Development of a patient-centred medication management model for polymedicated home-dwelling older adults after hospital discharge: results of a mixed methods study.

OBJECTIVE: This study aimed to investigate medication management among polymedicated, home-dwelling older adults after discharge from a hospital centre in French-speaking Switzerland and then develop a model to optimise medication management and prevent adverse health outcomes associated with medication-related problems (MRPs). DESIGN: Explanatory, sequential, mixed methods study based on detailed quantitative and qualitative findings reported previously. SETTING: Hospital and community healthcare in the French-speaking part of Switzerland. PARTICIPANTS: The quantitative strand retrospectively examined 3 years of hospital electronic patient records (n=53 690 hospitalisations of inpatients aged 65 years or older) to identify the different profiles of those at risk of 30-day hospital readmission and unplanned nursing home admission. The qualitative strand explored the perspectives of older adults (n=28), their informal caregivers (n=17) and healthcare professionals (n=13) on medication management after hospital discharge. RESULTS: Quantitative results from older adults' profiles, affected by similar patient-related, medication-related and environment-related factors, were enhanced and supported by qualitative findings. The combined findings enabled us to design an interprofessional, collaborative medication management model to prevent MRPs among home-dwelling older adults after hospital discharge. The model comprised four interactive fields of action: listening to polymedicated home-dwelling older adults and their informal caregivers; involving older adults and their informal caregivers in shared, medication-related decision-making; empowering older adults and their informal caregivers for safe medication self-management; optimising collaborative medication management practices. CONCLUSION: By linking the retrospective and prospective findings from our explanatory sequential study involving multiple stakeholders' perspectives, we created a deeper comprehension of the complexities and challenges of safe medication management among polymedicated, home-dwelling older adults after their discharge from hospital. We subsequently designed an innovative, collaborative, patient-centred model for optimising medication management and preventing MRPs in this population.

"My job is to keep my body healthy": biopedagogies, beauty and institutional greed in professional ballet.

CONTEXT: The ballet institution is known for its aesthetic and performative standards. In professional dancers' everyday lives, self-improvement and body awareness entwine with striving for artistic excellence. In this context, 'health' has primarily been explored in relation to eating disorders, pain, and injuries. AIM: This paper explores dancers' health practices, namely how they are shaped by the ballet institution and how they relate to broader health discourses. METHODOLOGY: A reflexive thematic analysis was conducted upon interviews with nine dancers (each interviewed twice) using a theoretical framework based on the concepts of greedy institutions and biopedagogies. ANALYSES: Two themes were developed: What it takes to be an 'insider' of the ballet institution and Learning to develop an acute embodied self-awareness. Dancers described ballet as a 'lifestyle' rather than a 'job'; practices of self-care defined by continuous self and body work were framed as necessary to meet the demands of this lifestyle. Participants 'played with' institutional and societal norms, often resisting docile bodies promoted within the ballet institution. CONCLUSION: Dancers' constructions of health and the art of ballet as not fitting neatly into 'good' nor 'bad' make room to consider the tensions between adopting and resisting dominant health discourses in this institution.

Promoting Hand Hygiene During the COVID-19 Pandemic: Parallel Randomized Trial for the Optimization of the Soapp App.

