The Role of Resilience, Happiness, and Social Support in the Psychological Function during the Late Stages of the Lockdown in Individuals with and without Chronic Pain.

There is mounting evidence to suggest that individuals with chronic pain adjusted poorly to and were impacted negatively by social distancing measures during the lockdown. However, there is limited data on the factors that might protect against the negative effects associated with social distancing measures, as most research has been conducted in the general population and in the initial stages of the lockdown. The aim of this study was to improve the understanding of the role that resilience, happiness, and social support, all factors that are thought to have a protective role, played in the psychological function (measured as anxiety, depression, and stress) to the social distancing measures during the late stages of the lockdown in a sample of adults with and without chronic pain living in Spain. A group of 434 adults responded to an online survey and provided information on sociodemographic issues, which included measures of pain, perceived health and quality of life, depression, anxiety, stress, resilience, happiness, and social support. The data showed that individuals with chronic pain (N = 200; 46%) reported statistically significant worst psychological function, that is to say, they reported higher levels of anxiety, depression, and stress (all ps < 0.001). Resilience, social support, and happiness proved to be significant predictors of anxiety, depression, and stress, after controlling for the effects of age, gender, and chronic pain. Although the effect sizes were small to medium, they are consistent with the findings of other studies. The findings from this study provide important additional new information regarding the associations between resilience, happiness, and social support and the adjustment to the social distancing measures during the late stages of the lockdown. These findings can be used to develop programs to improve adjustment to and coping with the demands of social distancing measures.

Confidencialidad. Recomendaciones del Grupo de Bioética de la Sociedad Española de Medicina Intensiva Crítica y Unidades Coronarias (SEMICYUC) / No disponible

No disponible

Valoración clínica y radiológica de las prótesis unicompartimentales de rodilla implantadas con técnica mínimamente invasiva / Clinical and radiological assessment of unicompartmental knee prostheses implanted with a minimally invasive technique

Objetivos: Valorar la posición radiológica y el resultado clínico a corto plazo de una serie de prótesis unicompartimentales de rodilla implantadas mediante mínima incisión. Material y método: Revisión retrospectiva de las primeras 44 artroplastias de este tipo realizadas en el servicio de este hospital con un seguimiento mínimo de un año. Se analizó la relación existente entre el resultado obtenido según la escala de la American Knee Society y la edad del sujeto, el sexo, el índice de masa corporal (IMC), el diagnóstico, el número de cirugías previas y 25 variables radiológicas registradas a partir de proyecciones anteroposterior, lateral y axial. Se determinaron, a su vez, los errores en el posicionamiento de cada uno de los componentes en todos los planos. Resultados: Se encontraron resultados significativamente peores cuanto mayor era el IMC (coeficiente de correlación [r] = −0,42; p = 0,01) y cuanto mayor era el grado de inclinación posterior del componente tibial (r = −0,34; p = 0,02), estadísticamente a partir de los 8° (t = −2,15; p = 0,04). La mayor variabilidad en la colocación protésica se encontró en el grado de rotación del componente tibial en el plano axial y en el grado de flexoextensión del femoral en el plano sagital. La experiencia quirúrgica es determinante en la implantación correcta de la prótesis, y se han demostrado menores errores de forma significativa cuanto mayor número de cirugías se realizara (t = 2,06; p = 0,04). Conclusiones: La prótesis unicondílea de rodilla es una alternativa terapéutica atractiva para la enfermedad unicompartimental, aunque es técnicamente demandante y necesita una curva de aprendizaje obligada. Además de una buena selección del sujeto, la implantación correcta de los componentes resulta fundamental para un resultado final satisfactorio (AU)

Purpose: To assess the radiological position and the short-term clinical outcome of a series of unicompartmental knee prostheses implanted through a small incision. Materials and methods: Retrospective review of the first 44 arthroplasties of this kind performed in our Department with a minimum 1-year follow-up. The study includes an analysis of the relationship between the result obtained in terms of the American Knee Society score and the patients´ age, gender, body mass index, diagnosis, number of previous surgeries and 25 radiological variables recorded on the basis of anteroposterior, lateral and axial views. Any errors in the positioning of each of the components on the different planes were also determined. Results: The results obtained are significantly poorer the higher the body mass index (r=−0.42; P=.01) and the higher the degree of posterior inclination of the tibial component (r=−0.34; P=.02); this difference is statistically significant from 8° (t=−2.15; P=.04) onwards. The greatest variability in terms of prosthetic placement is found in the degree of rotation of the tibial component on the axial plane and in the flexion-extension of the femoral component on the sagittal plane. Surgical expertise is crucial when it comes to sound prosthetic placement, with significantly fewer errors being committed by surgeons who perform the procedure habitually (t=2.06; P=.04). Conclusions: Unicondylar knee replacement is an attractive yet technically demanding therapeutic alternative for unicompartmental pathology, which is associated to a mandatory learning curve. In addition to appropriate patient selection, correct implant placement is crucial to obtain a satisfactory end result (AU)

