Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol

Background: Health personnel are susceptible to high levels of work stress and burnout due to the psychological and emotional demands of their work, as well as to other aspects related to the organisation of that work. This paper describes the rationale and design of the MINDUUDD study, the aim of which is to evaluate the effectiveness of a mindfulness and self-compassion 4-session programme versus the standard 8-session programme to reduce work stress and burnout in Family and Community Medicine and Nursing tutors and residents. Methods: The MINDUDD study is a multicentre cluster randomised controlled trial with three parallel arms. Six Teaching Units will be randomised to one of the three study groups: 1) Experimental Group-8 (EG8); 2) Experimental Group-4 (EG4) Control group (CG). At least 132 subjects will participate (66 tutors/66 residents), 44 in the EG8, 44 in the EG4, and 44 in the CG. Interventions will be based on the Mindfulness-Based Stress Reduction (MBSR) program, including some self-compassion practices of the Mindful Self-Compassion (MSC) programme. The EG8 intervention will be implemented during 8 weekly face-to-face sessions of 2.5 h each, while the EG4 intervention will consist of 4 sessions of 2.5 h each. The participants will have to practice at home for 30 min/day in the EG8 and 15 min/day in the EG4. The Five Facet Mindfulness Questionnaire (FFMQ), Self-Compassion Scale (SCS), Perceived Stress Questionnaire (PSQ), Maslach Burnout Inventory (MBI), Jefferson Scale of Physician Empathy (JSPE), and Goldberg Anxiety-Depression Scale (GADS) will be administered. Measurements will be taken at baseline, at the end of the programs, and at three months after completion. The effect of the interventions will be evaluated by bivariate and multivariate analyses (Multiple Linear Regression). Discussion: If the abbreviated mindfulness programme is at least as effective as the standard program, its incorporation into the curriculum and training plans will be easier and more appropriate. It will also be more easily applied and accepted by primary care professionals because of the reduced resources and means required for its implementation, and it may also extend beyond care settings to academic and teaching environments as well

A semi-parabolic wake model for large offshore wind farms based on the open source CFD solver OpenFOAM

Wake effect represents one of the main sources of energy loss and uncertainty when designing offshore wind farms. Traditionally analytical models have been used to optimize and estimate power deficits. However these models have shown to underestimate wake effect and consequently overestimate output power [1, 2]. This means that analytical models can be very helpful at optimizing preliminary layouts but not as accurate as needed for an ultimate fine design. Different techniques can be found in the literature to study wind turbine wakes that include simplified kinematic models and more advanced field models, that solve flow equations with different turbulence closure schemes. See the review papers of Crespo et al. [3], Vermeer et al. [4], and Sanderse et al. [5]. Purely elliptic Computational Fluid Dynamics (CFD) models based on the actuator disk technique have been developed during the last years [6–8]. They consider wind turbine rotor as a disk where a distribution of axial forces act over the incoming air. It is a fair approach but it can still be computationally expensive for big wind farms in an operative mode. With this technique still active, an alternative approach inspired on the parabolic wake models [9, 10] is proposed. Wind turbine rotors continue to be represented as actuator disks but now the domain is split into subdomains containing one or more wind turbines. The output of each subdomain is mapped onto the input boundary of the next one until the end of the domain is reached, getting a considerable decrease on computational time, by a factor of order 10. As the model is based on the open source CFD solver OpenFOAM, it can be parallelized to speed-up convergence. The near wake is calculated so no initial wind speed deficit profiles have to be supposed as in totally parabolic models and alternative turbulence models, such as the anisotropic Reynolds Stress Model (RSM) can be used. Traditional problems of elliptic models related to the estimation of the reference wind speed at each rotor position are mitigated due to the semi-parabolic algorithm. The model has been validated at the ECN test farm and at the offshore Horns Rev wind farm with significant results and also have been compared to other wake models

Deep brain stimulation for patients with Parkinson's disease: Effect on caregiver burden