BACKGROUND: Hand hygiene is an effective behavior for preventing the spread of the respiratory disease COVID-19 and was included in public health guidelines worldwide. Behavior change interventions addressing hand hygiene have the potential to support the adherence to public health recommendations and, thereby, prevent the spread of COVID-19. However, randomized trials are largely absent during a pandemic; therefore, there is little knowledge about the most effective strategies to promote hand hygiene during an ongoing pandemic. This study addresses this gap by presenting the results of the optimization phase of a Multiphase Optimization Strategy of Soapp, a smartphone app for promoting hand hygiene in the context of the COVID-19 pandemic. OBJECTIVE: This study aimed to identify the most effective combination and sequence of 3 theory- and evidence-based intervention modules (habit, motivation, and social norms) for promoting hand hygiene. To this end, 9 versions of Soapp were developed (conditions), and 2 optimization criteria were defined: the condition with the largest increase in hand hygiene at follow-up and condition with the highest engagement, usability, and satisfaction based on quantitative and qualitative analyses. METHODS: This study was a parallel randomized trial with 9 intervention conditions defined by the combination of 2 intervention modules and their sequence. The trial was conducted from March to August 2021 with interested participants from the Swiss general population (N=232; randomized). Randomization was performed using Qualtrics (Qualtrics International Inc), and blinding was ensured. The duration of the intervention was 34 days. The primary outcome was self-reported hand hygiene at follow-up, which was assessed using an electronic diary. The secondary outcomes were user engagement, usability, and satisfaction assessed at follow-up. Nine participants were further invited to participate in semistructured exit interviews. A set of ANOVAs was performed to test the main hypotheses, whereas a thematic analysis was performed to analyze the qualitative data. RESULTS: The results showed a significant increase in hand hygiene over time across all conditions. There was no interaction effect between time and intervention condition. Similarly, no between-group differences in engagement, usability, and satisfaction emerged. Seven themes (eg, "variety and timeliness of the task load" and "social interaction") were found in the thematic analysis. CONCLUSIONS: The effectiveness of Soapp in promoting hand hygiene laid the foundation for the next evaluation phase of the app. More generally, the study supported the value of digital interventions in pandemic contexts. The findings showed no differential effect of intervention conditions involving different combinations and sequences of the habit, motivation, and social norms modules on hand hygiene, engagement, usability, and satisfaction. In the absence of quantitative differences, we relied on the results from the thematic analysis to select the best version of Soapp for the evaluation phase. TRIAL REGISTRATION: ClinicalTrials.gov NCT04830761; https://clinicaltrials.gov/ct2/show/NCT04830761. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1136/bmjopen-2021-055971.

Corrigendum: Translating planetary health principles into sustainable primary care services.

[This corrects the article DOI: 10.3389/fpubh.2022.931212.].

Collaborative medication management for older adults after hospital discharge: a qualitative descriptive study.

BACKGROUND: Safe medication management for older adults after hospital discharge requires a well-coordinated, interprofessional, patient-centered approach. This study aimed to describe the perceived needs for collaborative medication management for older adults taking several different medications at home after hospital discharge. METHODS: A qualitative descriptive study was conducted using semi-structured interviews with older adults (n = 28), informal (n = 17), and professional caregivers (n = 13). RESULTS: Findings revealed four main needs: older adults and informal caregivers' perceived needs for greater involvement in discharge planning; older adults' perceived needs to be informed, listened to, and to be actively involved in decision-making; informal caregivers' perceived needs for help in supporting and coordinating medication management; and older adults' and informal and professional caregivers' perceived needs for better communication and coordination between professional caregivers. CONCLUSION: This study revealed two underutilized pathways towards improving collaborative medication management: medication follow-up involving a community healthcare professional taking an overarching responsibility and empowering older adults and their informal caregivers in medication management after hospital discharge.

Translating Planetary Health Principles Into Sustainable Primary Care Services.

Global anthropogenic environmental degradations such as climate change are increasingly recognized as critical public health issues, on which human beings should urgently act in order to preserve sustainable conditions of living on Earth. "Planetary Health" is a breakthrough concept and emerging research field based on the recognition of the interdependent relationships between living organisms-both human and non-human-and their ecosystems. In that regards, there have been numerous calls by healthcare professionals for a greater recognition and adoption of Planetary Health perspective. At the same time, current Western healthcare systems are facing their limits when it comes to providing affordable, equitable and sustainable healthcare services. Furthermore, while hospital-centrism remains the dominant model of Western health systems, primary care and public health continue to be largely undervalued by policy makers. While healthcare services will have to adapt to the sanitary impacts of environmental degradations, they should also ambition to accompany and accelerate the societal transformations required to re-inscribe the functioning of human societies within planetary boundaries. The entire health system requires profound transformations to achieve this, with obviously a key role for public health. But we argue that the first line of care represented by primary care might also have an important role to play, with its holistic, interdisciplinary, and longitudinal approach to patients, strongly grounded in their living environments and communities. This will require however to redefine the roles, activities and organization of primary care actors to better integrate socio-environmental determinants of health, strengthen interprofessional collaborations, including non-medical collaborations and more generally develop new, environmentally-centered models of care. Furthermore, a planetary health perspective translated in primary care will require the strengthening of synergies between institutions and actors in the field of health and sustainability.