El desaprendizaje: propuesta para profesionales de la salud críticos / Unlearning: proposal for critic health professionals

El desaprendizaje como método reflexivo de cuestionamiento crítico de la realidad, ayuda a examinar las estructuras teóricas que cada sujeto ha asimilado, frecuentemente de manera acrítica, durante su trayectoria formativa y profesional. Este examen crítico de las formas habituales de pensar y actuar en el mundo no pretende erigirse como guía del proceso de transición hacia formas de conciencia más verdaderas y fundamentadas. Lo que se busca, por el contrario, es realizar un ejercicio constante de interrogación de lo evidente y de aceptar los límites del pensamiento y las incertidumbres del presente (AU)

Unlearning as a reflexive method of critical questioning of reality helps us examine the theoretical structures that each individual has mastered, more often than not in an "acritical" manner, during his or her professional and formative trajectory. This critical examination of the habitual ways of thinking and behaving in today’s world is not intended, however, to serve as a guide for this transition process towards more authentic and fundamental forms of awareness. On the contrary, what we are looking for is to Performa continuous questioning exercise of what is evident and to accept the limits of our thinking patterns and the uncertainties of our time

Influencia del modelo organizativo en los Servicios de Urgencias sobre la eficiencia de la atención de procesos críticos / Influence of the organisational model on the efficiency of critical care in the Emergency Department

El objetivo de este estudio es el de comparar la eficiencia de los diferentes modelos organizativos y gestión de la atención en Servicios de urgencias existentes en diversos hospitales de la provincia de Barcelona. El trabajo está diseñado como un estudio multicéntrico observacional de cohortes. El ámbito fue el de los Servicios de Urgencias de Hospitales de segundo y tercer niel, con distintos modelos organizativos de atención al paciente crítico: modelo de atención integrada: coordinación y atención de los pacientes que acuden a Urgencias por médico polivalentes; el médico especialista interviene en las técnicas diagnósticas y terapéuticas específicas. Modelo de atención especializada: intervención del especialista en primera línea sobre los pacientes que acuden a Urgencias. Modelo de atención en centro no especializado: servicios de Urgencias de Hospitales sin disponibilidad de recursos especializados y que requiere la colaboración de un centro de referencia para completar el diagnóstico y tratamiento. Se estudiaron todos los pacientes que llegan al Servicio de Urgencias y que reunían los siguientes criterios de inclusión: Síndrome coronario agudo con o sin elevación del ST. Accidente vascular cerebral isquémico o hemorragia subaracnoidea. Traumatismo craneoencefálico con GCS < 13. Enfermedad pulmonar obstructiva crónica agudizada que requerirá soporte ventilatorio mecánico.

The objective of this article is to compare the efficiency according to different organisational and management models of the existing care provided in Emergency Services in different hospitals of the provence of Barcelona. It presents a comparative analysis model which makes it possible to obtain certified conclusions and possibilities for improvement (AU)

[Is a preanesthetic interview by a team including nurses effective, safe, and efficient?]. / Es eficaz, segura y eficiente una consulta preanestésica en equipo con enfermería?

OBJECTIVE: To analyze the effectiveness, safety, and performance of anesthetist-led preanesthetic interviews in which specifically trained nurses exercise defined roles under supervision. MATERIAL AND METHODS: This descriptive study analyzed preanesthetic interviews performed by a team of anesthesiologists and nurses in surgically treated patients over a 1-year period. We assessed the impact of those interviews on the rate of procedures canceled due to errors in presurgical assessment. Study variables were the percentage of procedures canceled due to failure of presurgical assessment and the difference in the cancellation rate according to whether the interviews were undertaken by anesthesiologists or nurses, number of preanesthetic assessments made by nurses; number of consultations made by nurses to anesthesiologists, number of patients referred for a second interview with an anesthesiologist after assessment by a nurse, rate of substitution by nurses of anesthesiologists, and time dedicated daily by anesthesiologists responding to nurses' consultations. The results were analyzed using descriptive statistics. RESULTS: A total of 7343 preoperative assessments were performed. Of those, 28.6% were undertaken by nurses. Surgery was canceled because of errors in presurgical assessment in 78 cases (1.06%), corresponding to 1.0% of the preoperative evaluations performed by anesthesiologists and 0.7% of those performed by nurses. In 317 (18.2%) nurse-led preoperative assessments the anesthesiologist was consulted, and in another 121 cases (6.9%) a second preanesthetic interview was required. The rate of substitution of anesthesiologists by nursing staff was 26.5% and the time anesthesiologists dedicated daily to consultation during nurse-led assessments was 17.7 minutes. CONCLUSIONS: The involvement of nurses in preanesthesia assessments of surgical patients is a clinically safe and effective initiative.

