Selective decontamination of the digestive tract in a burns unit reduces the incidence of hospital-acquired infections: A retrospective before-and-after cohort study.

OBJECTIVE: To evaluate the effect of selective decontamination of the digestive tract (SDD) on hospital-acquired infections (HAIs) in patients with acute burn injury requiring admission to a Burns Unit (BU). DESIGN: Retrospective before-and-after cohort study, between January 2017 and June 2023. SDD was implemented in March 2019, dividing patients into two groups. SETTING: Four-bed BU, in a referral University Hospital in Spain. PATIENTS: All the patients admitted during the study period were eligible for analysis. Patients who died or were discharged within 48hours of admission, and patients with an estimated survival less than 10% not considered for full escalation of therapy were excluded. INTERVENTION: SDD comprised the administration of a 4-day course of an intravenous antibiotic, and an oral suspension and oral topical paste of non-absorbable antibiotics during the stay in the BU. MAIN VARIABLE OF INTEREST: Incidence of HAIs during the stay in the BU. SECONDARY OUTCOMES: incidence of specific types of infections by site (bacteremia, pneumonia, skin and soft tissue infection) and microorganism (Gram-positive, Gram-negative, fungi), and safety endpoints. RESULTS: We analyzed 72 patients: 27 did not receive SDD, and 45 received SDD. The number of patients who developed HAIs were 21 (77.8%) and 21 (46.7%) in the non-SDD and the SDD groups, respectively (p=0.009). The number of hospital-acquired infectious episodes were 2.52 (1.21-3.82) and 1.13 (0.54-1.73), respectively (p=0.029). CONCLUSIONS: SDD was associated with a reduced incidence of bacterial HAIs and a decrease in the number of infectious episodes per patient.

Bromelain-based enzymatic burn debridement: Spanish multidisciplinary consensus.

Background: Bromelain-based enzymatic debridement is gaining increased interest from burn specialists in the last few years. The objective of this manuscript is to update the previous, first Spanish consensus document from 2017 (Martínez-Méndez et al. 43:193-202, 2017), on the use of enzymatic debridement with NexoBrid® in burn injuries, adding the clinical experience of a larger panel of experts, integrating plastic surgeons, intensivists, and anesthesiologists. Methods: A consensus guideline was established by following a modified Delphi methodology of a 38-topic survey in two rounds of participation. Items were grouped in six domains: general indication, indication in critical patients, pain management, conditions for NexoBrid® application, NexoBrid® application technique, and post-debridement wound care. Results: In the first round, experts established consensus (strongly agree or agree) on 13 of the 38 statements. After the second round, a consensus was reached on 24 of the 25 remaining statements (97.2%). Conclusions: The present updated consensus document provides recommendations on the use of bromelain-based enzymatic debridement NexoBrid®, integrating the extensive clinical experience of plastic surgeons, intensivists, and anesthesiologists in Spain. Further clinical trials and studies are required to corroborate, modify, or fine tune the current statements.

The relationship between jumping to conclusions and social cognition in first-episode psychosis.

Jumping to conclusions (JTC) and impaired social cognition (SC) affect the decoding, processing, and use of social information by people with psychosis. However, the relationship between them had not been deeply explored within psychosis in general, and in first-episode psychosis (FEP) in particular. Our aim was to study the relationship between JTC and SC in a sample with FEP. We conducted a cross-sectional study with 121 patients with FEP, with measures to assess JTC (easy, hard, and salient probability tasks) and SC (emotional recognition, attributional style, and theory of mind). We performed Student's t-test and logistic regression in order to analyse these associations.We found a statistically significant and consistent relationship of small-moderate effect size between JTC (all three tasks) and impaired emotional recognition. Also, our results suggest a relationship between JTC and internal attributions for negative events. Relationships between JTC and theory of mind were not found. These results highlight the importance of psychological treatments oriented to work on a hasty reasoning style and on improving processing of social information linked to emotional recognition and single-cause attributions.

A Multicentre, Randomised, Controlled Trial of a Combined Clinical Treatment for First-Episode Psychosis.