Safe Medication Management for Polymedicated Home-Dwelling Older Adults after Hospital Discharge: A Qualitative Study of Older Adults, Informal Caregivers and Healthcare Professionals' Perspectives.

Safe medication management is particularly challenging among polymedicated home-dwelling older adults after hospital discharge. This study aimed to identify and categorise the stressors experienced and reconstitution strategies adopted by older adults, their informal caregivers, and healthcare professionals as they manage older adults' medications after hospital discharge. A primary study collected the perspectives of 28 older adults, 17 informal caregivers, and 13 healthcare professionals using a qualitative descriptive design. The Neuman Systems Model was used as the basis for a secondary deductive content analysis. Findings revealed that post-discharge medication management at home involved numerous stressors, often including dysfunctions in communication, collaboration, and coordination between the multiple stakeholders involved. Reconstitution strategies for safe medication management were not always successful or satisfactory and were sometimes identified as stressors themselves. Older adults, informal caregivers, and healthcare professionals' perspectives highlighted several potential opportunities for improving safe medication management through nurse-led, interprofessional, patient-centred practices.

'I wanted to share with you some of my healthy habits': YouTubers' staging of health-related practices.

Professional YouTubers have become highly popular in producing video content through self-mediation. Objective. The present article aimed to study ways in which lifestyle YouTubers construct health practices in their videos within the YouTube media culture. Design. We conducted a narrative and visual analysis across a selection of 15 videos. Results. Results showed that YouTubers' practices and recommendations for a better life were structured around three themes: Eating to live well; Exercising to live well; Resting to live well and, a fourth cross-cutting theme on Practices aimed at self-development to achieve health and happiness. YouTubers were mainly female presenting, as well as middle/upper-class and white appearing. An overall optimistic tone characterised their health stories, as they delivered personal experiences of success on becoming healthy, happy, and better persons, while encouraging viewers to act similarly. Our findings suggested that YouTubers actively contribute to construct unprecedented definitions of health, enhanced by the social media culture and broader societal logics of healthism and postfeminism. Conclusion. Our study constitutes an original contribution to critical health psychology by examining some of the paradoxes raised by social media influencers like YouTubers regarding health and wellbeing.

Unplanned nursing home admission among discharged polymedicated older inpatients: a single-centre, registry-based study in Switzerland.

OBJECTIVE: To investigate patient characteristics and the available health and drug data associated with unplanned nursing home admission following an acute hospital admission or readmission. DESIGN: A population-based hospital registry study. SETTING: A public hospital in southern Switzerland (Valais Hospital). PARTICIPANTS: We explored a population-based longitudinal dataset of 14 705 hospital admissions from 2015 to 2018. OUTCOME MEASURES: Sociodemographic, health and drug data, and their interactions predicting the risk of unplanned nursing home admission. RESULTS: The mean prevalence of unplanned nursing home admission after hospital discharge was 6.1% (n=903/N=14 705). Our predictive analysis revealed that the oldest adults (OR=1.07 for each additional year of age; 95% CI 1.05 to 1.08) presenting with impaired functional mobility (OR=3.22; 95% CI 2.67 to 3.87), dependency in the activities of daily living (OR=4.62; 95% CI 3.76 to 5.67), cognitive impairment (OR=3.75; 95% CI 3.06 to 4.59) and traumatic injuries (OR=1.58; 95% CI 1.25 to 2.01) had a higher probability of unplanned nursing home admission. The number of International Classification of Diseases, 10th version diagnoses had no significant impact on nursing home admissions, contrarily to the number of prescribed drugs (OR=1.17; 95% CI 1.15 to 1.19). Antiemetics/antinauseants (OR=2.53; 95% CI 1.21 to 5.30), digestives (OR=1.78; 95% CI 1.09 to 2.90), psycholeptics (OR=1.76; 95% CI 1.60 to 1.93), antiepileptics (OR=1.49; 95% CI 1.25 to 1.79) and anti-Parkinson's drugs (OR=1.40; 95% CI 1.12 to 1.75) were strongly linked to unplanned nursing home admission. CONCLUSIONS: Numerous risk factors for unplanned nursing home admission were identified. To prevent the adverse health outcomes that precipitate acute hospitalisations and unplanned nursing home admissions, ambulatory care providers should consider these risk factors in their care planning for older adults before they reach a state requiring hospitalisation.

