History, Paranoia, Fragmentation1.

In his book Aion, Jung describes something like a quasi-Hegelian progressive historical realization of the Self in a perspective similar to Fernand Braudel's longue durée history. This article deals with a similar perspective, as it tries to focus on what we may call a "cultural complex" yet within its unfolding in historical time and belonging not to just one specific cultural group, but to a large cultural basin, which we may indicate as the "West". This complex marks the birth and development of modernity. The depth, pervasiveness and duration of this cultural complex permeates the lives and psychologies of all of those that are part of it. Therefore, every analytical project must take into account the underlying emotional, epistemic and social field within which this complex constellates. One of the main features of this (trans)cultural complex, strictly connected with the progressive fragmentation of the self and the transformation of the numinosum with its meaning-giving force, is paranoia. This article analyses the historical and cultural features that produce paranoia and fragmentation and determine paranoid symptoms and attitudes.

Dans son livre Aïon, Jung décrit quelque chose comme une réalisation historique progressive quasi hégélienne du Soi dans une perspective similaire à l'histoire de longue durée de Fernand Braudel. Cet article aborde une perspective semblable, car il tente de se concentrer sur ce que nous pouvons appeler un « complexe culturel ¼. Mais ici il s'agit de son déroulement dans le temps historique et de son appartenance non pas à un groupe culturel spécifique, mais à un grand bassin culturel, que nous pouvons désigner comme « l'Occident ¼. Ce complexe marque la naissance et le développement de la modernité. La profondeur, l'omniprésence et la durée de ce complexe culturel imprègnent la vie et la psychologie de tous ceux qui en font partie. Par conséquent, tout projet analytique doit prendre en compte le champ émotionnel, épistémique et social sous­jacent dans lequel ce complexe se constelle. L'une des principales caractéristiques de ce complexe (trans)culturel, étroitement lié à la fragmentation progressive du soi et à la transformation du numinosum et de sa capacité à donner du sens, c'est la paranoïa. Cet article analyse les caractéristiques historiques et culturelles qui produisent la paranoïa et la fragmentation et déterminent les symptômes et les attitudes paranoïdes.

En su libro 'Aion', Jung describe algo así como una realización histórica progresiva cuasi­hegeliana del Self en una perspectiva similar a la historia 'longue durée' de Fernand Braudel. El presente artículo aborda una perspectiva similar, ya que trata de centrarse en lo que podríamos denominar un "complejo cultural", pero dentro de su despliegue en el tiempo histórico y perteneciente no sólo a un grupo cultural concreto, sino a una gran cuenca cultural, que podríamos señalar como "Occidente". Este complejo marca el nacimiento y el desarrollo de la modernidad. La profundidad, la omnipresencia y la duración de este complejo cultural impregnan la vida y la psicología de todos los que forman parte de él. Por lo tanto, todo proyecto analítico debe tener en cuenta el campo emocional, epistémico y social subyacente en el que se inscribe este complejo. Uno de los principales rasgos de este complejo (trans)cultural, estrictamente relacionado con la progresiva fragmentación del self y la transformación de lo numinoso con su fuerza dadora de sentido, es la paranoia. Este artículo analiza los rasgos históricos y culturales que producen la paranoia y la fragmentación y determinan síntomas y actitudes paranoides.

Ensayo clínico multicéntrico para la resección de pólipos rectales mediante un nuevo dispositivo de acceso transanal híbrido laparoendoscópico / Multicenter clinical trial for the resection of rectal polyps using a new laparoendoscopic hybrid transanal access device

Introducción: Los pólipos complejos requieren el uso de técnicas endoscópicas avanzadas o la cirugía mínimamente invasiva para su abordaje. En los pólipos rectales es de especial relevancia llegar a un consenso de cuál es el mejor abordaje de estos para evitar infratratamientos o sobretratamientos que incrementen una morbimortalidad innecesaria. Métodos: Se describe un ensayo clínico piloto con un producto sanitario de primer uso en humanos multicéntrico y prospectivo. Se plantea la hipótesis que UNI-VEC® facilita la cirugía laparoendoscópica transanal para la extirpación de tumores rectales precoces. El objetivo principal es evaluar que es seguro y cumple los requisitos funcionales establecidos. Los secundarios son evaluar resultados, complicaciones y nivel de satisfacción.Resultados: Se reclutaron 16 pacientes en 12 meses con un seguimiento mínimo de dos meses. El tamaño medio ha sido de 3,4 cm, siendo el pólipo mayor de 6 cm. Respecto a la localización, la media se encontraba a 6,6 cm del margen anal. Se realizó resección endoscópica mucosa (REM) (6,3%), disección submucosa endoscópica (DSE) (43,8%), resección espesor completo (REC) (6,3%) y transanal minimally invasive surgery (TAMIS) (43,8%). El tiempo medio fueron 73,25 min; 56,3% utiliza una cámara de 30̊ y 43,8% el endoscopio flexible como instrumento de visión. El 56,3% son lesiones benignas y 43,8% malignas. En 87,5% se consigue resección completa. En cuanto a las complicaciones, se presenta sangrado leve (Clavien I) en 25, 6,3 y 21,4% a las 24 h, 48 h y siete días, respectivamente. La continencia se valora según la Escala de Wexner. A los siete días, 60% presentan continencia perfecta, 26,7% IF leve y 13,3% IF moderada. A los 30 días, 66,7% continencia perfecta, 20% IF leve y 13,3% IF moderada. A los dos meses se revisan cuatro de los pacientes que a los 30 días presentaban un Wexner superior al preoperatorio y se demuestra continencia perfecta en 25% de los pacientes, 50% leve y 25% moderada. (AU)

