Autonomy with responsibility ¿Is informed consent just a signature on a paper? Evaluation in patients who underwent spine's surgery.

PURPOSE: To evaluate the information that patients undergoing spine surgery truly receive and assimilate when they sign their informed consent documents. METHODS: This was a retrospective study on patients who underwent spine arthrodesis or spine discectomy. Patients were given a full explanation of the surgical technique to be employed and its potential risks before they were included on the surgical waiting list. Before surgery, they were asked to sign an informed consent form. The studied variables included whether patients read the informed consent form, whether they recalled the surgical technique used or the spinal segment operated, whether they were aware of the surgical risks involved, and if they had looked for information about their procedure elsewhere. Answers were analyzed by age and educational level. RESULTS: Of a total of 458 total patients, only 51.9% answered all the questions. Sixty-three percent of patients said they had read the informed consent document before surgery. Although 91.6% of patients were aware of the spine segment operated, only 73.5% remembered the surgical technique employed. A total of 63.9% of patients could recall the vertebral levels operated. 39.1% were not aware of the surgical risks involved, and only 16.0% of patients admitted having looked for additional information. A statistically significant correlation was found between the search for additional information and young age (p < 0.001) on the one hand, and high educational level on the other (p = 0.023). CONCLUSION: Even though obtaining informed consent is an important procedure before spinal surgery, almost 40% of the patients in this study underwent surgery without reading the informed consent document or being aware of the risks posed by the procedure.

Primary Cardiac Triple-Hit Lymphoma.

Cardiac double-hit and triple-hit lymphomas (DHLs, THLs) are rare; in fact, studies examining both DHL and THL remain scarce. THL with cardiac involvement constitutes a rare disease with few cases reported so far. Thus, in this study, we report the case of a 67-year-old woman who presented with initial symptoms of pulmonary embolism. Upon further evaluation, a right atrial mass was detected incidentally, and this was surgically removed under the assumption of a cardiac myxoma. Later, immunohistochemistry analysis of the mass revealed a THL. Aggressive treatment with chemotherapy was necessary; however, the patient refused treatment and had a poor prognosis.

Islands in the desert for cavity-nesting bees and wasps: Ecology, patterns of diversity, and conservation at oases of Baja California Peninsula.

AIMS: The oases of Baja California Peninsula (BCP) have been proposed as important hotspots of biodiversity that hold an exceptional richness in the middle of desert conditions. We tested the effect of habitat and anthropogenic disturbance on communities of cavity-nesting taxa, with specific emphasis on bees, wasps, and their natural enemies. METHODS: In oases of BCP and desert neighbor environments, trap-nesting taxa were evaluated in response to factors affecting the nest abundance, richness, and community structure. We used statistical models to find correlates of nest abundance and patterns of diversity, as well as ecological analyses to determine the effect of habitat and human disturbance on species diversity and community structure. RESULTS: Solar irradiation, distance to a perennial waterbody and relative humidity influenced the presence of nests, number of brood cells, and parasitism. In general, abundance, species richness, and parasitism were higher in oases, especially in those with less human disturbance. Bees did not discriminate between oases and deserts to nest, whereas mud-daubing wasps were more dependent of oases. The degree of anthropogenic disturbance did not affect the occurrence of parasitism, but it had an adverse effect on the parasitism intensity (number of attacked cells). The community structure was more complex and even in oases and low-disturbed sites. The similarity between sites did not exceed 30%, and the proportion of shared species between oases and deserts varied from 2.7% to 26.6%. MAIN CONCLUSIONS: The oases of Baja California are functioning as mesic islands in the desert, each oasis hosting a unique community of cavity-nesting taxa. About 65% of the nests and 50% of species occurred exclusively in the oasis. Thus, cavity-nesting species that depend on mesic conditions could be threatened if the oases of BCP disappear in the future. Local conditions in the oases and deserts of the BCP are shaping the community structure. However, large-scale factors such as climate can influence the seasonality and occurrence of species within the community of cavity-nesting dwellers. Since habitat loss and fragmentation can degrade the oases' functionality, strategies to maintain the ecosystem services of pollination and biological control should be included in the conservation programs of these fragile habitats.

Implications of Vitamin D in Multiple Sclerosis and Other Neurodegenerative Processes: Bibliometric Analysis and Systematic Review.