"What I thought was so important isn't really that important": international perspectives on making meaning during the first wave of the COVID-19 pandemic.

BACKGROUND: The global COVID-19 pandemic has had a significant impact on the physical and mental health of people everywhere. The aim of the study is to understand how people living in 15 countries around the globe experience an unexpected crisis which threatens their health and that of loved ones, and how they make meaning of this disruption in their narratives. METHODS: Data were collected through an anonymous online survey during May-September 2020, which was during or just after the first wave of the COVID-19 pandemic, depending on the country. The questionnaire included demographic and three open-ended questions as prompts for stories about experiences during the initial months of the pandemic. The text was analyzed through inductive thematic content analysis and quantified for full sample description, demographic and subsequently international comparisons. RESULTS: The final qualitative dataset included stories from n = 1685 respondents. The sample was 73.6% women and 26.4% men. The mean age of participants was 39.55 years (SD = 14.71). The identified four groups of overarching themes were: The presence and absence of others; Rediscovering oneself; The meaning of daily life; Rethinking societal and environmental values. We discuss the prevalence of each theme for the sample as a whole and differences by demographic groups. The most prevalent theme referred to disruptions in interpersonal contacts, made meaningful by the increased appreciation of the value of relationships, present in (45.6%) of stories. It was more prevalent in the stories of women compared to men (χ² = 24.88, p = .001). CONCLUSIONS: The paper provides a detailed overview of the methodology, the main themes identified inductively in the stories and differences according to select demographic variables. We identify several major ways of making meaning of the pandemic. The pandemic has impacted many aspects of people's lives which give it meaning, no matter where they live.

Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study.

Although home-dwelling older adults are frequently assisted with polypharmacy management by their informal caregivers, they can still face medication-related problems. Identifying older adults' and their informal caregivers' beliefs about medication is a gateway to understanding and improving medication adherence. This study aimed to analyse beliefs about polypharmacy among home-dwelling older adults with multiple chronic conditions and their informal caregivers, focusing on their daily medication practices. Semi-structured interviews were conducted with 28 older adults, 17 informal caregivers, but also 13 healthcare professionals. Based on an inductive methodological approach, data were analysed using thematic content analysis. Interviews revealed the different attitudes adopted by older adults and their informal caregivers in relation to the treatment information provided by healthcare professionals. A variety of beliefs were identified and linked to medication adherence by examining daily medication practices. Polypharmacy was experienced as a habit but also an obligation, highlighting some of the strategies and negotiations underlying medication use at home. Collecting viewpoints from multiple stakeholders is an innovative way of accessing and analysing beliefs about polypharmacy. Daily medication practices provided information about medication beliefs and may contribute to developing targeted professional interventions that improve medication adherence.

Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis.