Introduction: Complex polyps require the use of advanced endoscopic techniques or minimally invasive surgery for their approach. In rectal polyps it is of special relevance to reach a consensus on the best approach to avoid under- or overtreatment that increases unnecessary morbidity and mortality. Methods: We describe a prospective, multicenter, pilot clinical trial with a first-in-human medical device. It is hypothesized that UNI-VEC® facilitates transanal laparoendoscopic surgery for the removal of early rectal tumors. The primary objective is to evaluate that it is safe and meets the established functional requirements. Secondary objectives are to evaluate results, complications and level of satisfaction. Results: Sixteen patients were recruited in 12 months with a minimum follow-up of 2 months. The mean size was 3.4 cm with the largest polyp being 6 cm. Regarding location, the mean was 6.6 cm from the anal margin. Endoscopic mucosal resection (EMR) (6.3%), endoscopic submucosal dissection (ESD) (43.8%), REC (6.3%) and TAMIS (43.8%) were performed. The mean time was 73.25 min. The 56.3% used a 30° camera and 43.8% used the flexible endoscope as a viewing instrument. The 56.3% were benign lesions and 43.8% malignant. Complete resection is achieved in 87.5%. Regarding complications, mild bleeding (Clavien I) occurred in 25%, 6.3% and 21.4% at 24 h, 48 h and 7 days, respectively. Continence was assessed according to the Wexner scale. At 7 days, 60% showed perfect continence, 26.7% mild FI and 13.3% moderate FI. At 30 days, 66.7% had perfect continence, 20% mild FI and 13.3% moderate FI. At 2 months, 4 patients were reviewed who at 30 days had a Wexner's degree higher than preoperative and perfect continence was demonstrated in 25% of the patients, 50% mild and 25% moderate. (AU)

Atención farmacéutica al paciente ingresado en una unidad multidisciplinar de paciente crónico complejo / Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit

Objetivo: evaluar la contribución del farmacéutico mediante el análisis de la prescripción potencialmente inapropiada y la conciliación del tratamiento domiciliario en la unidad de pacientes crónicos complejos de un hospital terciario. Métodos: estudio observacional, prospectivo y multidisciplinar de los pacientes de la unidad de pacientes crónicos complejos de un hospital durante febrero de 2019 - junio de 2020. El equipo multidisciplinar del crónico complejo elaboró un checklist con una selección de fármacos no recomendados basado en los criterios STOPP/START, Beers y PRISCUS y fármacos susceptibles de desprescripción según los criterios LESS-CHRON. El farmacéutico aplicaba el checklist diariamente en los pacientes que ingresaban en la unidad, además de realizar la conciliación del tratamiento domiciliario revisando el tratamiento prescrito con el detallado en la receta electrónica domiciliaria. Por eso, se recogieron las siguientes variables: edad, sexo y número de fármacos al ingreso como variables independientes, y variables dependientes: número de fármacos al alta, tipo de prescripción potencialmente inapropiada, motivos de conciliación, fármacos implicados y grado de aceptación de la recomendación por parte del médico prescriptor para evaluar la contribución farmacéutica. El análisis estadístico se realizó con IBM® SPSS® Statistics22. Resultados : se revisaron 621 pacientes con una mediana de edad de 84 años (56,4% mujeres), y se intervino en 218 (35,1%). La mediana del número de fármacos fue de 11 (2-26) al ingreso y de 10 (0-25) al alta. Se realizaron 373 intervenciones: 235 por conciliación de la medicación (78,3% aceptadas), 71 por medicamentos no recomendados (57,7% aceptadas), 42 por desprescripción (61,9% aceptadas) y 25 por otros motivos. ... (AU)

Objective: To assess the pharmacist’s contributions by analysing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital.MethodObservational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019 - June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and PRISCUS criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22.Results: We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). ...(AU)

Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit. / [Artículo traducido] Atención farmacéutica al paciente ingresado en una unidad multidisciplinar de paciente crónico complejo.

OBJECTIVE: To assess the pharmacist's contributions by analysing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. METHOD: Observational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019 - June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and PRISCUS criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. RESULTS: We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). CONCLUSIONS: The integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favoured deprescription.

Implantes de titanio trabecular en cirugía de revisión acetabular compleja / Trabecular titanium implants in complex acetabular revision surgery

Introducción: La cirugía de revisión acetabular supone un reto quirúrgico sobre todo cuando aparecen los defectos óseos complejos, pues dificultan la fijación primaria y osteointegración de los implantes, lo que condiciona la aparición de complicaciones. Los cotilos de titanio trabecular intentan solventar estos problemas. Objetivos: Valorar los resultados clínico-radiológicos, la supervivencia de los implantes y aparición de complicaciones a medio plazo en cirugía de revisión acetabular en una serie de 37 recambios acetabulares con defectos óseos tipo IIIA y IIIB de Paprosky en los que se utilizó un implante de revisión tipo Cup-Cage de titanio trabecular. Material y método: Realizamos un estudio observacional, descriptivo y retrospectivo de 37 casos con defectos acetabulares complejos (20 tipo IIIA y 17 tipo IIIB, cinco de ellos con discontinuidad pélvica) en los que se realizó recambio del componente acetabular por implantes de titanio trabecular entre los años 2011 y 2019. Analizamos resultados clínicos (dolor y funcionalidad) y parámetros radiológicos (restauración del centro de rotación de la cadera y la movilización de los implantes), así como la aparición de complicaciones. Resultados: El seguimiento medio fue de 61 meses. Obtuvimos una mejoría en la mediana de 8 puntos en la escala de funcionalidad de Merlé D’Aubigné-Postel y de 6 puntos en la escala EVA de dolor percibido por el paciente. Registramos dos casos de aflojamiento acetabular, un caso de inestabilidad y tres infecciones de herida quirúrgica sin afectar al implante. Conclusiones: La utilización de implantes tipo Cup-Cage de titanio trabecular podría constituir una opción válida en cirugía de revisión acetabular con defectos acetabulares complejos, presentando buenos resultados clínico-radiológicos y en cuanto a complicaciones y supervivencia de los implantes, debido a su buena fijación primaria y osteointegración.(AU)

