Hermeneutics of the Patient's Discourse

Illness episodes are events in the life of patients, which stand out in their narratives. Being ill is to be interpreted as ill. In this hermeneutical process, the analysing of the story is decisive. The objective of our study has been to analyse the clinical interviews of patients with respiratory diseases. Through qualitative methodology, codes related to the experience of the disease were created. Subsequently, the textual content linked to the codes was discussed considering the contemporary hermeneutical philosophy. Text coding of the text shows that the units of meaning related to respiratory disease occupy less than a half of those of the textual corpus. If we circumscribe the encounter from a conventional point of view, we can consider just of part of the speech of the patient, which is predetermined by our methods and conceptual networks. Human experience is associated with the act of telling in time. The testimonies show that health is an unconscious process, when everything flows smoothly, without obstacles. It is the ability to achieve vital goals. The disease alters the life of the patient, his projects and the previous balance

Hermenéutica y análisis cualitativo del discurso del enfermo. Una aproximación desde la hermenéutica contemporánea

El objetivo de nuestro estudio ha sido analizar el texto de las entrevistas clínicas de pacientes con enfermedades respiratorias atendidos en una consulta hospitalaria. Mediante metodología cualitativa se crearon códigos relacionados con la sintomatología habitual de la enfermedad respiratoria, identidad narrativa, experiencia de la enfermedad y del cuerpo enfermo, metáforas utilizadas, comprensión médico-enfermo, el encuentro clínico, la inserción del tiempo en el relato, así como la presencia de la angustia y de la muerte. En una fase posterior, el contenido textual vinculado con cada código se discutió a la luz de la filosofía hermenéutica contemporánea. La codificación pone de manifiesto que las unidades de sentido relacionadas con la enfermedad respiratoria ocupan menos de la mitad de las del corpus textual. Si circunscribimos el encuentro con el enfermo a la perspectiva convencional, podemos llegar a hacernos cargo solo de una parte de su discurso, la que apuntan nuestros métodos y redes conceptuales predeterminadas. Pero para comprender la enfermedad en su contexto, la realidad viva del paciente necesitamos otras categorías o esquemas, que entran en juego desde una mirada de tipo interpretativo o hermenéutico

Metastases of renal cell carcinoma to the thyroid gland with synchronous benign and malignant follicular cell-derived neoplasms

Clear cell renal cell carcinoma (CCRCC) is the most common origin for metastasis in the thyroid. A 51-year-old woman was referred to our hospital for a subcarinal lesion. Ten years before, the patient had undergone a nephrectomy for CCRCC. Whole-body fluorodeoxyglucose positron emission tomography revealed elevated values in the thyroid gland, while the mediastinum was normal. An endoscopic ultrasonography-guided fine-needle aspiration biopsy of the mediastinal mass was consistent with CCRCC, and this was confirmed after resection. The thyroidectomy specimen also revealed lymphocytic thyroiditis, nodular hyperplasia, one follicular adenoma, two papillary microcarcinomas, and six foci of metastatic CCRCC involving both thyroid lobes. Curiously two of the six metastatic foci were located inside two adenomatoid nodules (tumor-in-tumor). The metastatic cells were positive for cytokeratins, CD10, epidermal growth factor receptor, and vascular endothelial growth factor receptor 2. No BRAF gene mutations were found in any of the primary and metastatic lesions. The patient was treated with sunitinib and finally died due to CCRCC distant metastases 6 years after the thyroidectomy. In CCRCC patients, a particularly prolonged survival rate may be achieved with the appropriate therapy, in contrast to the ominous prognosis typically found in patients with thyroid metastases from other origins

Impact of a home telehealth program after a hospitalized COPD exacerbation: a propensity score analysis