This study explored and compared the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge. We used a cross-sectional registry of geriatric patients' hospital records from a multi-site public hospital center in Switzerland. The analysis included all inpatients aged 65 years old or more admitted between 1 January 2015 and 31 December 2017 (n = 53,690), of whom 67.5% were polymedicated at hospital discharge, 52.1% were women (n = 18,909), and 42.7% were 75-84 years old (n = 15,485). On average, the polymedicated patients' hospital lengths of stay were six days longer, they presented with more than three comorbidities, and they were prescribed more than nine medications at hospital discharge (p < 0.001). They showed more frequent general mobility decline (43.2% vs. 41.9%), gait disorders (46.2% vs. 43%), fatigue (48.6% vs. 43.4%) and dependence on lower-body care (49.7% vs. 47.6%), and presented a higher malnutrition risk (OR = 1.411; 95%CI 1.263-1.577; p < 0.001). However, the non-polymedicated inpatients had proportionally more physical and cognitive impairments. The comparison of the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge is important for clinicians trying to identify and monitor those who are most vulnerable to functional decline, and to design targeted strategies for the prevention of functional impairment and related adverse health outcomes.

General Practitioners' Perceptions of the Use of Wearable Electronic Health Monitoring Devices: Qualitative Analysis of Risks and Benefits.

BACKGROUND: The rapid diffusion of wearable electronic health monitoring devices (wearable devices or wearables) among lay populations shows that self-tracking and self-monitoring are pervasively expanding, while influencing health-related practices. General practitioners are confronted with this phenomenon, since they often are the expert-voice that patients will seek. OBJECTIVE: This article aims to explore general practitioners' perceptions of the role of wearable devices in family medicine and of their benefits, risks, and challenges associated with their use. It also explores their perceptions of the future development of these devices. METHODS: Data were collected during a medical conference among 19 Swiss general practitioners through mind maps. Maps were first sketched at the conference and their content was later compared with notes and reports written during the conference, which allowed for further integration of information. This tool represents an innovative methodology in qualitative research that allows for time-efficient data collection and data analysis. RESULTS: Data analysis highlighted that wearable devices were described as user-friendly, adaptable devices that could enable performance monitoring and support medical research. Benefits included support for patients' empowerment and education, behavior change facilitation, better awareness of personal medical history and body functioning, efficient information transmission, and connection with the patient's medical network; however, general practitioners were concerned by a lack of scientific validation, lack of clarity over data protection, and the risk of stakeholder-associated financial interests. Other perceived risks included the promotion of an overly medicalized health culture and the risk of supporting patients' self-diagnosis and self-medication. General practitioners also feared increased pressure on their workload and a compromised doctor-patient relationship. Finally, they raised important questions that can guide wearables' future design and development, highlighting a need for general practitioners and medical professionals to be involved in the process. CONCLUSIONS: Wearables play an increasingly central role in daily health-related practices, and general practitioners expressed a desire to become more involved in the development of such technologies. Described as useful information providers, wearables were generally positively perceived and did not seem to pose a threat to the doctor-patient relationship. However, general practitioners expressed their concern that wearables may fuel a self-monitoring logic, to the detriment of patients' autonomy and overall well-being. While wearables can contribute to health promotion, it is crucial to clarify the logic underpinning the design of such devices. Through the analysis of group discussions, this study contributes to the existing literature by presenting general practitioners' perceptions of wearable devices. This paper provides insight on general practitioners' perception to be considered in the context of product development and marketing.

Embodying health behaviours in everyday life: the social and gendered practices of female senior managers.

Objective: This article extends current theorising around health behaviours using insights from a study with women working in senior management positions in Switzerland. The study aimed to explore the meanings they attached to their everyday activities and examine implications for health and wellbeing by drawing on 1) social practices theory, 2) a socio-constructionist approach to gender, and 3) conceptualisations of embodiment.Design: Twenty female senior managers were interviewed at two time points six months apart: the first interview elicited highly-detailed, descriptive accounts of activities during the previous day, while in the second interview participants reflected on their previous accounts and discussed the meanings they ascribed to their activities. A thematic and narrative analysis of both sets of transcripts was conducted.Results: Three main themes captured the ways female senior managers talked about their everyday behaviours, all focused around their bodies: 'Functional bodies: Being on-the-go and meeting responsibilities'; 'Limiting bodies: Threats to everyday activities'; and 'Intentional bodies: Activities for wellbeing'.Conclusions: Results are considered in terms of contemporary postfeminist/neoliberal discourses in Western societies, how these are shaping and affecting everyday practices and subjectivities, and their consequences for women's health and wellbeing at work.