Introduction: Acetabular revision surgery is a surgical challenge, especially when complex bone defects appear. This makes primary fixation and osseointegration of the implants difficult, which conditions the appearance of complications. Trabecular titanium implants attempt to solve these problems. Objectives: To evaluate our clinical-radiological results, the survival of the implants and the appearance of mid-term complications in acetabular revision surgery in a series of 37 acetabular replacements with Paprosky type IIIA and IIIB bone defects in which a trabecular titanium Cup-Cage revision implant was used. Material and method: We conducted an observational, descriptive and retrospective study of 37 cases with complex acetabular defects (20 type IIIA and 17 type IIIB, five of them with pelvic discontinuity) in which the acetabular component was replaced by trabecular titanium cups between 2011 and 2019. We analyzed clinical results (pain and functionality) and radiological parameters (restoration of the hip rotation centre and the mobilization of the implants), as well as the appearance of complications. Results: The mean follow-up was 61 months. We obtained a median improvement of 8 points on the Merlé D’Aubigné-Postel functionality scale and 6 points on the VAS scale of pain perceived by the patient. We recorded two cases of acetabular loosening, one case of dislocation and three surgical wound infections without affecting the implant. Conclusions: The use of trabecular titanium Cup-Cage implants could be a valid option in acetabular revision surgery with complex acetabular defects, presenting good clinical and radiological results and in terms of complications and survival of the implants, mainly due to their good primary fixation and subsequent osseointegration.(AU)

[Translated article] Trabecular titanium implants in complex acetabular revision surgery / Implantes de titanio trabecular en cirugía de revisión acetabular compleja

Introducción: La cirugía de revisión acetabular supone un reto quirúrgico sobre todo cuando aparecen los defectos óseos complejos, pues dificultan la fijación primaria y osteointegración de los implantes, lo que condiciona la aparición de complicaciones. Los cotilos de titanio trabecular intentan solventar estos problemas. Objetivos: Valorar los resultados clínico-radiológicos, la supervivencia de los implantes y aparición de complicaciones a medio plazo en cirugía de revisión acetabular en una serie de 37 recambios acetabulares con defectos óseos tipo IIIA y IIIB de Paprosky en los que se utilizó un implante de revisión tipo Cup-Cage de titanio trabecular. Material y método: Realizamos un estudio observacional, descriptivo y retrospectivo de 37 casos con defectos acetabulares complejos (20 tipo IIIA y 17 tipo IIIB, cinco de ellos con discontinuidad pélvica) en los que se realizó recambio del componente acetabular por implantes de titanio trabecular entre los años 2011 y 2019. Analizamos resultados clínicos (dolor y funcionalidad) y parámetros radiológicos (restauración del centro de rotación de la cadera y la movilización de los implantes), así como la aparición de complicaciones. Resultados: El seguimiento medio fue de 61 meses. Obtuvimos una mejoría en la mediana de 8 puntos en la escala de funcionalidad de Merlé D’Aubigné-Postel y de 6 puntos en la escala EVA de dolor percibido por el paciente. Registramos dos casos de aflojamiento acetabular, un caso de inestabilidad y tres infecciones de herida quirúrgica sin afectar al implante. Conclusiones: La utilización de implantes tipo Cup-Cage de titanio trabecular podría constituir una opción válida en cirugía de revisión acetabular con defectos acetabulares complejos, presentando buenos resultados clínico-radiológicos y en cuanto a complicaciones y supervivencia de los implantes, debido a su buena fijación primaria y osteointegración.(AU)

Introduction: Acetabular revision surgery is a surgical challenge, especially when complex bone defects appear. This makes primary fixation and osseointegration of the implants difficult, which conditions the appearance of complications. Trabecular titanium implants attempt to solve these problems. Objectives: To evaluate our clinical-radiological results, the survival of the implants and the appearance of mid-term complications in acetabular revision surgery in a series of 37 acetabular replacements with Paprosky type IIIA and IIIB bone defects in which a trabecular titanium Cup-Cage revision implant was used. Material and method: We conducted an observational, descriptive and retrospective study of 37 cases with complex acetabular defects (20 type IIIA and 17 type IIIB, five of them with pelvic discontinuity) in which the acetabular component was replaced by trabecular titanium cups between 2011 and 2019. We analyzed clinical results (pain and functionality) and radiological parameters (restoration of the hip rotation centre and the mobilization of the implants), as well as the appearance of complications. Results: The mean follow-up was 61 months. We obtained a median improvement of 8 points on the Merlé D’Aubigné-Postel functionality scale and 6 points on the VAS scale of pain perceived by the patient. We recorded two cases of acetabular loosening, one case of dislocation and three surgical wound infections without affecting the implant. Conclusions: The use of trabecular titanium Cup-Cage implants could be a valid option in acetabular revision surgery with complex acetabular defects, presenting good clinical and radiological results and in terms of complications and survival of the implants, mainly due to their good primary fixation and subsequent osseointegration.(AU)

Teoría de la complejidad y los sistemas de salud / Complexity theory and health systems

