La agresividad terapéutica y los tratamientos limitados en el tiempo en pacientes oncológicos al final de la vida: fundamentos éticos y aplicación clínica

El objetivo de esta Tesis Doctoral es el análisis de la agresividad terapéutica en los pacientes oncológicos al final de la vida, su correlación con los cuidados y con los Test Limitados en el Tiempo como herramienta clínica, de gran riqueza ética, para la toma de decisiones compartidas y prudentes. Los criterios de agresividad propuestos en la literatura científica hace una década proporcionan un juicio de calidad en la atención de pacientes con cáncer avanzado, pero su utilización no está generalizada en la evaluación de los Servicios de Oncología. En este trabajo, analizamos la agresividad terapéutica, según los criterios establecidos, en 1001 pacientes con cáncer avanzado fallecidos en el Complejo Hospitalario Universitario de Santiago de Compostela, entre los años 2010 y 2013. Los resultados muestran que la agresividad terapéutica al final de la vida está presente en nuestra realidad asistencial con más frecuencia de lo que recomiendan los expertos. El 25% de los pacientes cumple al menos un criterio de agresividad. Los cuidados, dirigidos a la atención de las necesidades y articulados en modelos centrados en la comunicación y en la dignidad, están recomendados por las sociedades científicas y algunas entidades estatales para la mejora de la atención del paciente con cáncer avanzado próximo al final de la vida. Sus fundamentos son la toma de decisiones compartidas y la planificación anticipada de los cuidados mediante la implantación en la práctica clínica de “conversaciones de fin de vida”. Los Tratamientos Limitados en el Tiempo son un instrumento clínico útil para la aplicación de los modelos de cuidados en la asistencia y para reducir la agresividad terapéutica al final de la vida. Su implantación en la práctica clínica mejoraría los resultados de la asistencia del paciente oncológico aumentando la eficiencia del sistema y la justicia distributiva

Complementary music therapy for cancer patients in at-home palliative care and their caregivers: protocol for a multicentre randomised controlled trial

Background Patients with advanced cancer, receiving at-home palliative care, are subject to numerous symptoms that are changeable and often require attention, a stressful situation that also impacts on the family caregiver. It has been suggested that music therapy may benefit both the patient and the caregiver. We propose a study to analyse the efficacy and cost utility of a music intervention programme, applied as complementary therapy, for cancer patients in palliative care and for their at-home caregivers, compared to usual treatment. Method A randomised, double-blind, multicentre clinical trial will be performed in cancer patients in at-home palliative care and their family caregivers. The study population will include two samples of 40 patients and two samples of 41 caregivers. Participants will be randomly assigned either to the intervention group or to the control group. The intervention group will receive a seven-day programme including music sessions, while the control group will receive seven sessions of (spoken word) therapeutic education. In this study, the primary outcome measure is the assessment of patients' symptoms, according to the Edmonton Symptom Assessment System, and of the overload experienced by family caregivers, measured by the Caregiver Strain Index. The secondary outcomes considered will be the participants' health-related quality of life, their satisfaction with the intervention, and an economic valuation. Discussion This study is expected to enhance our understanding of the efficacy and cost-utility of music therapy for cancer patients in palliative care and for their family caregivers. The results of this project are expected to be applicable and transferrable to usual clinical practice for patients in home palliative care and for their caregivers. The approach described can be incorporated as an additional therapeutic resource within comprehensive palliative care. To our knowledge, no previous high quality studies, based on a double-blind clinical trial, have been undertaken to evaluate the cost-effectiveness of music therapy. The cost-effectiveness of the project will provide information to support decision making, thereby improving the management of health resources and their use within the health system

