the selection criteria, 12 relevant studies were identified. Subsequently, two of the reviewers jointly performed a qualitative content analysis of them. RESULTS: The analysis permitted the caregivers' experiences to be grouped into five themes: 1) Learning the diagnosis: uncertainty about the future and the prospects of death; 2) Feeling the physical and emotional burden of care; 3) Experiencing a limited life; 4) Redefining the relationship with the person being cared for; and 5) Valuing the importance of the support of the environment. CONCLUSIONS: This review shows that caring for a family member with advanced illness in the home has a great impact on the personal realm of the caregiver and in the relationship he or she maintains with the ill family member. Being involved in the process of dying translates into a prodigious physical and psychological effort, together with a substantial limitation on the normal development of their own life. Additionally, the caregiver must face and establish a new relationship with the family member, in accordance with the new ethos, without the help of a formal structure providing the necessary support. These results may help to focus attention on family caregiver needs and to develop the knowledge necessary to meet the current demands of end-of-life health care in the home.

Nivel de empoderamiento de las personas con insuficiencia cardíaca crónica hospitalizadas / Level of empowerment of hospitalized chronic heart failure patient

Fundamento: Conocer el nivel de empoderamiento de laspersonas con insuficiencia cardiaca crónica hospitalizadas es crucial para identificar a las personas con un nivelde empoderamiento más bajo y fundamentar el diseño deestrategias efectivas para mejorar su control sobre lasdecisiones y acciones que afectan a su salud y bienestar.La falta de estudio de este fenómeno en esta poblacióny contexto, sugiere que estos pacientes no están siendoatendidos adecuadamente. Material y métodos: Estudio descriptivo, prospectivo. Seutilizó el Cuestionario de empoderamiento del pacientecon enfermedad crónica, traducido y validado al español,que consta de 47 ítems, agrupados en tres dimensiones:Actitud positiva y sentido del control, Toma de decisiones compartida e informada, y Búsqueda de informacióny compartir entre iguales. Fue distribuido para su cumplimentación en las 24 horas previas al alta hospitalaria.Resultados: Se recogieron 25 cuestionarios (81%). La puntuación global media de empoderamiento fue de 165,92 ±20,9. La dimensión Actitud positiva y sentido de controlfue la peor puntuada, con una media de 3,4 ± 0,5. Se encontró una relación inversa y débil entre el nivel de em-poderamiento y la edad (rho = -0,240; p = 0,000) y una relación débil y positiva con la supervivencia a los 10 años(rho = 0,316; p = 0,01).Conclusión: El nivel de empoderamiento de los pacientesde este estudio fue medio-alto. Las estrategias para abordar la atención de esta población deberían centrarse entrabajar su actitud respecto a la enfermedad y percepciónde control de la situación e individualizarse conforme ala edad.(AU)

Background: Establishing the level of chronic cardiac inpatient empowerment is essential. By doing so, it is possible to identify groups with a lower level. It also providesa basis for designing effective strategies to improve theircontrol over decision making and the actions that affecttheir health and wellness. The shortage of studies of thisphenomenon for this particular population and contextsuggests that such patients are not receiving proper care. Methods: A prospective and descriptive study was carried out. A validated Spanish version of the Patient empowerment in long-term conditions scale was used. Thesurvey has 47 items, grouped into three dimensions: Positive attitude and feeling of control, Knowledge in shareddecision making, and Seeking information and sharingwith other patients. It was distributed 24 hours beforehospital discharge. Results: Twenty five questionnaires were collected (81%).The mean global empowerment score of the patients was165.92 ± 20.9. The dimension Positive attitude and senseof control showed the lowest score, with a mean of 3.4± 0.5. An inverse weak relationship was found betweenthe level of empowerment and age (rho = -0.240; p = 0.000)while a positive one was found with 10-year survival(rho = 0,316; p = 0.01). Conclusion: The level of empowerment of the patients inthis study was medium-high. The strategies used to address the care of this population should focus on workingon their attitude towards the disease and perceived control of the situation, and should be individualized according to age.(AU)

Deletion of chromosome 4: 46,XY, del(4) (q31.3) after gamete intrafallopian transfer and in vitro fertilization-embryo transfer.

It seems that assisted reproduction technology does not increase the rate of chromosome abnormalities, and up to now, a few cases have been reported. The case we describe here is the first one of monosomy 4q31 in a full-term liveborn after a combined GIFT-IVF procedure. Once more, this case raises the question of whether pregnancies resulting from IVF should be monitored for chromosome abnormalities or not.