En la investigación en salud es todavía poco frecuente el uso de la Teoría de la Complejidad y de la Fractalidad (más aún en tópicos no relacionados directamente con la biología molecular o con la clínica). La complejidad nos propone complementar con propuestas desde nuevas perspectivas el pensamiento lineal y cuantitativo predominante todavía en la metodología de producción del conocimiento científico. El estudio de los sistemas de salud necesita un enfoque que se aparte de la linealidad, lo rígido y lo direccional, dado que los mismos son sistemas complejos en los que el todo es más que la simple suma de sus partes. La crisis global generada ante la pandemia por COVID-19 nos puso frente a la oportunidad (y a la obligación) de repensar tanto nuestra praxis cotidiana como nuestra forma de producir conocimiento (AU)

In health research, the use of the Complexity and Fractality Theory is still infrequent (even more so in topics not directly related to molecular or clinical biology). The complexity proposes us to complement with proposals from new perspectives the linear and quantitative thinking still predominant in the methodology of production of scientific knowledge. The study of health systems needs an approach that moves away from linearity, rigidity and direction, since they are complex systems in which the whole is more than the simple sum of its parts. The global crisis generated by the COVID-19 pandemic presented us with the opportunity (and the obligation) to rethink both our daily praxis and our way of producing knowledge (AU)

Pharmaceutical care for the patients admitted to a multidisciplinary complex chronic patient unit.

OBJECTIVE: To assess the pharmacist's contributions by analyzing potentially inappropriate prescription and home treatment reconciliation in the complex chronic patient unit of a tertiary hospital. METHOD: Observational, prospective, multidisciplinary study of patients in the complex chronic patient unit of a hospital during February 2019-June 2020. Multidisciplinary team of the complex chronic developed a checklist with a selection of non-recommended drugs based on STOPP/START, Beers and Priscus criteria, and drugs susceptible to deprescription according to LESS-CHRON criteria. The pharmacist applied the checklist daily in patients admitted to the unit, in addition to reconciling home treatment by reviewing the prescribed treatment with that detailed in the electronic home prescription. Therefore, the following variables were collected: age, sex and number of drugs on admission as independent variables, and dependent variables: number of drugs at discharge, type of potentially inappropriate prescription, reasons for reconciliation, drugs involved and degree of acceptance of the recommendation by the prescribing physician to assess the pharmaceutical contribution. The statistical analysis was performed with IBM® SPSS® Statistics22. RESULTS: We reviewed 621 patients with a median age of 84 years (56.4% women), and intervention was performed in 218 (35.1%). The median number of drugs was 11 (2-26) at admission and 10 (0-25) at discharge. 373 interventions were performed: 235 for medication reconciliation (78.3% accepted), 71 for non-recommended drugs (57.7% accepted), 42 for deprescription (61.9% accepted) and 25 for other reasons. Statistically significant differences were observed between the number of drugs at discharge and at admission in both intervention patients (n = 218) and complex chronic patients (n = 114) (p < 0.001 in both cases). Moreover, statistically significant differences were observed in the number of drugs at admission between patients included in the complex chronic programme and those not included (p = 0.001), and in the number of drugs at discharge (p = 0.006). CONCLUSIONS: The integration of the pharmacist in the multidisciplinary team of the complex chronic patient unit improves patient safety and quality of care. The selected criteria were useful for detecting inappropriate drugs in this population and favored deprescription.

Trabecular titanium implants in complex acetabular revision surgery. / Implantes de titanio trabecular en cirugía de revisión acetabular compleja.

INTRODUCTION: Acetabular revision surgery is a surgical challenge, especially when complex bone defects appear. This makes primary fixation and osseointegration of the implants difficult, which conditions the appearance of complications. Trabecular titanium implants attempt to solve these problems. OBJECTIVES: To evaluate our clinical-radiological results, the survival of the implants and the appearance of mid-term complications in acetabular revision surgery in a series of 37 acetabular replacements with Paprosky type IIIA and IIIB bone defects in which a trabecular titanium Cup-Cage revision implant was used. MATERIAL AND METHOD: We conducted an observational, descriptive and retrospective study of 37 cases with complex acetabular defects (20 type IIIA and 17 type IIIB, five of them with pelvic discontinuity) in which the acetabular component was replaced by trabecular titanium cups between 2011 and 2019. We analyzed clinical results (pain and functionality) and radiological parameters (restoration of the hip rotation centre and the mobilization of the implants), as well as the appearance of complications. RESULTS: The mean follow-up was 61 months. We obtained a median improvement of 8 points on the Merlé D'Aubigné-Postel functionality scale and 6 points on the VAS scale of pain perceived by the patient. We recorded two cases of acetabular loosening, one case of dislocation and three surgical wound infections without affecting the implant. CONCLUSIONS: The use of trabecular titanium Cup-Cage implants could be a valid option in acetabular revision surgery with complex acetabular defects, presenting good clinical and radiological results and in terms of complications and survival of the implants, mainly due to their good primary fixation and subsequent osseointegration.

[Translated article] Trabecular titanium implants in complex acetabular revision surgery.

INTRODUCTION: Acetabular revision surgery is a surgical challenge, especially when complex bone defects appear. This makes primary fixation and osseointegration of the implants difficult, which conditions the appearance of complications. Trabecular titanium implants attempt to solve these problems. OBJECTIVES: To evaluate our clinical-radiological results, the survival of the implants and the appearance of mid-term complications in acetabular revision surgery in a series of 37 acetabular replacements with Paprosky type IIIA and IIIB bone defects in which a trabecular titanium Cup-Cage revision implant was used. MATERIAL AND METHOD: We conducted an observational, descriptive and retrospective study of 37 cases with complex acetabular defects (20 type IIIA and 17 type IIIB, five of them with pelvic discontinuity) in which the acetabular component was replaced by trabecular titanium cups between 2011 and 2019. We analysed clinical results (pain and functionality) and radiological parameters (restoration of the hip rotation centre and the mobilisation of the implants), as well as the appearance of complications. RESULTS: The mean follow-up was 61 months. We obtained a median improvement of 8 points on the Merlé D'Aubigné-Postel functionality scale and 6 points on the VAS scale of pain perceived by the patient. We recorded two cases of acetabular loosening, one case of dislocation and three surgical wound infections without affecting the implant. CONCLUSIONS: The use of trabecular titanium Cup-Cage implants could be a valid option in acetabular revision surgery with complex acetabular defects, presenting good clinical and radiological results and in terms of complications and survival of the implants, mainly due to their good primary fixation and subsequent osseointegration.