INTRODUCTION: There is evidence that early intervention contributes to improving the prognosis and course of first-episode psychosis (FEP). However, further randomised treatment clinical trials are needed. OBJECTIVES: The aim of this study was to compare the efficacy of a combined clinical treatment involving Cognitive Behavioural Therapy (CBT) as an adjunctive to treatment-as-usual (TAU) (CBT+TAU) versus TAU alone for FEP. PATIENTS AND METHODS: In this multicentre, single-blind, randomised controlled trial, 177 participants were randomly allocated to either CBT+TAU or TAU. The primary outcome was post-treatment patient functioning. RESULTS: The CBT+TAU group showed a greater improvement in functioning, which was measured using the Global Assessment Functioning (GAF) and Functioning Assessment Short Test (FAST), compared to the TAU group post-treatment. The CBT+TAU participants exhibited a greater decline in depressive, negative, and general psychotic symptoms; a better awareness of the disease and treatment adherence; and a greater increase in brain-derived neurotrophic factor levels than TAU participants. CONCLUSIONS: Early intervention based on a combined clinical treatment involving CBT as an adjunctive to standard treatment may improve clinical and functional outcomes in FEP.

Jumping to conclusions and suicidal behavior in depression and psychosis.

Suicidal behavior (SB) involves an impairment in decision-making (DM). Jumping to conclusions bias (JTC), described as the tendency to make hasty decisions based on insufficient information, could be considered as analogous of impaired DM. However, the link between JTC and SB in psychosis and other diagnoses (e.g., depression) has never been studied. This study aims to explore the presence of JTC and SB in a sample comprising 121 patients with psychosis and 101 with depression. Sociodemographic and clinical data were collected, including history of SB and symptom-severity scores. JTC was assessed by the beads task, and patients who reached decisions with the second bead or before were considered to exhibit JTC. Age, gender, diagnosis, educational level, symptom severity, substance use, and SB were compared according to JTC presence. Variables found to be significantly different in this comparison were included in a multivariate analysis. JTC was more prevalent in patients with depression than with psychosis: 55.6% in an 85:15 ratio and 64.6% in a 60:40 ratio. When multivariate logistic regression was applied to study the influence of diagnosis (psychosis versus depression), age, and SB, only SB remained statistically significant (OR 2.05; 95% CI 0.99-4.22; p = 0.05). The population studied was assembled by grouping different samples from previous research, and we have not included control variables such as other clinical variables, neurocognitive measurements, or personality traits. JTC may be more closely linked to SB, as a transdiagnostic variable, rather than to a specific diagnosis.

Cold-Induced Injury Affecting 27% of TBSA: A Case Report.

Frostbite is a particularly severe form of cold-induced injury that most frequently causes tissular damage in acral parts (hands and feet) and usually involves a small extension of the TBSA. Here, we present a rare case of frostbite affecting a large area (27%), which was successfully treated in a similar way to a thermal burn injury.

Infección nosocomial por Trichosporon asahii en un paciente quemado crítico / Nosocomial infection due to Trichosporon asahii in a critical burned patient

Antecedentes. La infección fúngica invasiva es una causa importante de morbimortalidad en los pacientes con quemaduras graves. Los avances en el tratamiento del paciente quemado crítico han llevado a una supervivencia mayor, pero, a su vez, a un aumento de las complicaciones sépticas, en especial de las infecciones fúngicas, con un incremento de las infecciones por diferentes especies de Candida. Sin embargo, algunos hongos oportunistas, como Trichosporon asahii, están emergiendo como causa importante de infección nosocomial. Caso clínico. Presentamos un caso de infección nosocomial por T. asahii en un paciente quemado crítico tratado de forma exitosa con voriconazol. El tratamiento de las infecciones fúngicas invasivas en el paciente quemado, desde su diagnóstico hasta la elección de la mejor opción terapéutica, continúa siendo un desafío. El diagnóstico y el tratamiento tempranos de estas se asocia a un mejor pronóstico. En la discusión del caso hacemos referencia a la experiencia publicada y a las pautas de tratamiento actual. Conclusiones. Debido a la dificultad para el diagnóstico de las micosis invasivas y su asociación con una alta mortalidad, en aquellos pacientes susceptibles de padecer una trichosporonosis se debe mantener un alto grado de sospecha y vigilancia clínica para el diagnóstico de esta infección, incluidos los pacientes quemados. Su presencia en las muestras clínicas de este tipo de pacientes debe ser tenida en cuenta porque puede preceder a una infección invasiva (AU)