The rapid expansion of (mainstream) health psychology in France: Historical foundations.

This article traces the historical evolution of ongoing theoretical debates in psychology in France from the 1940s until today. Its aim is to show how the conjunction of certain conditions led to a rapid expansion of American-derived mainstream health psychology during the 1980s. The authors describe the French context in the post-World War II period and outline the implementation of 'clinical psychology in health settings' in the 1950s, under the influence of Daniel Lagache. The strong critiques of the new psychology profession in the 1950s, 1960s and 1970s are examined. Our conclusion reflects upon future implications of ongoing rivalries between different approaches to psychology.

Eficacia e impacto económico del bisturí armónico Focus frente al dispositivo ACS-14C en la tiroidectomía total por bocio multinodular. Estudio prospectivo aleatorizado / Efficacy and budget impact of the Focus harmonic scalpel compared to the ACS-14C device in total thyroidectomy due to multinodular goitre. A prospective randomised study

OBJETIVO: El bisturí armónico ha mejorado la cirugía tiroidea, cuando se compara con cirugía convencional, en términos de reducción del tiempo quirúrgico, número de ligaduras, dolor postoperatorio y uso de drenajes. Analizamos las posibles ventajas en reducción de tiempo quirúrgico y ahorro de recursos del terminal Focus en comparación con el terminal ACS-14C en la cirugía tiroidea benigna. MÉTODOS: Estudio ciego, prospectivo y aleatorizado realizado desde 2009 hasta 2010.Se compararon los resultados del ACS-14C (grupo I ) con Focus (grupo II ) en pacientes con bocio multinodular operados de tiroidectomía total. Se incluyó a pacientes entre 18 y 80 años que aceptaron participar en el estudio sin cirugía cervical previa, lesión del nervio recurrente laríngeo, tratamiento analgésico crónico, coagulopatía o problemas cognitivos. La variable principal fue el tiempo quirúrgico. Otras variables secundarias fueron: tiempo de uso del dispositivo durante el procedimiento, número de ligaduras, pérdida hemática, hipocalcemia, lesión del nervio recurrente faríngeo, dolor postoperatorio y análisis de calidad de vida. RESULTADOS: Se incluyó a 54 pacientes, 26 en el grupo I y 28 en el grupo II . En el grupo de Focus hubo una reducción del tiempo quirúrgico de 16% (78,7 ± 22,01 vs. 66 ± 17,0 min; p < 0,05), del número de ligaduras (0,3 ± 0,8 vs. 2,9 ± 3,6; p < 0,05) y un ahorro adicional de 179,74 € por procedimiento. Focus se utilizó más tiempo que ACE-14S tanto en valor absoluto (26,0+-7,7 vs. 10,0+-3,5 min; p < 0.05) como en valor relativo (40,7+-11,8 vs. 13,1+-4,1%; p < 0,05). CONCLUSIONES: Focus mejora el tiempo operatorio en la tiroidectomía, causando impacto positivo sobre el presupuesto. Su mayor utilización hace que sea una herramienta más coste-eficaz que el terminal ACS-14C