Multicenter clinical trial for the resection of rectal polyps using a new laparoendoscopic hybrid transanal access device.

INTRODUCTION: Complex polyps require the use of advanced endoscopic techniques or minimally invasive surgery for their approach. In rectal polyps it is of special relevance to reach a consensus on the best approach to avoid under- or overtreatment that increases unnecessary morbidity and mortality. METHODS: We describe a prospective, multicenter, pilot clinical trial with a first-in-human medical device. It is hypothesized that UNI-VEC® facilitates transanal laparoendoscopic surgery for the removal of early rectal tumors. The primary objective is to evaluate that it is safe and meets the established functional requirements. Secondary objectives are to evaluate results, complications and level of satisfaction. RESULTS: 16 patients were recruited in 12 months with a minimum follow-up of 2 months. The mean size was 3.4 cm with the largest polyp being 6 cm. Regarding location, the mean was 6.6 cm from the anal margin. Endoscopic Mucosal Resection (EMR) (6.3%), Endoscopic Submucosal Dissection ESD (43.8%), REC (6.3%) and TAMIS (43.8%) were performed. The mean time was 73.25 min. The 56.3% used a 30° camera and 43.8% used the flexible endoscope as a viewing instrument. The 56.3% were benign lesions and 43.8% malignant. Complete resection is achieved in 87.5%. Regarding complications, mild bleeding (Clavien I) occurred in 25%, 6.3% and 21.4% at 24 h, 48 h and 7 days respectively. Continence was assessed according to the Wexner scale. At 7 days, 60% showed perfect continence, 26.7% mild FI and 13.3% moderate FI. At 30 days, 66.7% had perfect continence, 20% mild FI and 13.3% moderate FI. At 2 months, 4 patients were reviewed who at 30 days had a Wexner's degree higher than preoperative and perfect continence was demonstrated in 25% of the patients, 50% mild and 25% moderate. In no case did rectal perforation or major complications requiring urgent reintervention occur. As for the level of reproducibility, safety, level of satisfaction with the device and evaluation of the blister, the evaluation on a scale of 0-10 (9.43, 9.71, 9.29 and 9.50 respectively). All the investigators have previous experience with transanal devices. CONCLUSIONS: The study demonstrates the efficacy and safety of UNI-VEC® for the treatment of rectal lesions. It will facilitate the implementation of hybrid procedures that seek to solve the limitations of pure endoscopic techniques by allowing the concomitant use of conventional laparoscopic and robotic instrumentation with the flexible endoscope.

Eco-anxiety in everyday life: facing the anxiety and fear of a degraded Earth in analytic work.

This paper focuses on eco-anxiety, an over-arching term used to describe anxiety caused by the climate crisis and the impacts of environmental contamination, environmental disasters, species extinctions and ecological system degradation. A brief literature review of eco-anxiety is provided from both psychoanalytic and Jungian perspectives which includes a discussion of Jung's view of our split with nature, displacement anxiety, precarity, climate change denial, and anticipatory anxiety. The author draws on his own theory of what he calls the Nature archetype to explicate the psychological changes brought about by our environmental crisis that cause increased anxiety, depression, PTSD and which, sometimes, lead to suicide. Two clinical vignettes are provided. The first shows how eco-complexes cluster around and interweave with generalized anxiety disorder, and the way in which eco-anxiety can be incorporated into a fusional complex that draws the analyst into a fusional field experienced as a state of connection and disconnection over both personal and collective material. The second vignette illustrates the way in which eco-complexes, eco-anxiety and environmental issues are interwoven with an early childhood abuse history.

Nous sommes face à une menace concernant la planète du fait des ravages de la crise globale du climat et de l'externalisation de nos déchets dans l'environnement, comme le montrent la mauvaise qualité de l'air, la hausse de la température et de l'acidité de l'eau, les schémas climatiques destructeurs, les extinctions sans précédent d'espèces, et un point de bascule qui n'arrête pas de se rapprocher où les changements environnementaux deviennent irréversibles. Psychologiquement, ces changements produisent une anxiété accrue, de la dépression, des PTSD (trouble de stress post-traumatique) et des suicides. Cet article se concentre sur l'éco-anxiété, un terme fondamental pour décrire l'anxiété provoquée par la crise du climat, les impacts de la contamination de l'environnement, les catastrophes environnementales et la dégradation du système écologique. Ceci provoquant une instabilité socioéconomique, de la précarité, de l'instabilité ontologique, et la peur d'un effondrement planétaire. Je m'appuie sur la documentation sur l'éco-anxiété, qui contient une discussion sur la précarité, le déni du changement climatique et l'angoisse d'anticipation. L'article contient deux vignettes cliniques. La première montre comment les éco-complexes se tissent autour et s'entremêlent avec un trouble anxieux généralisé. Elle montre également comment l'éco-anxiété est incorporée dans un complexe fusionnel qui attire l'analyste dans un champ fusionnel dans lequel il y a un état de connexion et de déconnexion à la fois sur le matériel personnel et le matériel collectif. La seconde vignette illustre comment les éco-complexes, l'éco-anxiété et les questions environnementales sont entremêlées avec une histoire infantile d'abus.