¿Es eficaz, segura y eficiente una consulta preanestésica en equipo con enfermería? / Is a preanesthetic interview by a team including nurses effective, safe, and efficient?

OBJETIVO: Analizar la eficacia, seguridad y rendimientode una consulta preanestésica, liderada por anestesiólogos,en la que participa, por delegación de funciones, supervisaday previo entrenamiento específico enfermería.MATERIAL Y MÉTODOS: Estudio descriptivo de las evaluacionespreanestésicas de pacientes sometidos a intervencionesquirúrgicas durante el período de un año porun equipo compuesto por anestesiólogos (CAnest) y enfermería(CEnfAnest) y su impacto sobre el índice de suspensionesquirúrgicas por fallo del Circuito Preoperatorio(CP). Variables del estudio: Porcentaje de suspensionesquirúrgicas por fallo del CP; relación de las mismas conCAnest y CEnfAnest. Número de evaluaciones preanestésicasrealizadas por enfermería, número de consultas desdeCEnfAnest a CAnest, número de pacientes derivadoscomo segunda visita a CAnest tras visita en CEnfAnest,índice de sustitución (IS) de CEnfAnest, tiempo del anestesiólogodedicado diariamente a las consultas de CEnfAnest(TAnest). Estudio estadístico: estadística descriptiva.RESULTADOS: Total de evaluaciones preoperatorias:7.343. El 28,6% de las mismas fueron realizadas porCEnfAnest. Suspensiones quirúrgicas por fallo del CP:78 casos (1,06%); correspondieron al 1% de las evaluacionespreoperatorias realizadas en CAnest y al 0,7% delas realizadas en CEnfAnest. En 317 (18,2%) evaluacionespreoperatorias de CEnfAnest se consultó al anestesiólogoy en otros 121 casos (6,9%) se requirió nuevavisita preanestésica. El IS de CEnfAnest fue del 26,5%;el TAnest de 17,7 minutos.CONCLUSIONES: La participación de enfermería en lasvaloraciones preanestésicas de los pacientes quirúrgicoses una iniciativa eficaz y segura desde el punto de vistaclínico

OBJETIVE: To analyze the effectiveness, safety, and performance of anesthetist-led preanesthetic interviews in which specifically trained nurses exercise defined roles under supervision. MATERIAL AND METHODS: This descriptive study analyzed preanesthetic interviews performed by a team of anesthesiologists and nurses in surgically treated patients over a 1-year period. We assessed the impact of those interviews on the rate of procedures canceled due to errors in presurgical assessment. Study variables were the percentage of procedures canceled due to failure of presurgical assessment and the difference in the cancellation rate according to whether the interviews were undertaken by anesthesiologists or nurses, number of preanesthetic assessments made by nurses; number of consultations made by nurses to anesthesiologists, number of patients referred for a second interview with an anesthesiologist after assessment by a nurse, rate of substitution by nurses of anesthesiologists, and time dedicated daily by anesthesiologists responding to nurses’ consultations. The results were analyzed using descriptive statistics. RESULTS: A total of 7343 preoperative assessments were performed. Of those, 28.6% were undertaken by nurses. Surgery was canceled because of errors in presurgical assessment in 78 cases (1.06%), corresponding to 1.0% of the preoperative evaluations performed by anesthesiologists and 0.7% of those performed by nurses. In 317 (18.2%) nurse-led preoperative assessments the anesthesiologist was consulted, and in another 121 cases (6.9%) a second preanesthetic interview was required. The rate of substitution of anesthesiologists by nursing staff was 26.5% and the time anesthesiologists dedicated daily to consultation during nurse-led assessments was 17.7 minutes. CONCLUSIONS: The involvement of nurses in preanesthesia assessments of surgical patients is a clinically safe and effective initiative