OBJECTIVE: To analyse the potential advantages and outcomes of the new Harmonic Focus™ (Focus) device compared to the Harmonic Scalpel™ ACS-14C in benign thyroid surgery. METHODS: A controlled randomised study was conducted in which the Focus was compared to former ACS-14C device in patients undergoing total thyroidectomy for multinodular goitre. The primary endpoint was time of surgery. The secondary endpoints were time of use of the device, number of ligatures, blood loss, hypocalcaemia, laryngeal nerve impairment, postoperative pain and quality of life. RESULTS: Two groups of patients were included, 26 patients in group I (ACS-14C) and 28 in group II (Focus). There was a 16% reduction in surgical time (78.7 ± 22.01 vs. 66 ± 17.0 min; P < .05) between group I and II respectively. The Focus was used longer than ACE-14S, both in absolute time (26.0 ± 7.7 vs. 10.0 ± 3.5 minutes; P < .05), as well as in relative time (40.7 ± 11.8% vs. 13.1 ± 4.1%; P < .05), respectively. A significant reduction in number of ligatures in Focus patients was also observed (0,3 ± 0,8 vs. 2.9 ± 3.6; P < .05).Budget impact analysis showed an additional average savings per procedure of 179.74 €. CONCLUSIONS: Focus ergonomics significantly improved the operation time in thyroidectomy causing a positive impact on the budget.Focus also adds further benefits to those previously achieved by Harmonic technology, and it is by itself more cost-effective in total thyroidectomy than ACS-14C

[Efficacy and budget impact of the Focus harmonic scalpel compared to the ACS-14C device in total thyroidectomy due to multinodular goitre. A prospective randomised study]. / Eficacia e impacto económico del bisturí armónico Focus frente al dispositivo ACS-14C en la tiroidectomía total por bocio multinodular. Estudio prospectivo aleatorizado.

OBJECTIVE: To analyse the potential advantages and outcomes of the new Harmonic Focus™ (Focus) device compared to the Harmonic Scalpel™ ACS-14C in benign thyroid surgery. METHODS: A controlled randomised study was conducted in which the Focus was compared to former ACS-14C device in patients undergoing total thyroidectomy for multinodular goitre. The primary endpoint was time of surgery. The secondary endpoints were time of use of the device, number of ligatures, blood loss, hypocalcaemia, laryngeal nerve impairment, postoperative pain and quality of life. RESULTS: Two groups of patients were included, 26 patients in group i (ACS-14C) and 28 in group ii (Focus). There was a 16% reduction in surgical time (78.7 ± 22.01 vs. 66 ± 17.0 min; P<.05) between group i and ii respectively. The Focus was used longer than ACE-14S, both in absolute time (26.0 ± 7.7 vs. 10.0 ± 3.5 minutes; P<.05), as well as in relative time (40.7 ± 11.8% vs. 13.1 ± 4.1%; P<.05), respectively. A significant reduction in number of ligatures in Focus patients was also observed (0,3 ± 0,8 vs. 2.9 ± 3.6; P<.05). Budget impact analysis showed an additional average savings per procedure of 179.74 €. CONCLUSIONS: Focus ergonomics significantly improved the operation time in thyroidectomy causing a positive impact on the budget. Focus also adds further benefits to those previously achieved by Harmonic technology, and it is by itself more cost-effective in total thyroidectomy than ACS-14C.

Low-frequency transcranial magnetic stimulation in patients with fibromyalgia and major depression.

OBJECTIVE: To study the efficacy of low-frequency transcranial magnetic stimulation in patients with fibromyalgia and major depression. DESIGN: Twenty-eight patients were randomly assigned to receive 20 sessions of real or sham transcranial magnetic stimulation of the right dorsolateral prefrontal cortex. The main stimulation parameters were 15 trains at 110% of the motor threshold for 60 seconds at a frequency of 1 Hz. Blinded external evaluators administered the fibromyalgia scales (FibroFatigue, Likert pain) and the depression scales (Hamilton Depression Rating Scale, Clinical Global Impression) during the study. RESULTS: Both treatment groups (real and sham) improved their scores in some of the scales (FibroFatigue and Clinical Global Impression), although there were no differences between them. No improvements were observed in the Likert Pain Scale in either of the groups. CONCLUSION: With the methodology used in this study, patients with fibromyalgia and major depression who received real magnetic stimulation did not present significant differences in symptoms with respect to those who received sham magnetic stimulation.