Enfrentamos una amenaza significativa al planeta a causa de los estragos producidos por la crisis climática global y la externalización de nuestros residuos en el medio ambiente, como lo demuestra la pobre calidad del aire, el incremento de temperatura y acidez del mar, los patrones climáticos destructivos, las extinciones de especies sin precedentes, y un cada vez más cercano punto de inflexión donde los cambios ambientales están deviniendo irreversibles. Psicológicamente, estos cambios causan ansiedad creciente, depresión, PTSD, y suicidio. El presente trabajo se focaliza en la eco-ansiedad, un término extensivo que describe la ansiedad causada por la crisis climática, los impactos de la contaminación ambiental, los desastres ambientales y la degradación del sistema ecológico, los cuales resultan en una inestabilidad socioeconómica, precariedad, inestabilidad ontológica, y un miedo a un colapso planetario. Me baso en la literatura sobre eco-ansiedad incluyendo una discusión sobre precariedad, la negación del cambio climático y la ansiedad anticipatoria. Se describen dos viñetas clínicas. La primera muestra como los eco-complejos se agrupan alrededor y entretejiéndose con el trastorno de ansiedad generalizada, y cómo la eco-ansiedad es incorporada en un complejo fusional que conduce al analista a un campo fusional en el cual hay un estado de conexión y desconexión de material tanto personal como colectivo. La segunda viñeta ilustra como los eco-complejos, la eco-ansiedad y los temas medio ambientales se entretejen con una historia temprana de abuso infantil.

The Other made visible: creative methods, inner figures and agents of change when working through early childhood trauma in adulthood.

Jung used creative methods such as picture-making and active imagination to work with complexes and in particular trauma and dissociation. A clinical example of a 60-year-old woman demonstrates the benefits of using creative methods to work with issues linked to early life, such as somatic intrusions of early childhood trauma. Significant inner figures were delineated, including the original figure associated with the infantile dissociative split. The figures illustrated Jung's complex theory by making visible the nonverbal inner states that were initially feared and experienced as Other. Within an analytic relationship that included a working through, an innate creative process unfolded that permitted inner figures to become agents of change within her psyche. This paper highlights the value of Jung's complex theory and the use of creative methods when working with dissociation, regression and unformulated infantile states, even when the analysand is in the later stages of adulthood.

Jung utilisa des méthodes créatives telles que la création d'images et l'imagination active pour travailler sur les complexes et en particulier le traumatisme et la dissociation. Un exemple clinique d'une femme de 60 ans montre les avantages à utiliser des méthodes créatives pour travailler sur des problématiques liées à la vie précoce, telles que les intrusions somatiques des traumatismes infantiles précoces. Les personnages intérieurs importants furent définis, y compris le personnage d'origine associé au clivage dissociatif infantile. Les personnages illustraient la théorie des complexes de Jung en rendant visible les états intérieurs non-verbaux, qui étaient au départ redoutés et ressentis comme Autre. Au sein d'une relation analytique qui inclut la perlaboration, un processus créatif naturel put se déployer, qui permit aux personnages internes de devenir des moteurs du changement dans sa psyché. Cet article souligne la valeur de la théorie des complexes de Jung et de l'utilisation de méthodes créatives dans le travail avec la dissociation, la régression et les états infantiles non-formulés, et ceci même lorsque l'analysant est dans la phase avancée de l'âge adulte.

Jung utilizó métodos creativos como la pintura de imágenes y la imaginación activa al trabajar con complejos y particularmente con trauma y disociación. Un ejemplo clínico de una mujer de 60 años demuestra los beneficios de utilizar métodos creativos al trabajar con temas vinculados a una etapa temprana de la vida, a saber las intrusiones somáticas de un trauma infantil. Figuras internas significativas fueron delineadas, incluyendo a la figura original ligada con la escisión disociativa temprana. Las figuras ilustraron la teoría de los complejos de Jung, al hacer visible los estados no-verbales internos que inicialmente fueron temidos y experimentados como Otredad. En el contexto del trabajo contenido por la relación analítica, se desplegó un proceso creativo interno que permitió a las figuras internas devenir en agentes de cambio al interior de su psique. El presente trabajo destaca el valor de la teoría de los complejos de Jung y la utilización de métodos creativos al trabajar con disociación, regresión y estados infantiles no-formulados, aun cuando el/la analizando/a esté en la etapa de adultez tardía.

Ablación exitosa con radiofrecuencia a través de la cúspide coronariana derecha de un complejo ventricular prematuro parahisiano / Successful radiofrequency ablation through the right coronary cups of a parahisian premature ventricular complexes

Resumen Los complejos ventriculares prematuros (CVP) son hallazgos frecuentes en individuos con o sin enfermedad estructural cardiaca. Los CVP cuyo origen se localiza en la región parahisiana son poco frecuentes y su manejo a través de ablación con catéter de radiofrecuencia es un reto, pues su localización favorece un alto riesgo de desarrollo de bloqueo aurículo-ventricular. Se describen dos casos de pacientes con CVP parahisianos llevados a ablación con catéter de radiofrecuencia.

Abstract Premature ventricular complexes (PVC) are common findings in patients with or without structural heart disease. Parahisian PVC are uncommon and their management through radiofrequency catheter ablation remains a challenge, since their location favors a high risk for developing atrioventricular block. Two cases of patients with parahisian PVC undergoing radiofrequency catheter ablation are described.