Background. Invasive fungal infection is an important cause of morbimortality in patients with severe burns. The advances in burn care therapy have considerably extended the survival of seriously burned patients, exposing them to infectious complications, notably fungal infections, with increased recognition of invasive infections caused by Candida species. However, some opportunistic fungi, like Trichosporon asahii, have emerged as important causes of nosocomial infection. Case report. A case of nosocomial infection due to T. asahii in a severely ill burned patient successfully treated with voriconazole is presented. The management of invasive fungal infections in burned patients, from diagnosis to selection of the therapeutic protocol, is often a challenge. Early diagnosis and treatment are associated with a better prognosis. In this case report, current treatment options are discussed, and a review of previously published cases is presented. Conclusions. Due to the difficulty in the diagnosis of invasive mycoses and their high associated mortality rates, it is advisable to keep a high degree of clinical suspicion of trichosporonosis in susceptible patients, including burned patients. The isolation of T. asahii in clinical specimens of this type of host must raise clinical alert, since it may precede an invasive infection (AU)

[Nosocomial infection due to Trichosporon asahii in a critical burned patient]. / Infección nosocomial por Trichosporon asahii en un paciente quemado crítico.

BACKGROUND: Invasive fungal infection is an important cause of morbimortality in patients with severe burns. The advances in burn care therapy have considerably extended the survival of seriously burned patients, exposing them to infectious complications, notably fungal infections, with increased recognition of invasive infections caused by Candida species. However, some opportunistic fungi, like Trichosporon asahii, have emerged as important causes of nosocomial infection. CASE REPORT: A case of nosocomial infection due to T. asahii in a severely ill burned patient successfully treated with voriconazole is presented. The management of invasive fungal infections in burned patients, from diagnosis to selection of the therapeutic protocol, is often a challenge. Early diagnosis and treatment are associated with a better prognosis. In this case report, current treatment options are discussed, and a review of previously published cases is presented. CONCLUSIONS: Due to the difficulty in the diagnosis of invasive mycoses and their high associated mortality rates, it is advisable to keep a high degree of clinical suspicion of trichosporonosis in susceptible patients, including burned patients. The isolation of T. asahii in clinical specimens of this type of host must raise clinical alert, since it may precede an invasive infection.

Integrated treatment of first episode psychosis with online training (e-learning): study protocol for a randomised controlled trial.

BACKGROUND: The integrated treatment of first episode psychosis has been shown to improve functionality and negative symptoms in previous studies. In this paper, we describe a study of integrated treatment (individual psychoeducation complementary to pharmacotherapy) versus treatment as usual, comparing results at baseline with those at 6-month re-assessment (at the end of the study) for these patients, and online training of professionals to provide this complementary treatment, with the following objectives: 1) to compare the efficacy of individual psychoeducation as add-on treatment versus treatment as usual in improving psychotic and mood symptoms; 2) to compare adherence to medication, functioning, insight, social response, quality of life, and brain-derived neurotrophic factor, between both groups; and 3) to analyse the efficacy of online training of psychotherapists. METHODS/DESIGN: This is a single-blind randomised clinical trial including patients with first episode psychosis from hospitals across Spain, randomly assigned to either a control group with pharmacotherapy and regular sessions with their psychiatrist (treatment as usual) or an intervention group with integrated care including treatment as usual plus a psychoeducational intervention (14 sessions). Training for professionals involved at each participating centre was provided by the coordinating centre (University Hospital of Álava) through video conferences. Patients are evaluated with an extensive battery of tests assessing clinical and sociodemographic characteristics (Positive and Negative Syndrome Scale, State-Trait Anxiety Inventory, Liebowitz Social Anxiety Scale, Hamilton Rating Scale for Depression, Scale to Assess Unawareness of Mental Disorders, Strauss and Carpenter Prognostic Scale, Global Assessment of Functioning Scale, Morisky Green Adherence Scale, Functioning Assessment Short Test, World Health Organization Quality of Life instrument WHOQOL-BREF (an abbreviated version of the WHOQOL-100), and EuroQoL questionnaire), and brain-derived neurotrophic factor levels are measured in peripheral blood at baseline and at 6 months. The statistical analysis, including bivariate analysis, linear and logistic regression models, will be performed using SPSS. DISCUSSION: This is an innovative study that includes the assessment of an integrated intervention for patients with first episode psychosis provided by professionals who are trained online, potentially making it possible to offer the intervention to more patients. TRIAL REGISTRATION: NCT01783457 clinical trials.gov. Date of registration in primary registry 23 January 2013.