[Abstract] Introduction: Currently there is lack of data regarding the impact of a home telehealth program on readmissions and mortality rate after a COPD exacerbation-related hospitalization. Objective: To demonstrate if a tele-monitoring system after a COPD exacerbation admission could have a favorable effect in 1-year readmissions and mortality in a real-world setting. Methods: This is an observational study where we compared an intervention group of COPD patients treated after hospitalization that conveyed a telehealth program with a followance period of 1 year with a control group of patients evaluated during one year before the intervention began. A propensity-score analyses was developed to control for confounders. The main clinical outcome was 1-year all-cause mortality or COPD-related readmission. Results: The analysis comprised 351 telemonitoring patients and 495 patients in the control group. The intervention resulted in less mortality or readmission after 12 months (35.2% vs. 45.2%; hazard ratio [HR] 0.71 [95% CI=0.56-0.91] 0.71 [95% CI=0.56-0.91; p=0.007). This benefit was maintained after the propensity score analysis (HR=0.66 [95% CI=0.51-0.84]). This benefit, which was seen from the first month of the study and during its whole duration, is maintained when mortality (HR=0.54; 95% CI=[0.36-0.82]) or readmission (subdistribution hazard ratio [SHR] 0.66; 95% CI=[0.50-0.86]) are analyzed separately. Conclusion: Telemonitoring after a severe COPD exacerbation is associated with less mortality or readmissions at 12 months in a real world clinical setting

Microevolution, reinfection and highly complex genomic diversity in patients with sequential isolates of Mycobacterium abscessus

Mycobacterium abscessus is an opportunistic, extensively drug-resistant non-tuberculous mycobacterium. Few genomic studies consider its diversity in persistent infections. Our aim was to characterize microevolution/reinfection events in persistent infections. Fifty-three sequential isolates from 14 patients were sequenced to determine SNV-based distances, assign resistance mutations and characterize plasmids. Genomic analysis revealed 12 persistent cases (0-13 differential SNVs), one reinfection (15,956 SNVs) and one very complex case (23 sequential isolates over 192 months), in which a first period of persistence (58 months) involving the same genotype 1 was followed by identification of a genotype 2 (76 SNVs) in 6 additional alternating isolates; additionally, ten transient genotypes (88-243 SNVs) were found. A macrolide resistance mutation was identified from the second isolate. Despite high diversity, the genotypes shared a common phylogenetic ancestor and some coexisted in the same specimens. Genomic analysis is required to access the true intra-patient complexity behind persistent infections involving M. abscessus.This work was supported by the Instituto de Salud Carlos III [AC16/00057, FIS15/01554, PI21/01823, PI19/00331, FI20/00129, PI21/01738], co-financed by European Regional Development Funds of the European Commission: “A way of making Europe”; a Miguel Servet Contract (ISCIII) CPII20/00001 to LPL. FI22/00145 contract from a PFIS (ISCIII) to SBS and Ministerio de Ciencia (MCIN/AEI/10.13039/501100011033, grant PID2020-112865RB-I00).Peer reviewe

Proceso asistencial integrado de esclerosis lateral amiotrófica

O proceso asistencial integrado da esclerose lateral amiotrófica, elaborouse co obxectivo de crear un proceso de traballo común en todas as áreas para facilitar a asistencia sanitaria ás persoas diagnosticadas desta enfermidade. Establécense actuacións como o asesoramento continuo, as consultas en acto único, a coordinación asistencial, tanto entre especialidades como coa atención primaria e a coordinación administrativa do sistema socio sanitario. Neste proceso participaron profesionais das diferentes áreas sanitarias especialistas en neuroloxía, endocrinoloxía, neumoloxía, psicoloxía clínica, rehabilitación, traballo social e hospitalización a domicilioEl proceso asistencial integrado de la esclerosis lateral amiotrófica, se elaboró con el objetivo de crear un proceso de trabajo común en todas las áreas para facilitar la asistencia sanitaria a las personas diagnosticadas de esta enfermedad. Se establecen actuaciones como el asesoramiento continuo, las consultas en acto único, la coordinación asistencial, tanto entre especialidades como con la atención primaria y la coordinación administrativa del sistema socio sanitario. En este proceso participaron profesionales de las diferentes áreas sanitarias especialistas en neurología, endocrinología, neumología, psicología clínica, rehabilitación, trabajo social y hospitalización a domicili