Syntheses and magnetic properties of substituted bis-indacenyl bi-metallic complexes & application / Síntesis y propiedades magnéticas de complejos bimetálicos de bis-indacenilo sustituido y su aplicación / Sínteses e propriedades magnéticas de complexos bimetálicos bis-indaceníli-cossubstituídos e aplicação

Abstract Organometallic compounds, Bis (2,4,6,8 teramethyl-indacenyl) di Iron (1), Bis (2,4,6,8 teramethyl s-indacenyl) mono iron, mono cobalt (2), and Bis (2,6 diethyl-4,8-dimethyl-s-indacenyl) di cobalt (3) were synthesised by means of salt elimination strategy, using Fe(II) and Co(II) salts. The compounds were characterised through spectroscopic and electrochemical methods. Magnetic measurements were carried out by Physical Property Measurement System (PPMS). Mossbauer spectroscopic data reveals that in all compounds, surprisingly, Iron is in +3 oxidation state. DFT calculations have been carried out to understand the change in the oxidation state of a metal. DFT study confirms the electron transfer nature of ligand to metal. Cyclic voltametric study on these compounds shows a large separation (ΔE>800mV) between two oxidation peaks confirming the strong interaction between the metal centres. Magnetic measurements on these organometallic compounds reveals that they exhibit a ferrimagnetic behaviour at temperatures below 40 K.

Resumen En este trabajo se sintetizaron los compuestos organometálicos Bis (2,4,6,8 terametil-indacenil) férrico (1), Bis (2,4,6,8 terametil s-indacenil) ferroso, cobaltoso (2) y Bis (2,6 dietil-4,8-dimetil-s-indacenil) di cobalto (3) mediante la estrategia de eliminación de sales, utilizando sales de Fe(II) y Co(II).Los compuestos se caracterizan por métodos espectroscópicos y electroquímicos. Las mediciones magnéticas se llevaron a cabo mediante el sistema de medición de propiedades físicas (PPMS). Los datos espectroscópicos Mossbauer revelan que, en todos los compuestos, sorprendentemente, el hierro se encuentra en el estado de oxidación +3. También se realizaron cálculos DFT para comprender el cambio en el estado de oxidación de los metales. El estudio DFT confirmó la naturaleza de transferencia de electrones del ligando al metal. El estudio voltamperométrico cíclico de estos compuestos muestra una gran separación (ΔE>800mV) entre los dos picos de oxidación que confirman la fuerte interacción entre los centros metálicos. Las mediciones magnéticas de estos compuestos organometálicos revelan que presentan un comportamiento ferrimagnético a temperaturas inferiores a 40 K.

Resumo Compostos organometálicos, Bis (2,4,6,8 terametil-indacenil) di ferro (1), Bis (2,4,6,8 terametil s-indacenil) mono ferro, mono cobalto (2) e Bis (2,6 dietil-4,8-dimetil-s-indacenil) di cobalto (3) foram sintetizados por estratégia de eliminação de sal, utilizando sais de Fe(II) e Co(II). Os compostossão caracterizados por métodos espectroscópicos e eletroquímicos. As medições magnéticas foram realizadas pelo Sistema de Medição de Propriedades Físicas (PPMS). Os dados espectroscópicos Mossbauerrevelam que em todos os compostos, surpreendentemente, o ferro está em +3 estado de oxidação.Os cálculos do DFT foram realizados para entender a mudança no estado de oxidação de um metal. O estudo DFT confirma a natureza da transferência de elétrons do ligante para o metal. O estudovoltamétrico cíclico dessescompostosmostrauma grande separação (ΔE>800mV) entre dois picos de oxidação confirmando a forteinteração entre os centros metálicos. As medições magnéticas nestescompostos organometálicos revelam que eles apresentam um comportamento ferrimagnético a uma temperatura abaixo de 40 K.

Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015-2019).

BACKGROUND AND OBJECTIVE: Inappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs). OBJECTIVE: Surveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015-2019. METHOD: Descriptive population-based study. SETTING: 'València-Clínic-Malvarrosa' Health Department, Valencia, Spain. PERIOD: 2015-2019. SUBJECTS: Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate. ANALYSES: frequencies and time trends, both overall and by specific type. RESULTS: Overall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: "≥75 years of age with inappropriate medication", which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics). CONCLUSIONS: IP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs.

Prevalence of inappropriate prescribing in complex chronic patients: Time trends in a health department of Valencia, Spain (2015–2019) / Prevalencia de prescripción inapropiada en pacientes crónicos complejos: tendencias temporales en un departamento de salud de Valencia, España (2015-2019)

Background and objective: Inappropriate prescribing (IP) is an important cause of health problems among elderly and complex chronic patients (CCPs).Objective: Surveillance of IP prevalence among elderly and CCPs in a health department. IP time trends across the period 2015–2019.Method: Descriptive population-based study. Setting: ‘València-Clínic-Malvarrosa’ Health Department, Valencia, Spain. Period: 2015–2019. Subjects: Complete set of CCPs in the department, defined by clinical risk groups. Number of CCPs (annual average in the period): 9102 (75% ≥65 years of age). IP was measured using an indicator consisting of 13 specific types of prescriptions defined as inappropriate. Analyses: frequencies and time trends, both overall and by specific type.Results: Overall prevalence of IP ranged from 0.276 (2015) to 0.289 (2018) per patient, without time trend. The most frequent inappropriate prescription was type 1: “≥75 years of age with inappropriate medication”, which showed a stable rate across the period. Some types of inappropriate prescriptions displayed favourable decreasing time trends, while others showed no change or an unfavourable trend (i.e., joint prescription of absorbents and urinary antispasmodics).Conclusions: IP prevalence is a serious and persistent problem among the elderly and CCPs, especially in the oldest. It is therefore necessary its continuous surveillance (overall and by specific types of prescription). As well as interventions to optimise prescribing, thus improving the quality and efficiency of care for the elderly and CCPs. (AU)