Introduction: Our aim is to assess the burden on caregivers of patients with Parkinson's disease (PD) treated with deep brain stimulation (DBS) compared to those caring for patients at advanced stages and undergoing other treatments. We have also assessed the variables associated with presence of caregiver overload. Material and methods: We included consecutive patients with PD treated with DBS. Our control group included patients in advanced stages of PD undergoing other treatments. Patients were assessed with the following scales: UPDRS-II, UPDRS-III, UPDRS-IV, Hoehn and Yahr, Schwab & England, Barthel, PDQ-39, MoCA, Apathy Evaluation Scale, HADS, and the abbreviated QUIP. Caregiver burden was evaluated with the Zarit caregiver burden interview and their moods were assessed with the HADS scale. Results: We included 11 patients treated with DBS and 11 with other treatments. For patients treated with DBS, we observed a better quality of life according to the PDQ-39 questionnaire (P = .028), and a lower score on the HADS anxiety subscale (P = .010). Caregiver overload was observed in 54.5% of the caregivers of patients in both groups (P = 1.000); Zarit scores were similar (P = .835). Caregiver overload was associated with higher scores on the caregiver's Apathy Evaluation Scale (P = .048) and on the HADS anxiety subscale (P = .006). Conclusion: According to our results, treatment with DBS is not associated with lower caregiver burden. Apathy in patients and anxiety in caregivers are factors associated with the appearance of overload. Resumen: Introducción: Nuestro objetivo es determinar el grado de carga de cuidadores de pacientes con enfermedad de Parkinson (EP) en tratamiento con estimulación cerebral profunda (ECP) con respecto a aquellos en estadios avanzados con otros tratamientos y las variables asociadas a la presencia de sobrecarga. Material y métodos: Se incluyeron de forma consecutiva a pacientes con EP en tratamiento con ECP, utilizando como grupo control a otros con EP en estadío avanzado sin ECP. Los pacientes fueron sometidos a una valoración mediante las escalas UPDRS-II, UPDRS-III, UPDRS-IV, Hoehn y Yahr, Schawb & England, Barthel, PDQ-39, MoCA, Apathy Scale, HADS y la QUIP abreviada. A los cuidadores se les estudió mediante el inventario de sobrecarga de Zarit y de valoración afectiva HADS. Resultados: Se incluyeron 11 pacientes en tratamiento con ECP y 11 con otros tratamientos. En aquellos con ECP se observó una mejor calidad de vida según la escala PDQ-39 (p = 0,028), y una menor puntuación en la subescala HADS para la ansiedad (p = 0,010). Se observó sobrecarga en un 54,5% de los cuidadores de pacientes de ambos grupos (p = 1,000), con una puntuación similar en la escala Zarit (p = 0,835). La presencia de sobrecarga se asoció una mayor puntuación en la escala de apatía (p = 0,048) y en la subescala HADS de ansiedad en el cuidador (p = 0,006). Conclusión: Según los resultados de nuestro estudio el tratamiento con ECP no se relaciona con una menor carga del cuidador, siendo la apatía del paciente y la ansiedad del cuidador factores asociados a su desarrollo. Keywords: Anxiety, Apathy, Burden, Caregiver, Parkinson's disease, Deep brain stimulation, Palabras clave: Ansiedad, Apatía, Carga, Cuidador, Enfermedad de Parkinson, Estimulación cerebral profund

Uso de un sistema extracorpóreo de asistencia circulatoria de flujo continuo, corta duración e inserción quirúrgica como puente a trasplante

Introduction and objectives: We aimed to describe the clinical outcomes of the use of the CentriMag acute circulatory support system as a bridge to emergency heart transplantation (HTx). Methods: We conducted a descriptive analysis of the clinical outcomes of consecutive HTx candidates included in a multicenter retrospective registry who were treated with the CentriMag device, configured either for left ventricular support (LVS) or biventricular support (BVS). All patients were listed for high-priority HTx. The study assessed the period 2010 to 2020 and involved 16 transplant centers around Spain. We excluded patients treated with isolated right ventricular support or venoarterial extracorporeal membrane oxygenation without LVS. The primary endpoint was 1-year post-HTx survival. Results: The study population comprised 213 emergency HTx candidates bridged on CentriMag LVS and 145 on CentriMag BVS. Overall, 303 (84.6%) patients received a transplant and 53 (14.8%) died without having an organ donor during the index hospitalization. Median time on the device was 15 days, with 66 (18.6%) patients being supported for > 30 days. One-year posttransplant survival was 77.6%. Univariable and multivariable analyses showed no statistically significant differences in pre-or post-HTx survival in patients managed with BVS vs LVS. Patients managed with BVS had higher rates of bleeding, need for transfusion, hemolysis and renal failure than patients managed with LVS, while the latter group showed a higher incidence of ischemic stroke. Conclusions: In a setting of candidate prioritization with short waiting list times, bridging to HTx with the CentriMag system was feasible and resulted in acceptable on-support and posttransplant outcomes.Fundacion Mutua Madrilena (Madrid, Spain)5.9 JCR Q1 20220.593 SJR Q2 2023No data IDR 2022UE