Cinética de crecimiento in vitro de osteoblastos humanos sobre cerámica porosa de hidroxiapatita / In vitro growth kinematics of human osteoblasts on porous hydroxyapatite ceramics

Objetivo. Estudio de la respuesta in vitro de osteoblastos humanos frente a una cerámica porosa de hidroxiapatita para su consideración como matriz en ingeniería tisular. Material y método. Se han aislado caracterizado y cultivado osteoblastos humanos. Se sembraron sobre discos del material y sobre plástico (control) y se ha estudiado mediante técnica de reducción de la sal de tetrazolio su adherencia, extensión y proliferación. Se comprobó sus características funcionales, determinando la producción de fosfatasas alcalinas, osteocalcina, colágeno I y mineralización in vitro. Resultados. Las células se adhirieron y crecieron sobre la superficie del material, y en el interior de los poros. A las 24 horas se adhirieron el 20% de las células sembradas, mientras que en el control lo hicieron el 95%, además, se observó un crecimiento más lento. La producción de fosfatasas alcalinas, osteocalcina y colágeno I por las células que crecieron sobre la cerámica fue positiva y en similar rango que los controles. Conclusiones. Los osteoblastos colonizaron la cerámica de forma más lenta que el control, mantuvieron su fenotipo y produjeron matriz extracelular. El ensayo de reducción de las sales de tetrazolio (XTT) fue satisfactorio para cuantificar la proliferación de osteoblastos sobre la cerámica. El modelo utilizado permite cuantificar y observar la funcionalidad in vitro de osteoblastos en respuesta a cerámicas de hidroxiapatita. En función de los resultados obtenidos el material utilizado en el estudio puede ser considerado, en el campo de la ingeniería tisular, como una matriz adecuada para soportar el crecimiento de osteoblastos humanos

Purpose. To study the in vitro response of human osteoblasts when in contact with porous hydroxyapatite ceramics, with a view to considering them a matrix for tissue engineering. Materials and methods. Human osteoblasts were isolated, characterized and cultured. They were seeded onto discs made of HA and onto a plastic material (control) and their adhesiveness, extension and proliferation were studied by means of a tetrazolium salt reduction test. Their functional characteristics were examined in order to determine the production of alkaline phosphatases, osteocalcin, collagen I as well as in vitro mineralization. Results. The cells adhered to and grew onto the material's surface and inside its pores. Within 24 hours, 20% of seeded cells had adhered; in the control group this percentage was 95% and the growth was slower. The cells growing onto the ceramics were found to produce alkaline phosphatases, osteocalcin and collagen in amounts similar to those in the control group. Conclusions. Osteoblasts colonized the ceramics at a lower pace than plastic; they also retained their phenotype and generated extracellular matrix. The tetrazolium salt reduction test served the purpose of validating the proliferation of osteoblasts on the ceramics. The model used makes it possible to quantify and observe the in vitro functionality of osteoblasts in their response to hydroxyapatite ceramics. On the basis of the results obtained, the material used in the study can be considered, in the field of tissue engineering, a suitable matrix to support the growth of human osteoblasts

Prognostic factors in laryngotracheal injury following intubation and/or tracheotomy in ICU patients.

The aim of this study was to determine the incidence of laryngotracheal injuries following intubation and/or tracheotomy in intensive care unit (ICU) patients and to analyze their prognostic factors. This prospective study includes the clinical data and endoscopic exploration of 654 ICU patients who underwent oro-tracheal intubation between September 1992 and February 1999. The prognostic factors for upper airway injuries were analyzed using a multivariate statistical study. Endoscopic exploration of the upper airway 6 to 12 months after extubation revealed laryngotracheal injuries in 30 of the 280 patients examined (11%). The most important factors influencing the development of laryngotracheal lesions were the duration of the oro-tracheal intubation and the length of time in the ICU. Patients at high risk of developing injuries were those with pathological background, a non-neurological or non-surgical (medical) admission or upper-airway injuries at an early stage. The length of oro-tracheal intubation is the most important factor in the development of laryngotracheal injuries. Consequently, it is essential to establish a time limit to perform tracheotomy in ICU patients. Such timing should be adapted to each patient and pathology.