Crayfish Procambarus clarkii shows circadian variations in different parameters of the GSH cycle.

The present study investigated the rhythmic changes in glutathione status in midgut gland and hemolymph as well as in glutathione reductase (GR) activity in the crayfish Procambarus clarkii. In order to determine the circadian nature of these rhythms different groups of crayfish were submitted to constant-darkness conditions for 24 or 72 h after they had spent 15 days under light-dark 12:12 cycles. The animals of the different batches were killed at 6 h intervals during a 24 h cycle. Reduced glutathione (GSH) and oxidized glutathione (GSSG) in hemolymph and midgut as well as midgut GR activity were determined in midgut gland and hemolymph by fluorometric and spectrophotometric method. Data analysis by chronogram and single Cosinor revealed circadian rhythmicity for GSH and GSSG concentration in both tissues as well as midgut GR activity. The rhythm parameters revealed oxidative stress induced by light. The possible correlation between the glutathione rhythm and other metabolic and behavioral rhythms of crayfish as well as the importance of the glutathione circadian temporal order in the adaptation of crayfish are discussed.

Changes in hemolymph glutathione status after variation in photoperiod and light-irradiance in crayfish Procambarus clarkii and Procambarus digueti.

This work studied the effect of light-stressors, irradiance and photoperiod length on the status of hemolymph glutathione in two species of crayfish, Procambarus clarkii and Procambarus digueti. Adult animals of each species were submitted to two experimental approaches: (1) two batches of each species were placed under low or high light irradiant conditions of light-dark (LD) 24 h cycles of two different photoperiod lengths, one normal LD 12: 12 and one extreme LD 20:4 low and high irradiance for 10 weeks. Time-dependent light changes on hemolymph glutathione concentration were determined throughout the entire experimental period; and (2) three batches of the two species were submitted to independent treatments consisting of the same LD 12:12 cycles of high and low irradiance and 20:4 high-irradiance LD cycles. Reduced and oxidized glutathione hemolymph concentrations were determined and total glutathione was calculated. In addition midgut glutathione reductase activity in both species was determined. The two species showed different hemolymph glutathione reactivity and glutathione status for the two light parameters. Dissimilar responses of both species, as well as the rate of mortality of P. digueti represent specific differences in the metabolic responses, as well as tolerance to photo-oxidative stress produced by light. The role of glutathione in the tolerance of crayfish to photo-oxidative stress is discussed.

Creatine supplementation and performance in 6 consecutive 60 meter sprints.

Creatine is an ergogenic aid used in individual and team sports. The aim of this study is to analyze the effect of monohydrate creatine supplementation on physical performance during 6 consecutive maximal speed 60 meter races, and the changes induced in some characteristic biochemical and ventilatory parameters. The study was carried out on nineteen healthy and physically active male volunteers, and randomly distributed into two groups: Group C received a supplement of creatine monohydrate (20 g/day for 5 days) and group P received placebo. Tests were performed before and after supplementation. No significant changes were observed in weight or body water measured by bioimpedance or the sum of 7 skinfold or performance during the 60 meter races. Group C showed a statistically significant increase in plasma creatinine from 69.8 +/- 12.4 to 89.3 +/- 12.4 micromol x L(-1) (p<0.05). In group C in the second control day (after creatine supplementation), expiratory volume V(E), O2 uptake and CO2 production were lower after 2 minutes of active recovery period. These results indicate that creatine monohydrate supplementation does not appear to improve the performance in 6 consecutive 60 meter repeated races but may modify ventilatory dynamics during the recovery after maximal effort.

[Heart malformations in trisomy 13 and trisomy 18]. / Malformaciones cardíacas en las trisomías 13 y 18.

Congenital heart diseases were studied in children diagnosed of trisomy 13 and trisomy 18 in our hospital between January 1973 and July 1990. Twenty patients with trisomy 18 were diagnosed (18 females and two males). All had cardiac malformations. The findings were: ventricular septal defect in 16 cases (80%), valvular anomalies in 12 (63%), patent ductus arteriosus in nine (47%) and atrial septal defect or patent foramen ovale in 7 cases (36%). We found some complex congenital cardiac diseases: one atrioventricular canal, one tetralogy of Fallot, one hypoplastic left ventricle with mitral atresia and double outlet right ventricle, one case of univentricular heart with aortic outlet from a rudimentary cavity, a right ventricular atresia with pulmonary and tricuspid valves atresia. Nine cases of trisomy 13 were diagnosed (seven females and two males). We found: ventricular septal defect in 7 cases (77%), valvular disease in five (100% of the necropsy studies), secundum atrial septal defect in 4 patients (80%) and patent ductus arteriosus in two. Two cases presented hypoplastic left ventricle with aortic arch hypoplasia, one of them had subaortic stenosis and left superior vena cava being connected to the right atrium via coronary sinus; one case showed fibroelastosis. Our results have been similar to the previously reported and confirm the invariably presence of cardiac malformations in these syndromes. These malformations are an important sign of suspicion in fetal ultrasonography.

