Patrones de comunicación entre paciente y cuidador en una unidad de cuidados paliativos / No disponible

Objetivo: describir las características de la comunicación entre paciente y cuidador en una unidad de cuidados paliativos. Método: se evaluó a 32 pacientes ingresados en la Unidad de Cuidados Paliativos del Hospital de la Santa Creu i Sant Pau de Barcelona, mediante una entrevista en la que se registraba si el paciente se comunicaba con el cuidador, si le transmitía su preocupación principal, y si estaba satisfecho con la comunicación que mantenía. Se evaluó, asimismo. a 25 cuidadores de esos pacientes utilizando el mismo formato de entrevista. Resultados: el porcentaje de pacientes que se comunicaba y estaba satisfecho con la comunicación era superior al de los cuidadores (78 y 75% vs. 68 y 56%, respectivamente). El porcentaje de pacientes que transmitía su preocupación principal también era superior al de los cuidadores, aunque las cifras eran más bajas (53 vs. 34%). Los pacientes que se comunicaban tenían una media de edad inferior a la de los que no lo hacían (63,56 vs. 75,57 años), pero esta relación no se observó entre los cuidadores. Por otra parte. a mayor tiempo transcurrido desde el diagnóstico, más tendencia a comunicarse por parte del cuidador. Conclusiones: pacientes y cuidadores muestran patrones de comunicación diferentes, siendo los primeros más proclives a comunicarse, lo cual se facilita si el paciente es más joven. Además, el que haya transcurrido más tiempo desde el diagnóstico facilita que el cuidador se comunique (AU)

Objective: the aim of this study was to describe patterns of communication between patients and their caregivers in a palliative care unit. Method: thirty-two patients were assessed at the palliative care unit in Hospital de la Santa Creu I Sant Pau, Barcelona, using a structured interview. The following features were registered: whether the patient maintained communication with his/her caregiver; whether the patient told the caregiver his/her main concern, and whether the patient was satisfied with this communication. Using the same structured interview 25 caregivers of these patients (one per patient) were also assessed. Results: the proportion of patients who maintained communication and were satisfied was higher than that of caregivers (78 and 75% vs. 68 and 56%, respectively). The proportion of patients who told their caregiver his/her main concern was also higher, although the proportion was lower (53% of patients vs. 34% of caregivers). Patients who maintained communication were younger than patients who did not (63.56 vs. 75.57 years), but this was not the case for caregivers. Caregivers were most prone to communicate when time from diagnosis was longer. Conclusions: patients and caregivers had different patterns of communication. Patients are more prone to establish communication than caregivers, and this communication is easier when patient age is younger and when time from diagnosis is longer (AU)

P300 endogen evoked potentials in somatization disorder: a controlled study.

INTRODUCTION: Somatization disorder (SD) is considered the most valid, reliable and consistent disorder over time from the entire group of somatoform disorders and the most disabling and expensive for the health system. The aim of this paper is to assess the discriminative, attentional and cognitive process in SD patients by auditory-stimulus P300 evoked potential. DESIGN: case-control study. SAMPLE: cases group is made up of 25 patients, selected from the Miguel Servet University Hospital Somatoform Disorder Unit, that fulfill DSM-IV-TR criteria of SD using EPEP psychiatric interview. Twenty-five healthy and volunteer individuals without psychiatric or neurological disorders or history of disease were selected as control group. Both groups were matched by gender and age. RESULTS: Mean P300 latency was significantly (p<0.01) higher in SD patients than in healthy people. The rest of variables studied (N100 latency, P200 latency, P300 amplitude in Pz) did not show any significant differences. CONCLUSIONS: SD patients show electrophysiological disturbances in the cognitive process of information.

Potenciales evocados endógenos P300 en el trastorno de somatización: un estudio controlado / P300 endogen evoked potentials in somatization disorder: a controlled study

Introducción. El trastorno por somatización (TS) se considera la entidad más válida, fiable y consistente a lo largo del tiempo de todo el grupo de trastornos somatomorfos, así como el más invalidante y el que mayor gasto sanitario produce. El objetivo de este trabajo es evaluar el procesamiento cognitivo atencional y discriminativo en pacientes diagnosticados de trastorno de somatización mediante el registro del potencial P300 con estímulo auditivo. Métodos. Diseño: estudio caso-control. Población: el grupo de casos está formado por 25 pacientes, seleccionados de forma sucesiva, procedentes de la Unidad de Trastornos Somatomorfos del Hospital Universitario Miguel Servet de Zaragoza y diagnosticados de trastorno de somatización según criterios DSM-IV-TR mediante la Entrevista Psiquiátrica Estandarizada Polivante (EPEP). Como grupo control se escogieron 25 sujetos sanos al azar, libres de patología psiquiátrica o neurológica, apareados por sexo y edad. Resultados. Se observa que la media de latencia de P300 es significativamente superior (p < 0,01) en pacientes con trastorno de somatización respecto al grupo control. En el resto de variables estudiadas (latencia de N100, latencia de P200 y amplitud de P300 en Pz) no se observan diferencias entre los dos grupos. Conclusiones. En los pacientes con TS existe una alteración electrofisiológica de los niveles del procesamiento cognitivo de la información