Respuesta emocional ante estímulos amenazantes en psicosis y trastornos de ansiedad / Emotional response to threatening stimuli in psychosis and anxiety disorders

La evolución ha dotado al ser humano de un sistema de detección de peligros cuyo adecuado funcionamiento facilita la adaptación al medio. Tanto en la psicosis como en los trastornos de ansiedad existe una disfunción de estos mecanismos de alarma. El objetivo de este estudio es comparar la respuesta ante estímulos visuales amenazantes entre estos grupos diagnósticos y sujetos sanos. Se estudiaron 24 pacientes con trastorno de ansiedad, 39 con psicosis y 39 controles, comparando las respuestas en percepción de amenaza y agradabilidad ante distintos tipos de estímulos visuales, humanos y no humanos, ya fueran amenazantes o no. Los resultados reflejan una diferente percepción de amenaza entre psicóticos y sanos, así como una valoración de las imágenes como más desagradables por parte del grupo ansioso. Todo ello sugeriría una diferente evaluación emocional de los distintos estímulos entre ambos trastornos (AU)

Evolution has provided humans with an alarm system that may facilitate adaptation. Both psychosis and anxiety disorders involve danger detection difficulties. Our main goal is to compare threat responses of these diagnostic groups and with those of healthy subjects. We studied 24 subjects with an anxiety disorder diagnosis, 39 with psychosis, and 39 healthy control subjects. We compared threat and pleasantness perception using visual stimuli (human and nonhuman stimuli, either threatening or nonthreatening). Regarding threat perception, significant differences were found between psychosis and control groups. Subjects with anxiety disorder diagnosis evaluated any kind of stimuli more negatively. These results suggest differential emotional processing of diverse visual stimuli in these diagnostic groups (AU)

[Emotional response to threatening stimuli in psychosis and anxiety disorders]. / Respuesta emocional ante estímulos amenazantes en psicosis y trastornos de ansiedad.

Emotional response to threatening stimuli in psychosis and anxiety disorders. Evolution has provided humans with an alarm system that may facilitate adaptation. Both psychosis and anxiety disorders involve danger detection difficulties. Our main goal is to compare threat responses of these diagnostic groups and with those of healthy subjects. We studied 24 subjects with an anxiety disorder diagnosis, 39 with psychosis, and 39 healthy control subjects. We compared threat and pleasantness perception using visual stimuli (human and nonhuman stimuli, either threatening or nonthreatening). Regarding threat perception, significant differences were found between psychosis and control groups. Subjects with anxiety disorder diagnosis evaluated any kind of stimuli more negatively. These results suggest differential emotional processing of diverse visual stimuli in these diagnostic groups.

Características clínicas y comorbilidad psiquiátrica en jugadores patológicos de máquinas recreativas con premio, en tratamiento: Estudio de la población menor de 30 años / No disponible

El objetivo de este estudio es la descripción de las características sociodemográficas, clínicas y la comorbilidad psiquiátrica que presenta una muestra, menor de 30 años de edad, de jugadores patológicos de máquinas recreativas con premio en tratamiento. La muestra está compuesta por 53 varones que cumplen los criterios DSM-IV de juego patológico. La edad media de la muestra se sitúa en los 22,89 años, siendo 17 la edad media con la que han comenzado a jugar a las máquinas recreativas con premio. Las principales formas de financiación del juego incluyen el préstamo de dinero realizado por personas del entorno del jugador (67,9%), la adquisición de dinero familiar a través de cuentas bancarias (56,6%), la comisión de robos a pequeña (50,9%) y gran escala (17%), la venta de droga o tabaco ilegal (18,9%) o el uso de tarjetas de crédito/débito ajenas (11,3%). El 47,1% ha contraído algún tipo de deuda debido al juego. Ganar dinero es el motivo esgrimido con mayor frecuencia para comenzar a jugar (45,3%) y recuperar el dinero perdido para continuar jugando (56,6%). El 34% de la muestra refiere un consumo regular de sustancias ilegales, ya sea en el pasado o en el momento de acudir a tratamiento (AU)