[Application of bidimensional echocardiography in the diagnosis of ventricular septal defect]. / Aplicación de la ecocardiografía bidimensional en el diagnóstico de la comunicación interventricular.

Between 1985-1990 we studied by means of two-dimensional echocardiography 286 patients with isolated ventricular septal defect (VSD). A hundred and sixty three being male and 123 female, as a mean age of 5 +/- 3 months. Sixty two cases (22.3%) reveales associated anomalies and in other 63 (22.4%) there was in the evolution an aneurysm of the septum membranous. The projections used were apical 4-chamber, with or without aortic root; parasternal long-short axis of great arterias or at ventricular level; subcostal 4-chamber; right oblique outlet right outflow tract and left oblique outlet left and right outflow tracts. Patients with VSD smaller than 3 mm were excluded. Perimembranous defects, 189 cases (66%), were more frequent than muscular, 91 31.8%), and subarterial defects, 6 (2.1%). Only 19 (9 apical muscular, 6 perimembranous outlet and 4 perimembranous trabecular) were initially misclassified. The diameter of the VSD was large in subarterial (0.85 +/- 0.1 cm) and perimembranous outlet VSD (0.75 +/- 0.5 cm) compared with the rest. Each group of defects was more easily shown by one particular projection except trabecular muscular defect. In conclusion, we are able to state that two-dimensional echocardiography enables us to discover the size and situation of isolated ventricular defects.

[The usefulness of two-dimensional echocardiography in the diagnosis of an interventricular aneurysm]. / Utilidad de la ecocardiografía bidimensional para el diagnóstico del aneurisma del septo interventricular.

The ventricular septal defect (VSD) may close spontaneously in the first few years of life. The closure occurs by muscle's growth of the borders of the defect or by the appearance of an aneurysm of ventricular septum composed mostly by tricuspid tissue. We believe that the two-dimensional echocardiography is the best method to determine the mechanisms that take part in the aneurysm formation. The study was carried out on 58 patients with aneurysms of ventricular septum observed in 230 patients with ventricular septal defects. 29 were male and 29 were female patients. The mean age at the time of diagnosis of aneurysm was 30 months (range 1 month-13 years). Forty seven patients had a perimembranous ventricular septal defect (perimembranous inlet 29, perimembranous trabecular nine, perimembranous outlet nine and of mixed's type seven), muscular defect nine (muscular inlet seven, and muscular trabecular two) and VSD closed in two. The size of the defect was 0.47 +/- 0.2 cm (range 0.2-1.1). In 16 the defect was larger than 0.6 cm. Thirty two patients had associated anomalies. On study the aneurysm in relation with tricuspid valve leaflets: in 27 cases (46.3%), the aneurysm was entirely formed by tricuspid septal leaflets tissue (17 had perimembranous ventricular septal defect and seven muscular), in eight (13.6) the aneurysm had tricuspid valve leaflets and interventricular component of the membranous septum tissue (five perimembranous defect and two muscular) and in another 16 cases membranous septum tissue only. In 7 patients the origin of the aneurysm wasn't confirmed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Aortic coarctation in the first 3 months of life. Surgical results]. / Coartación de aorta en los primeros 3 meses de vida. Resultados quirúrgicos.

Between January 1973 and September 1989, 51 patients younger than 3 months with coarctation of the aorta underwent surgery. All of them had atrio-ventricular and ventriculo-arterial concordance with well developed ventricular cavities. Thirty-four were male and 17 female. Thirty five had associated anomalies and catheterism was done in 36 before surgical correction. The surgical procedures we used were 19 subclavian plasty (Waldhausen), 13 end-to-end anastomosis, 13 Alvarez technique and three goterex parch. Twelve died (23.5%), three during surgery and the others in a period of 3 to 20 days after surgery. Eight were younger than 17 days, seven had aortic arch hypoplasia associated and six had ventricular septal defect (five with pulmonary hypertension). Other ten developed recoarctation (gradient greater than 20 mmHg) between 10 days and 8 months after first intervention (media = 3 months). Five had previously end-to-end correction (41.6%), two angioplasty with parch (66%), two Alvarez (20%) and one Waldhausen (7%). The correction of the recoarctation required surgery in 4 patients (three with angioplasty with parch and one with end to end correction), and the other six underwent angioplasty with catheter-balloon. None of the 15 patients without previous catheterism died, and neither did those who underwent surgery during the last 4 years. The associated anomalies required a second time surgery. We conclude that morbimortality is related to the aortic arch hypoplasia, pulmonary hypertension and surgery during the first 2 weeks. We recommend surgery without previous catheterism. The recoarctation is more frequent in patients with end to end correction, without an increase of the mortality.

