Grief elaboration of a patient with a diagnosis of advanced colon adenocarcinoma: a case study

Objective: The term grief, from the French term grever, which means “to burden, to oppress”, can be deined as the process through which a person must go due to the loss of a loved one. We present a case of grief elaboration in a patient and his family that face a terminal illness. Clinical case: The patient is a 51-year-old man diagnosed with stage T4a N2b M1 colon adenocarcinoma. He came to the Department of Psycho-Oncology presenting depressive symptoms, marital and family issues associated with a medical condition, and work related issues. Conclusions: The patient was diagnosed with a secondary major depressive disorder episode in reaction to his medical condition. He was prescribed anti-depressive treatment, and family psychotherapy was recommended for grief elaboration

SARS-CoV-2 Neutralizing Antibodies in Mexican Population: A Five Vaccine Comparison

Neutralizing antibodies (NAs) are key immunological markers and are part of the humoral response of the adaptive immune system. NA assays determine the presence of functional antibodies to prevent SARS-CoV-2 infection. We performed a real-world evidence study to detect NAs that confer protection against SARS-CoV-2 after the application of five vaccines (Pfizer/BioNTech, AstraZeneca, Sinovac, Moderna, and CanSino) in the Mexican population. Side effects of COVID-19 vaccines and clinical and demographic factors associated with low immunogenicity were also evaluated. A total of 242 SARS-CoV-2-vaccinated subjects were recruited. Pfizer/BioNTech and Moderna proved the highest percentage of inhibition in a mono-vaccine scheme. Muscular pain, headache, and fatigue were the most common adverse events. None of the patients reported severe adverse events. We found an estimated contagion-free time of 207 (IQR: 182–231) and 187 (IQR: 184–189) days for Pfizer/BioNTech and CanSino in 12 cases in each group. On the basis of our results, we consider that the emerging vaccination strategy in Mexico is effective and safe

Challenges in genetic counseling in hereditary cancer syndromes in a Mexican oncologic center

Background: In Mexico, hereditary cancer is underdiagnosed, medical geneticists give genetic counseling, but the access is limited due to the socio-economic characteristics of the population. The CUCC (Centro Universitario Contra el Cáncer) Early Cancer Detection Clinic (CECIL) created a model in which patients without cancer are enrolled in a prevention cancer screening program. Methods: From 2016 to 2021, 3014 patients were enrolled in the prevention program. Patients were evaluated with a hereditary cancer risk survey before a consultation. Those with at least one familial hereditary risk positive answer were assessed in a consultation. We also included patients with cancer diagnoses referred by oncologists of the CUCC. Those who fulfill hereditary cancer criteria were referred for genetic testing. Results: A total of 1119 subjects were evaluated. Of these, 248 (21%) were candidates for genetic testing, only 149 (60%) could be analyzed, 52 probands (59%) and 32 relatives (51%) had at least one variant. Among the probands: 33 had HBOC (Hereditary Breast and Ovarian Cancer syndrome), 7 had Lynch, 1 LFS (Li-Fraumeni syndrome), 1 LFLS (Li-Fraumeni like syndrome), 1 FAP (Familial Adenomatous Polyposis), and 9 had benign variants. In the relative\u27s group: 17 had Lynch, 10 HBOC, 1 LFS, and 4 FAP. To date, 3 patients under surveillance had an in situlesions (1 endometrial and two colon), and 3 more had a premalignant colon lesion, one in the not tested group. To achieve the genetic test cost for the probands, 50% had partial sponsors, 31% paid for their tests, research projects were supported by 13%, and 4.5% were donations. Among relatives, 94.4% paid for the tests, and 5.5% were supported by research. All relatives were tested using an in-house low-cost test. Conclusion: The model\u27s success made awareness of these diseases, leading last year to the formation of a state detection program, including all public and private health institutions attending to patients with cancer, these patients are referred to CECIL. We found an effective way to find support low-cost genetic testing via foundations

Cross-Validation of the Spanish HP-Version of the Jefferson Scale of Empathy Confirmed with Some Cross-Cultural Differences