In recent years, numerous investigations focused on the pleiotropic actions of vitamin D have been carried out. These actions include the participation of this molecule in neurophysiological and neuropathological processes. As a consequence, abundant scientific literature on the role of this vitamin in neurodegenerative entities has emerged, even concerning clinical studies. To identify the level of scientific evidence concerning the relation between vitamin D and neurodegenerative diseases, from a quantitative and qualitative perspective. To describe, by means of a bibliometric analysis, the scientific production and its evolution through time in quantitative terms, regarding the implications of vitamin D in neurodegeneration. To analyse and present the degree of evidence in the aforementioned field of study, a systematic review of the literature focused on the most prevalent neurodegenerative diseases was carried out. We retrieved 848 articles in the bibliometric analysis, the majority of which were dated between the years 2010-2017. The most studied metabolite was the 25(OH)D3 and the most cited disease was multiple sclerosis. In the systematic review, we found studies about Alzheimer's and Parkinson's diseases and again, about multiple sclerosis prominently (in number and quality), with 12 randomised double-blind clinical trials. The research about vitamin D and its relations with neurodegenerative diseases shows a growing evolution over the last decade. More studies are needed to find correlations between the clinical severity of these diseases and the specific status of vitamin D and the genotypes related with them, which seems to be a future trend.

Intraoperative stress and anxiety reduction with music therapy: a controlled randomized clinical trial of efficacy and safety.

OBJECTIVE: The purpose of this study was to investigate the music therapy (MT) effect in levels of intraoperative anxiety in patients undergoing crossectomy with stripping of the great saphenous vein and to assess the efficacy, safety, and feasibility of this alternative therapy as a complement of standard intraoperative care. MATERIAL AND METHODS: The study is a simple blind, controlled, parallel groups, prospective randomized clinical trial. Patients were allocated by means of randomized controlled sampling. The study was performed in the surgery room of Getafe University Hospital in Madrid. The study was carried out in 40 patients, 20 randomized to the experimental group and 20 randomized to the control group, with an age range from 27 to 70 years. The control group was given intraoperative routine attention, and the experimental group was given an MT passive intervention that consisted of audition of musical fragments during varicose veins surgery. These pieces previously showed relaxing actions on the cardiovascular system. The anxiety levels were measured by means of pre- and postsurgical questionnaires by a blinded investigator for the study arm to which the patients had been randomized. Heart rate and systolic and diastolic blood pressures were determined during the intervention, and adrenaline and noradrenaline plasma levels were determined before and after the surgical procedure. RESULTS: The majority of the patients in the MT group (95%) and standard care group (90%) completed the study. There were no statistical differences between the control and experimental groups in heart rate gradient or systolic and diastolic blood pressures measured after the intervention. The anxiety state and the stress feeling scale score after surgery were significantly inferior in the MT group (94.7% vs 57.9% decrease in anxiety levels, P < .05, and stress score of 1.31 vs 2.36, P < .05, respectively). The adverse events ratio was low and occurred with similar frequency in both groups. CONCLUSIONS: The MT intervention was easily implemented in the context of nursing care received during varicose vein surgery and was positively accepted and valued by the majority of the patients. MT is a safe procedure that is proved to reduce anxiety and stress in the study patients.

[Burnout syndrome of health workers in an assisted residence for the elderly]. / Síndrome de burnout en el personal sanitario de UNA residencia asistida de mayores.

OBJECTIVES: to estimate the prevalence of Burnout Syndrome and the sleep patterns alterations experienced by health workers who work in an Assisted Residence for the Elderly. MATERIAL AND METHODS: descriptive and cross-sectional research using the Maslach Burnout Inventory and the Sleepiness Epworth scales in a self questionnaire that was aimed to 150 employees at the institution. We used descriptive and inferential statistics with a 95% confidence interval. The relationship between categorical variables was carried out using the non-parametric Mann-Whitney test. RESULTS AND CONCLUSIONS: response rate of 92% (138) on the total respondents (150). The burnout prevalence rate is located at 21.7% with a high percentage of workers with low personal fulfillment (64.1%). There is also a slight tendency to suffer from daytime sleepiness in general. It is worth highlighting musculoskeletal problems as the main physiological conditions in relation to the type of work (70.3%), being coffee as the most consumed substance of those polled. High level prevalence of burnout syndrome in the population studied, especially among the nursing staff and the need to develop interventions to reduce them.