Utilización de la ventilación mecánica en 72 unidades de cuidados intensivos en España / Utilization of mechanical ventilation in 72 Spanish intensive care units

Fundamento. La ventilación mecánica es una técnica fundamental en las unidades de cuidados intensivos (UCI). El objetivo es conocer su utilización y las diferencias en su aplicación en 72 UCI españolas. Métodos. Estudio de cohortes de los pacientes ventilados durante más de 12 h. Se registraron datos demográficos, indicación de la ventilación mecánica, parámetros ventilatorios, modos de ventilación y desconexión, y días de soporte ventilatorio, días de estancia y situación al alta. Resultados. Se incluyó a 1.103 pacientes (29 per cent) de los ingresados, un 66 per cent de varones, con una mediana de edad de 65 años y del SAPS II de 43.No se observaron diferencias geográficas en la aplicación de la ventilación mecánica ni en los desenlaces principales. En el 64 per cent la indicación de ventilación fue insuficiencia respiratoria. Al inicio, la modalidad asistida-controlada fue la más utilizada (90 per cent), con un volumen tidal medio (desviación estándar [DE]) 8,9 (2,0) ml/kg y PEEP 5,5 (2,2) cmH2O. El 4 per cent recibió ventilación no invasora, el 68 per cent de los enfermos no precisó intubación. La duración de la ventilación fue 7 (8) días. El método de desconexión más utilizado fue una prueba única diaria de respiración espontánea (58 per cent). La duración fue de 3 (5) días. La incidencia de traqueostomía fue 15 per cent y se realizó a los 14 (8) días. La mortalidad en la UCI fue del 32,8 per cent y en el hospital del 42,8 per cent. Conclusiones. La comparación de la utilización de la ventilación mecánica en 72 UCI españolas evidencia una práctica similar, con mínimas diferencias en el uso de los modos de ventilación y desconexión y una similar mortalidad y días de estancia (AU)

The utility of serology in diagnosing candidosis in non-neutropenic critically ill patients.

This study was carried out to evaluate the utility of serological tests in the diagnosis of candidal infections in non-neutropenic critically ill patients. A prospective study was carried out in a 10-bed general intensive care unit; all patients with at least one organic sample with Candida spp. were included. A therapeutic-diagnostic algorithm was designed, and patients were treated or not, according to a classification. Blood samples were taken, and serological tests included: antigenaemia detection using two different commercial latex kits (Cand-Tec and Pastorex) and antibody detection by indirect haemagglutination (IHA) and indirect germ tube immunofluorescence (IFA). A total of 56% of antibody tests (IHA 45% and IFA 64%) and 26% of antigen tests (Cand-Tec 36% and Pastorex 17%) were positive. The sensitivity and specificity of these tests with respect to systemic candidosis were 37% and 78%, respectively, for antibodies, and 0% and 90% for antigens. There was statistical significance for mortality and low levels of antibodies; Candida glabrata was detected by IFA and Candida tropicalis by Cand-Tec. Serological tests may help to define the prognosis of these patients and to support the detection of specific Candida species.

[Traumatic rupture of the tricuspid valve. Its conservative surgical treatment]. / Rotura traumática de la válvula tricúspide. Tratamiento quirúrgico conservador.

Tricuspid insufficiency caused by blunt chest trauma is rare and usually unsuspected clinically, early after trauma. Cross-sectional Echocardiography and Cardiac Catheterization are essential to establish the diagnosis. Therapy applied varies from repair to valvular replacement. We describe an 18-year-old boy with traumatic tricuspid regurgitation treated by reconstruction of the attachments of the anterosuperior leaflet and annuloplasty with a Puig-Massana ring. Six month after surgery he is fully recovered, although persist a moderate degree of tricuspid insufficiency.

[Review of tetanus points of entry. Study of 229 cases]. / Revisión de las puertas de entrada en el tétanos. A propósito de 229 casos.

A revision of tetanus points of entry in 229 tetanic patients who were cared for at the Hospital del Mar, Barcelona, between 1970 and 1983, i carried out in order to determine in which kind of patients a adequate prophylaxis is not performed. It is found that 83% of point of entry are wounds which are not medically assisted. At the same time points of entry are classified in four main groups: a first group consisting of wounds localized in head and extremities (46.8%), second group to contaminated intramuscular injections (21.8%) a third group related to surgical and obstetric procedures (15.3%) an a fourth group which includes other points of entry not included in the previous groups (16.2%). This classification permits the detection of epidemiological characteristics of each group and the observation of the possible influence of point of entry on the evolution and prognosis of tetanus highlighting that the most severe situations are due to intramuscular injections and surgical and obstetric procedures. With this study we can conclude that an adequate antitetanic prophylaxis must not be restricted to high risk patients, but should be extended to the whole population.