[Cronkhite-Canada syndrome]. / Síndrome de Cronkhite-Canada.

The case of a 76-year-old patient with the Cronkhite-Canada syndrome admitted for diarrhea is presented. Although the clinical, endoscopical and histological data suggested the diagnosis, confirmation was achieved following necropsy, as well the evolution and the different treatment schedules carried out.

Enhancement of cognitive functioning and self-regulation of learning in adolescents.

This study assessed the effects of the administration of a package of activities, known as Portfolio, on adolescents' cognitive functioning and self-regulation of learning. The study was carried out with a group of 109 students (mean age 15 years old) from the first level of Vocational Training. The students had learning difficulties, were unmotivated to study, and had behavior problems. A quasi-experimental pretest-posttest design was employed. The intervention involved group sessions in which certain, specially selected tasks from the psychopedagogic Instrumental Enrichment Program, the Philosophy for Children Program, and Project Intelligence were carried out. The intervention tasks were distributed over the entire school year. Statistically significant differences were observed between the experimental and the control groups on measures of general intelligence, cognitive flexibility, and metacognitive strategies (all p < .01). Statistically significant gains were observed for the experimental group on measures of decision making, problem solving, and self-regulation of learning (all p < .01).

Explorando la experiencia de vivir con un trasplante cardíaco: una revisión sistemática de la literatura / Exploring the experience of living with a heart transplant: a systematic review of the literature

El enfoque de los profesionales de la salud está cambiando, pasando de centrarse en la enfermedad a orientarse hacia la salud y la experiencia individual de cada persona. Sin embargo, aunque esta perspectiva se considera relevante para los pacientes trasplantados cardíacos, la atención sanitaria actual se sigue centrando en la prevención y el tratamiento de las complicaciones médicas, dejando de lado otros aspectos importantes de su vivencia. El objetivo de esta revisión sistemática de la literatura fue explorar la experiencia de vivir con un corazón trasplantado y las implicaciones vitales que esto supone. Se realizó una búsqueda en las bases de datos Pubmed, Cinahl, Scielo, Scopus, Dialnet, Cuiden y PsyINFO, y en revistas especializadas y se incluyeron 25 artículos cuyo análisis e interpretación se basó en la metodología propuesta por Dixon-Woods y col y por Evans. Los resultados se agruparon en siete categorías: repercusiones espirituales, repercusiones psicológicas, repercusiones sociales, relación con el donante y el órgano, repercusiones en el ámbito físico y calidad de vida, estrategias de afrontamiento, y sentimientos hacia los profesionales. Los resultados confirman la necesidad de que haya un cambio en la atención que se presta a las personas trasplantadas cardíacas. Se ha visto que aunque el trasplante mejora la calidad y la cantidad de vida, tiene múltiples repercusiones psicosociales que afectan al bienestar y al día a día de estos pacientes

The focus of healthcare professionals is shifting from illness to health and the individual experience of each person. However, current health care continues to focus on the prevention and treatment of medical complications, leaving aside other important aspects of the experience of cardiac transplant patiens. The aim of this systematic review of the literature was to explore how living with a transplanted heart affects their lives. We searched the databases Pubmed, Cinahl, Scielo, Scopus, Dialnet, Cuiden and PsyINFO, and specialized journals. Twenty-five articles were included for study. The analysis and interpretation of the results was based on the methodology by Dixon-Woods et al and by Evans. The results were grouped into seven categories: spiritual repercussions, psychological repercussions, social repercussions, relationship with the donor and the organ, repercussions in the physical environment and quality of life, coping strategies, and feelings towards the healthcare professionals. The results confirm the need for a change in the care given to cardiac transplant patients given that, although transplantation has been shown to improve the quality and quantity of life, it has multiple psychosocial implications that affect the well-being and day-to-day life of these patients