Context: Medical educators agree that empathy is essential for physicians’ professionalism. The Health Professional Version of the Jefferson Scale of Empathy (JSE-HP) was developed in response to a need for a psychometrically sound instrument to measure empathy in the context of patient care. Although extensive support for its validity and reliability is available, the authors recognize the necessity to examine psychometrics of the JSE-HP in different socio-cultural contexts to assure the psychometric soundness of this instrument. The first aim of this study was to confirm its psychometric properties in the cross-cultural context of Spain and Latin American countries. The second aim was to measure the influence of social and cultural factors on the development of medical empathy in health practitioners.Methods: The original English version of the JSE-HP was translated into International Spanish using back-translation procedures. The Spanish version of the JSE-HP was administered to 896 physicians from Spain and thirteen Latin American countries. Data were subjected to exploratory factor analysis using principal component analysis with oblique rotation (promax) to allow for correlation among the resulting factors, followed by a second analysis, using confirmatory factor analysis. Two theoretical models, one based on the English JSE-HP and another on the first Spanish student version of the JSE (JSE-S), were tested. Demographic variables were compared using group comparisons.Results: A total of 715 (80%) surveys were returned fully completed. Cronbach’s alpha coefficient of the JSE for the entire sample was 0.84. The psychometric properties of the Spanish JSE-HP matched those of the original English JSE-HP. However, the Spanish JSE-S model proved more appropriate than the original English model for the sample in this study. Group comparisons among physicians classified by gender, medical specialties, cultural and cross-cultural backgrounds yielded statistically significant differences (p<0.001). Conclusions: The findings support the underlying factor structure of the Jefferson Scale of Empathy. The results reveal the importance of culture in the development of medical empathy. The cross-cultural differences described could open gates for further lines of medical education research

Cross-validation of the Spanish HP-Version of the Jefferson Scale of Empathy confirmed with some cross-cultural differences

Context: Medical educators agree that empathy is essential for physicians’ professionalism. The Health Professional Version of the Jefferson Scale of Empathy (JSE-HP) was developed in response to a need for a psychometrically sound instrument to measure empathy in the context of patient care. Although extensive support for its validity and reliability is available, the authors recognize the necessity to examine psychometrics of the JSE-HP in different socio-cultural contexts to assure the psychometric soundness of this instrument. The first aim of this study was to confirm its psychometric properties in the cross-cultural context of Spain and Latin American countries. The second aim was to measure the influence of social and cultural factors on the development of medical empathy in health practitioners.Methods: The original English version of the JSE-HP was translated into International Spanish using back-translation procedures. The Spanish version of the JSE-HP was administered to 896 physicians from Spain and thirteen Latin American countries. Data were subjected to exploratory factor analysis using principal component analysis with oblique rotation (promax) to allow for correlation among the resulting factors, followed by a second analysis, using confirmatory factor analysis. Two theoretical models, one based on the English JSE-HP and another on the first Spanish student version of the JSE (JSE-S), were tested. Demographic variables were compared using group comparisons.Results: A total of 715 (80%) surveys were returned fully completed. Cronbach’s alpha coefficient of the JSE for the entire sample was 0.84. The psychometric properties of the Spanish JSE-HP matched those of the original English JSE-HP. However, the Spanish JSE-S model proved more appropriate than the original English model for the sample in this study. Group comparisons among physicians classified by gender, medical specialties, cultural and cross-cultural backgrounds yielded statistically significant differences (p<0.001). Conclusions: The findings support the underlying factor structure of the Jefferson Scale of Empathy. The results reveal the importance of culture in the development of medical empathy. The cross-cultural differences described could open gates for further lines of medical education research

Identification of Germline Variants in Patients with Hereditary Cancer Syndromes in Northeast Mexico

Hereditary cancer syndromes (HCS) are genetic diseases with an increased risk of developing cancer. This research describes the implementation of a cancer prevention model, genetic counseling, and germline variants testing in an oncologic center in Mexico. A total of 315 patients received genetic counseling, genetic testing was offered, and 205 individuals were tested for HCS. In 6 years, 131 (63.90%) probands and 74 (36.09%) relatives were tested. Among the probands, we found that 85 (63.9%) had at least one germline variant. We identified founder mutations in BRCA1 and a novel variant in APC that led to the creation of an in-house detection process for the whole family. The most frequent syndrome was hereditary breast and ovarian cancer syndrome (HBOC) (41 cases with BRCA1 germline variants in most of the cases), followed by eight cases of hereditary non-polyposic cancer syndrome (HNPCC or Lynch syndrome) (with MLH1 as the primarily responsible gene), and other high cancer risk syndromes. Genetic counseling in HCS is still a global challenge. Multigene panels are an essential tool to detect the variants frequency. Our program has a high detection rate of probands with HCS and pathogenic variants (40%), compared with other reports that detect 10% in other populations