Introduction. Somatization disorder (SD) is considered the most valid, reliable and consistent disorder over time from the entire group of somatoform disorders and the most disabling and expensive for the health system. The aim of this paper is to assess the discriminative, attentional and cognitive process in SD patients by auditory-stimulus P300 evoked potential. Methods. Design: case-control study. Sample: cases group is made up of 25 patients, selected from the Miguel Servet University Hospital Somatoform Disorder Unit, that fulfill DSM-IV-TR criteria of SD using EPEP psychiatric interview. Twenty-five healthy and volunteer individuals without psychiatric or neurological disorders or history of disease were selected as control group. Both groups were matched by gender and age. Results. Mean P300 latency was significantly (p<0.01) higher in SD patients than in healthy people. The rest of variables studied (N100 latency, P200 latency, P300 amplitude in Pz) did not show any significant differences. Conclusions. SD patients show electrophysiological disturbances in the cognitive process of information

Atención médica al final de la vida / Medical care at the end of life

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[Thrombopenic purpura associated with human immunodeficiency virus infection. Analysis of 24 cases]. / Púrpura trombopénica asociada a infección por virus de la inmunodeficiencia humana. Análisis de 24 casos.

In 24 cases of thrombopenic purpura associated with human immunodeficiency virus infection the clinical, immunological and therapeutic features were evaluated. Thrombopenia resulted in clinical manifestations in 20 patients. Splenomegaly was found in only one fourth of patients. Antiplatelet antibodies were found in 9 patients, and thrombopenia was associated with anemia in 37% of cases and with leukopenia in 21%. Bone marrow examination showed megakaryocyte hyperplasia in two thirds of the patients. The major immunological abnormalities were an inverted helper/suppressor T lymphocytes ratio, a reduction in the number of helper T lymphocytes, polyclonal hypergammaglobulinemia, and increased serum concentrations of circulating immunocomplexes. The different therapeutic modalities, steroids, vincristine, danatrol and plasma exchange, resulted in short responses; only two patients had normal platelet counts. The median follow-up was 14 months; during this time three patients fulfilled the criteria of acquired immunodeficiency syndrome.

Serum bactericidal activity against Klebsiella pneumoniae in volunteers receiving increasing doses of tobramycin with or without cefamandole.

Ten volunteers received intravenously in a randomly allocated order and on separate days the following regimens: cefamandole (15 mg/kg); tobramycin (1.5 mg/kg); tobramycin (3 mg/kg); cefamandole (15 mg/kg) + tobramycin (1.5 mg/kg); cefamandole (15 mg/kg) + tobramycin (3 mg-kg). Tobramycin serum levels were 3.7 +/- 0.7 micrograms/ml one hour after infusion of the 1.5-mg/kg and 7.8 +/- 1.6 micrograms/ml after the higher dose. Cefamandole serum levels were 26.0 +/- 5.2 micrograms/ml at the same time. Serum bactericidal activity and killing-rate studies were performed on a collection of 18 strains of Klebsiella pneumoniae. Against cefamandole-sensitive strains, all regimens were satisfactory (median serum bactericidal activity 1:16 to 1:64). Tobramycin (3 mg/kg) and both combinations were slightly more active on cefamandole-resistant strains (1:16 to 1:32) than cefamandole (1:2) and tobramycin low dose (1:8). Except for cefamandole alone, all regimens were equivalent in killing studies.

BRL-36650: in vitro studies and assessment of serum bactericidal activity after single-dose administration in volunteers.

Ten healthy volunteers received 1 g of BRL-36650, a new formamido-penicillin derivative, given by intravenous infusion over 15 min. Levels in serum were measured microbiologically 30, 60, and 120 min after the start of the 15-min infusion and were (mean +/- standard deviation) 102.7 +/- 28.4, 59.7 +/- 11.5, and 9.6 +/- 1.9 mg/liter, respectively. A total of 10 strains each of Escherichia coli, Klebsiella pneumoniae, Serratia spp., and Enterobacter spp. and 14 strains of Pseudomonas aeruginosa were selected according to their susceptibility or resistance to piperacillin for the study of serum bactericidal activity (SBA). The MICs and MBCs of these strains were influenced by the choice of medium. Median SBA against E. coli and K. pneumoniae were greater than or equal to 1:2,048 and 1:512, respectively. The SBA against piperacillin-susceptible Serratia spp. (1:256), Enterobacter spp. (1:128), and P. aeruginosa (1:32) were significantly higher than against piperacillin-resistant strains (1:32, 1:8, and 1:4, respectively). Killing curves confirmed the high bactericidal activities obtained against the majority of strains. In the case of one Enterobacter sp. and one P. aeruginosa isolate with an MBC greater than or equal to 32, the absence of killing was noted.

Effect of increasing doses of amikacin with or without piperacillin in the serum bactericidal test.

To determine whether high doses of amikacin would prevent the development of resistance in clinical isolates, the serum bactericidal activity and killing rate of conventional and high doses of amikacin and piperacillin alone and in combination were measured in volunteer sera against a series of ten strains each of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Amikacin serum levels were 24.9 +/- 6.0 mg/l 1 h after infusion of the 7.5 mg/kg dose and 44.8 +/- 5.0 mg/l after the two-fold dose. Median serum bactericidal titers for low dose piperacillin + amikacin were 1:8-1:64 and for high-dose piperacillin + amikacin 1:16-1:128. Both were satisfactory, except against piperacillin-resistant Pseudomonas aeruginosa (median bactericidal titers less than or equal to 1:2), and both combinations had equivalent killing rates.