Antecedentes y objetivo: La prescripción inapropiada (PI) es una importante causa de problemas de salud en las personas mayores y pacientes crónicos complejos (PCC). Objetivo: Monitorizar la prevalencia de PI en personas mayores y PCC, en un departamento de salud. Tendencias temporales de la PI durante 2015-2019.Método: Estudio descriptivo de base poblacional. Lugar: Departamento de Salud «València-Clínic-Malvarrosa», Valencia, España. Periodo: 2015-2019. Sujetos: Conjunto completo de PCC en el Departamento, definidos mediante Clinical Risk Groups. Número de PCC (valor promedio anual en el periodo): 9.102 (75% ≥65 años de edad). La PI se cuantificó mediante un indicador que comprende 13 tipos concretos de prescripciones definidas como inapropiadas. Análisis: frecuencias y tendencia temporal, global y por tipos.Resultados: La prevalencia global de PI osciló entre 0,276 (2015) y 0,289 (2018) por paciente, sin tendencia temporal. El tipo concreto de PI más frecuente fue el 1: «≥75 años con medicación inapropiada», y fue estable en el periodo. Algunos de los tipos inapropiados de prescripción mostraron evolución temporal favorable, descendente; pero en otros no hubo cambios o fue desfavorable (como la prescripción conjunta de absorbentes y antiespasmódicos urinarios).Conclusiones: La prevalencia de la PI constituye un problema importante y persistente en las personas mayores y PCC, especialmente en las de más edad. Es pues necesaria su monitorización continuada (global y por tipos de prescripción), así como intervenciones para optimizar la prescripción, mejorando la calidad y eficiencia de la asistencia a las personas mayores y PCC. (AU)

Assessing a care programme for complex and advanced chronic patients: Use of resources and costs.

INTRODUCTION: The Public Health System of the Balearic Islands (IB-Salut) implemented between 2016 and 2019 the Chronic Patient Care Plan to properly manage complex chronicity and provide quality care attention. The goal of this study is assessing the use of healthcare services and their associated costs before and after the implementation of the programme. METHODS: Descriptive analyses of resources destined to complex and advanced chronic patients (CCP and ACP). RESULTS: After entering the programme: the frequency of CCP admissions to acute hospitals reduced by 6.9%, the frequency of CCP visits to emergency departments reduced by 8.4%, while the frequency of ACP admitted to intermediate care hospitals increased. Both the frequencies of ACP admitted to acute hospitals and emergency visits decreased to 16.7% and to 27.3%, respectively. Total cost before and after the implementation of the programme was €60,884,241 and €46,889,693, respectively. Taking into account the 1011 admissions avoided, the result is a negative incremental cost-effectiveness ratio (€-396.57) per acute hospital admission that was avoided. CONCLUSION: The Chronic Patient Care Plan might be interpreted as a cost-effective intervention. This first assessment would benefit from further research including control groups.

Typology, the eight-function model, and archetypal complexes.

This clinical presentation shows what insights a typology-conscious analysis of clients and their families may lead to and points out what is added by applying John Beebe's eight-function, eight-archetype model. To reflect on the inner balance between archetypal complexes in the eight-function structure that holds our psyche, the author invites clients to do a typological analysis, including an analysis of their archetypal patterns, which may, itself, provoke anxiety. This article includes a presentation of ideas and experiences sparked when confronting these complexes in clinical work. Clients are introduced to six stages of coping with stress that may allow them to be more conscious of their complexes when triggered. These stages are Faint, Freeze, Flight, Fidget, Fight, and Flow. To identify whether the stress is physiological, emotional, or intellectual, the idea of the Triune Brain is introduced. The therapeutic work may lead to redemption from opposites, which is an ethical task.

Cette présentation clinique montre comment une analyse consciente de la typologie peut aider les clients et leurs familles, ainsi que l'apport supplémentaire avec l'utilisation du modèle « huit fonction huit archétype ¼ de John Beebe. Pour réfléchir à l'équilibre intérieur entre les complexes archétypaux dans la structure « huit-fonction ¼ qui soutient notre psyché, l'auteur invite ses clients à faire une analyse typologique, incluant une analyse des schémas archétypaux, ce qui en soi peut provoquer de l'anxiété. Cet article comprend une présentation d'idées et d'expériences suscitées par la confrontation avec ces complexes dans le travail clinique. Les six étapes pour gérer le stress sont exposées aux clients pour les aider à devenir plus conscients de leurs complexes quand ceux-ci sont activés. Ces étapes sont: s'évanouir, se geler, fuir, s'agiter, se battre, se laisser aller dans le sens du courant. Afin d'identifier si le stress est physiologique, émotionnel, ou intellectuel, l'auteur introduit la notion de cerveau triunique. Le travail thérapeutique peut conduire à la rédemption des opposés, ce qui est une tâche éthique.

Esta presentación clínica muestra a qué comprensiones puede conducir un análisis, de clientes y sus familias, basado en el uso consciente de la tipología; y señala aquello que aporta al aplicar el modelo de John Beebe de las ocho funciones, y ocho arquetipos. Para reflexionar acerca del balance interno entre complejos arquetipales en la estructura de las ocho funciones que sostiene nuestra psique, la autora invita a los clientes a hacer un análisis tipológico, incluyendo un análisis de los patrones arquetipales, el cual, puede en sí mismo, provocar ansiedad. El artículo incluye una presentación de las ideas y experiencias suscitadas a partir de la confrontación con estos complejos en el trabajo clínico. Los clientes son introducidos a seis etapas de trabajo para superar el stress que les posibilita devenir más conscientes de sus complejos cuando éstos son activados. Estas etapas son Desmayo, Congelamiento, Huida, Inquietud, Lucha y Fluir. Se introduce la idea del cerebro Triuno con el objetivo de identificar si el estrés es fisiológico, emocional o intelectual. El trabajo terapéutico puede conducir a la redención de la polarización, lo cual es una tarea ética.