The purpose of this study is to describe the sociodemographic, clinical characteristics and psychiatric comorbility of a sample of pathological slot-machine gamblers, under 30 years of age, undergoing treatment. The sample comprises 53 men who met the DSM-IV criteria for pathological gambling. Mean age is 22.89 years, and the mean age at which they had started gambling on slot machines was 17 years. The main sources to finance their gambling include loans from people in the gambler’s environment (67.9%), taking money from family bank accounts (56.6%), petty theft (50.9%), serious theft (17%), illegal tobacco and drug sales (18.9%) or the use of someone else’s credit card (11.3%). Forty seven percent had incurred debts as a result of gambling. Winning money is the most frequent reason to begin gambling (45.3%), and recovering lost money, the reason to continue to gamble (56,6%). Thirtyfour percent of the sample regularly uses illegal substances, either in the past or when they commence treatment (AU)

Relación entre la reducción de las distorsiones cognitivas referidas al azar y la consecución de éxito terapéutico en jugadores patológicos / Relation between the decrease in cognitive distorsions about random and the acquisition of therapeutic success in pathological gamblers

El objetivo de esta investigación es establecer en qué medida el cambio en las distorsiones cognitivas referidas al azar es un factor determinante para la consecución de la abstinencia al juego. La muestra estaba compuesta por 88 jugadores patológicos (DSM-IV) de máquinas recreativas con premio que demandan asistencia profesional. Los sujetos son asignados al grupo de éxito o fracaso del tratamiento en función de la existencia de abstinencia al año de seguimiento. La medición de las distorsiones cognitivas (porcentaje del tipo de frases verbalizadas, tasa de producción de frases irracionales y tasa relativa de irracionalidad en las frases sobre estrategias) se realiza a través del procedimiento de Ladouceur de "pensar en voz alta" a lo largo de tres sesiones de juego en laboratorio. No aparecen diferencias estadísticamente significativas entre los dos grupos en las verbalizaciones emitidas postratamiento. Se discuten las implicaciones teóricas y prácticas de estos resultados (AU)

The main goal of this research is to establish how a change on cognitive distortions about random is a decisive factor to get gambling abstinence. The sample was 88 slot machine pathological gamblers (DSM-IV) which ask for professional treatment. Subjects are appointed to the success or failure group of treatment according to the existence of abstinence at one year follow-up. The assessment of the cognitive distortions (percentage of different verbalizations, the rate of production of irrational statements and the relative amount of irrationality in the strategic statements) is Ladouceur’s procedure of «Thinking aloud» throughout three laboratory gambling sessions. There is not significant differences on posttreatment verbalizations between the two groups. The possible theoretical and practical implications of these results are discussed (AU)

Análisis de las verbalizaciones de jugadores patológicos mientras juegan en máquinas recreativas con premio: estudio descriptivo / Analysis of throught verbalization in pathological gamblers while playing slot machines: Descriptive study

El objetivo del trabajo es analizar los pensamientos de los jugadores patológicos mientras están jugando. Para identificar estos pensamientos se utilizó el procedimiento de Ladouceur de "pensar en voz alta", clasificando las verbalizaciones de acuerdo con la propuesta de Walker (1992b). Se estudió a una muestra de 88 jugadores patológicos (DSM-IV), grabando las verbalizaciones de sus pensamientos a lo largo de tres sesiones de juego. Los resultados ponen de relieve una elevada tasa de frases irracionales (30 por ciento), una tasa muy reducida de verbalizaciones racionales (inferior al 1 por ciento), y un porcentaje de irracionalidad en las frases sobre estrategias en el juego del 97 por ciento. Se confirma, en una muestra amplia y de jugadores patológicos, la existencia de un porcentaje elevado de pensamientos irracionales mientras están jugando. Se discuten las posibles implicaciones de estos datos (AU)

The main goal of the study was to analize gamblers’ thoughts while gambling. In order to identify these thoughts, Ladouceur’s procedure of «Thinking aloud» was used, and verbalizations were classified according to Walker’s (1992b) proposal. An 88 pathological gamblers’ sample was studied (DSM-IV), recording all thought verbalizations throughout three gambling sessions. The results highlight a very high proportion of irrational thoughts (30%), a very low proportion of rational thoughts (below 1%), and a percentage of irrationality in verbalizations concerning gambling strategies of 97%. The study confirms, in a big sample of pathological gamblers, the existence of a high percentage of irrational thoughts while gambling. The possible implications of these data are dicussed (AU)