Síndrome de Burnout en el personal sanitario de una residencia asistida de mayores / Burnout síndrome of health workers in an assisted residence for the elderly

Objetivos: estimar la prevalencia del síndrome de burnout y la alteración en los patrones del sueño que sufren los trabajadores sanitarios de una residencia asistida de ancianos. Material y Métodos: estudio descriptivo de corte transversal utilizando como instrumentos las escalas de Maslach Burnout Inventory y de somnolencia de Epworth en un cuestionario autoadministrado dirigido a 150 trabajadores sanitarios del centro. Se utilizó estadística descriptiva e inferencial con un intervalo de confianza del 95%. La relación entre variables categóricas se realizó mediante la prueba no paramétrica de Mann-Whitney. Resultados y Conclusiones: del total de encuestados (150) se obtuvo una respuesta del 92% (138). El índice de prevalencia de burnout se sitúa en un 21,7% donde destaca el alto porcentaje de trabajadores con baja realización personal (64,1%). También se observa una ligera tendencia general a padecer somnolencia diurna. Destacan los problemas osteomusculares como principal alteración fisiológica en relación con el tipo de trabajo (70,3%), siendo el café la sustancia más consumida por los encuestados. Alta prevalencia del síndrome de burnout en la población estudiada, sobre todo entre el colectivo enfermero, y la necesidad de elaborar intervenciones orientadas a su reducción(AU)

Objective: to estimate the prevalence of Burnout Syndrome and the sleep patterns alterations experience by health workers who work in an Assisted Residence fot the Elderly. Material and Methods: descriptive and cross-sectional research using the Maslach Burnout Inventory and the Sleepiness Epworth scales in a self questionnaire tha was aimed to 150 employees at the institution. We used descriptive and inferential ween categorical variables was carried out using the non-parametric Mann-Whitney test. Results and Conclusions: response rate of 92% (138) on the total respondents (150). The burnout prevalence rate is located at 21.7% with a high percentage of workers with low personal fulfillment (64.1%). There is also a slight tendency to suffer from daytime sleepiness in general. It is worth highlighting musculoskeletal problems as the main physiological conditions in relation to the type of work (70.3%), being coffee as the most consumed substance of those polled. High level prevalence of burnout syndrome in the population studied, especially among the nursing staff, and the need to develop interventions to reduce them(AU)

Paciente anciano portador de marcapasos: características y evolución en función del tipo de dispositivo empleado / Pacemakers in the elderly. Characteristics and outcomes according to the type of device used

Objetivo: describir las características de un grupo de pacientes ancianos portadores de marcapasos, en términos de evolución clínica, funcional y mortalidad en los 4 años posteriores a la implantación en función del tipo de dispositivo implantado. Material y métodos: estudio retrospectivo de mayores de 75 años a los que se había implantado un marcapasos mediante revisión de las historias clínicas. Evaluación de antecedentes personales, medicación empleada, presentación clínica y electrocardiográfica, situación funcional (escalas de Cruz Roja Física [CRF] y Cruz Roja Mental [CRM]) y complicaciones. Se realizó una entrevista telefónica, 4 años después de la implantación del marcapasos, con datos funcionales, morbilidad y mortalidad. En el análisis estadístico se compararon las medias y proporciones y se realizó una regresión logística con un intervalo de confianza (IC) del 95% (p 0,05). La situación física y cognitiva al final del estudio no mostró diferencias significativas entre ambos grupos. Fallecieron 47 pacientes (37,6% de 125 casos). La mortalidad en el grupo de pacientes con dispositivo de doble cámara fue inferior a la del grupo con unicameral (p < 0,01), pero estos pacientes eran también más jóvenes (p < 0,01); esta diferencia se mantuvo en el análisis de regresión logística. Conclusiones: en los ancianos de esta muestra, con síncope y bloqueo auriculoventricular de alto grado, se eligió un marcapasos unicameral con mayor frecuencia. Los bicamerales asociaron a una menor mortalidad y a menos eventos cardiovasculares en el seguimiento, aunque sin diferencias estadísticamente significativas

Objective: the objectives of this study were two-fold: a) to describe the characteristics of a group of elderly patients with pacemakers, and b) to evaluate clinical and functional outcomes and mortality in these patients according to the type of device implanted during a 4-year follow-up. Material and methods: retrospective study of patients over 75 with a pacemaker performed through a review of medical records. Previous diseases, medications, clinical and electrocardiographic findings, and functional data (the functional and mental evaluation scales of the Spanish Red Cross [CRF, CRM]), were evaluated. To gather data on functional outcomes, morbidity and mortality, telephone interviews were conducted 4 years after pacemaker implantation. Statistical analysis consisted of comparison of means and proportions and logistic regression analysis with 95% confidence intervals (p.05). Functional and cognitive status at the end of the study showed no statistically significant differences between the two groups. Of 125 patients, 47 (37.6%) died. Mortality was lower in patients with dual-chamber devices than in the single-chamber group (P<.01) but patients in the former group were younger (P<.01). This difference was maintained in the logistic regression analysis. Conclusions: In our sample of elderly patients with syncope and high-grade atrioventricular blockade, there was a tendency to implant single-chamber pacemakers. Dual-chamber devices were associated with lower mortality and fewer cardiovascular events during follow-up, although no statistically significant differences were found