Identification of Germline Variants in Patients with Hereditary Cancer Syndromes in Northeast Mexico

Hereditary cancer syndromes (HCS) are genetic diseases with an increased risk of developing cancer. This research describes the implementation of a cancer prevention model, genetic counseling, and germline variants testing in an oncologic center in Mexico. A total of 315 patients received genetic counseling, genetic testing was offered, and 205 individuals were tested for HCS. In 6 years, 131 (63.90%) probands and 74 (36.09%) relatives were tested. Among the probands, we found that 85 (63.9%) had at least one germline variant. We identified founder mutations in BRCA1 and a novel variant in APC that led to the creation of an in-house detection process for the whole family. The most frequent syndrome was hereditary breast and ovarian cancer syndrome (HBOC) (41 cases with BRCA1 germline variants in most of the cases), followed by eight cases of hereditary non-polyposic cancer syndrome (HNPCC or Lynch syndrome) (with MLH1 as the primarily responsible gene), and other high cancer risk syndromes. Genetic counseling in HCS is still a global challenge. Multigene panels are an essential tool to detect the variants frequency. Our program has a high detection rate of probands with HCS and pathogenic variants (40%), compared with other reports that detect 10% in other populations

Empatía, habilidades de colaboración interprofesional y aprendizaje médico permanente en residentes españoles y latinoamericanos que inician los programas de formación médica especializada en España. Resultados preliminares

Objetivo: Identificar similitudes y diferencias en la empatía, en las habilidades de trabajo colaborativo interprofesional, y en las habilidades de aprendizaje médico permanente entre médicos residentes españoles y latinoamericanos que inician su formación especializada en hospitales docentes españoles. Diseño: Estudio observacional mediante encuesta. Emplazamiento: Cinco hospitales docentes de la provincia de Barcelona, España. Participantes: Médicos residentes, españoles y latinoamericanos, que inician el primer año de los programas de formación médica especializada. Mediciones principales: La empatía mediante la escala Jefferson de empatía médica. La colaboración interprofesional mediante la escala Jefferson de actitud hacia el trabajo colaborativo en equipos medicina-enfermería. El aprendizaje mediante la escala Jefferson de aprendizaje médico permanente. Resultados: En una muestra de 156 residentes, 110 españoles y 40 latinoamericanos, los españoles mostraron una mayor orientación empática que los latinoamericanos (p < 0,05). Por su parte, los extranjeros mostraron puntuaciones más altas en habilidades de aprendizaje médico permanente respecto a sus pares españoles (p < 0,001). En todo el grupo se observó una relación positiva entre la empatía y el trabajo colaborativo (r = +0,47; p < 0,001). Una asociación similar se observó en el grupo de latinoamericanos, entre las habilidades de aprendizaje y las de trabajo colaborativo (r = +0,34; p < 0,05). Conclusiones: Los resultados confirman observaciones preliminares y ponen en evidencia la asociación positiva que existe entre la empatía y las habilidades de trabajo colaborativo interprofesional. En médicos latinoamericanos que inician su formación en hospitales españoles, el mayor desarrollo de las habilidades de aprendizaje médico permanente parece influir positivamente en el desarrollo de otras competencias de interés profesional

Empatía, habilidades de colaboración interprofesional y aprendizaje médico permanente en residentes españoles y latinoamericanos que inician los programas de formación médica especializada en España. Resultados preliminares = Medical empathy of physicians-in-training who are enrolled in professional training programs. A comparative intercultural study in Spain

Objective: To characterise some of the environmental factors that are sensitive to cultural influence, and are involved in the development of medical empathy in Spanish and Latin American physicians-in-training. Design: Cross-sectional study using questionnaires. Setting: Primary care and specialized medicine centres of the Healthcare System of La Rioja, Logroño, Spain. Participants: Physicians-in-training. Main measurements:: Empathy was measured using the Jefferson Scale of Physician Empathy, version for healthcare professionals (JSE-HP). Socio-demographic, academic, and professional background information was collected. Results: A total of 104 residents (67 from Spain and 32 from Latin America) answered and returned the questionnairess. The JSE-HP showed adequate psychometric properties. The empathy mean score of Spanish group was higher than that of the Latin American group (P=.01). Differences in the development of empathy were associated with: the development of professional models (P<.001), the positive encounter with other professionals (P=.001), and with a continuing medical education (P=.008). Conclusions: Some factors involved in the development of empathy that are sensitive to cultural influence have been characterised. The development of future research areas is suggested. © 2015 Elsevier España, S.L.U