Factores de Riesgo Psicosocial en Estudiantes Universitarios

El siguiente trabajo está elaborado como auxiliar de investigación, ya que la investigación esta derivada por medio del grupo de Desarrollos Humanos Educativos y Organizacionales (DHEOS), donde se optó por la realización de la adaptación de la investigación pero en este caso solo se estaría enfocando en el módulo de riesgo psicosocial para la prevención de conductas suicidas en estudiantes universitarios, donde se realizó la búsqueda de información en fuentes bibliográficas para la obtención de datos. El suicidio a sido una de las causas de muerte que afecta a las personas que tengan algún tipo de problema psicológico o social, esto se ve mas afectado en los estudiantes universitarios ya que por diversas razones estos llegan a generar diversos síntomas negativos que lo conllevarían a realizar dicha conducta, de tal manera que por medio de esta investigación se buscaría optar por darles a conocer las causas y los factores de riesgo por las cuales pasan los universitarios. De tal manera principalmente en la realización del trabajo se realizó una idea de realizar un juego que fuera igual a un “escape room” donde el participante para poder pasar de habitaciones o de niveles tendría que resolver cada una de las preguntas presentadas, luego de haber terminado el juego podría encontrar un acceso a una página web donde podía encontrar información mas detallada sobre el tema, posterior a ello, se validó el contenido del módulo por medio de jueces expertos. Para la siguiente parte se realizó la adaptación de las actividades de cada sesión al medio virtual por medio de diferentes plataformas virtuales para que estas fueran de fácil acceso para los participantes.The following work is elaborated as a research assistant, since the research is derived through the group of Human Educational and Organizational Developments (DHEOS), where it was chosen to carry out the adaptation of the research but in this case, it would only be focusing on the module of psychosocial risk for the prevention of suicidal behaviors in university students, where the search for information in bibliographic sources was carried out to obtain data. Suicide has been one of the causes of death that affects people who have psychological or social problem, this is more affected in college students since for various reasons they come to generate various negative symptoms that would lead them to perform such conduct, so that through this research would seek to choose to give them to know the causes and risk factors through which university students go through. In this way, mainly in the realization of the work, an idea was made of making a game that was like an "escape room" where the participant to be able to pass rooms or levels would have to solve each of the questions presented, after having finished the game could find an access to a web page where he could find more detailed information on the subject, after that, the content of the module was validated by expert judges. For the next part, the activities of each session were adapted to the virtual environment by means of different virtual platforms so that the participants could easily access them

Intervention to improve quality of sleep of palliative patient carers in the community: protocol for a multicentre randomised controlled trial

Background: Sleep disorders are commonly experienced by community caregivers for persons with cancer, with at least 72% reporting moderate to severe disorders. A consequence of this condition, which is associated with the presence of overload in the caregiver, is the increased risk of clinical depression. The aim of this study is to evaluate the effects of music on the sleep quality achieved by informal caregivers for cancer patients receiving home palliative care. In addition, we will assess the influence of specific variables that could modify these effects, analyse the correlates related to nocturnal wakefulness and consider the diurnal consequences according to the sleep characteristics identified. Methods: This single-blind, multicentre, randomised clinical trial will focus on informal providers of care for cancer patients. Two samples of 40 caregivers will be recruited. The first, intervention, group will receive seven music-based sessions. The control group will be masked with seven sessions of therapeutic education (reinforcing previous sessions). Outcomes will be evaluated using the Pittsburgh Sleep Quality Index, a triaxial accelerometer, EuroQol-5D-5L, the Caregiver Strain Index, the Epworth Sleepiness Scale and the Client Satisfaction Questionnaire. The caregivers' satisfaction with the intervention performed will also be examined. Discussion: This study is expected to extend our understanding of the efficacy of music therapy in enhancing the sleep quality of caregivers for patients receiving home palliative care. To our knowledge, no reliable scientific investigations of this subject have previously been undertaken. Music is believed to benefit certain aspects of sleep, but this has yet to be proven and, according to a Cochrane review, high-quality research in this field is necessary. One of the main strengths of our study, which heightens the quality of the randomised clinical trial design, is the objective assessment of physical activity by accelerometry and the use of both objective and subjective measures of sleep in caregivers. Music therapy for the caregivers addressed in this study is complementary, readily applicable, provokes no harmful side effects and may produce significant benefits

Optimizando la Transmisión de Datos Ip Mediante la Conmutación de Etiquetas Multiprotocolo

This document shows the data transmission study results with different characterization (better effort, better effort with high priority, as well as two types of real time traffic), made through the use of label commutation multiprotol in IP nets, compared to the IP data transmission using Asynchronous Transfer Mode, the study illustrates the best performance that MPLS presents in network cogestion states. The discret events simulator NS_2, was used as the experimentation tool running on Linux operative system.El presente artículo muestar los resultdos del estudio de transmisión de datos con diferente caracterización (mejir esfuerzo, mejor esfuerzo con alta prioridad así como dos tipos de trafico de tiempo real) mediante el protocolo de conmutación de etiquetas multi-protocolo en redes IP, comparado con la transmisión de datos IP utilizando el Modo de Transferencia Asincrónico, el estudio ilustra el mejor rendimiento que presenta MPLS en condiciones de congestión de la red. Como herramienta de experimentación se utilizo el simulador de eventos discretos NS_2 sobre sistema operativo Linux

Dicotomia entre los componentes objetivos y subjetivos de la seguridad personal : el caso de la red de ciudades como vamos, Colombia.

This article focuses on the dichotomy between the objective and subjective components of personal security. For the above, this article analyzes the statistics of Homicide, Victimization and Perception on personal security in the cities of Barranquilla, Bogota, Bucaramanga, Cali, Cartagena, Ibagué, Manizales, Medellín and Pereira, all belonging to the cities´ network “Cómo Vamos Colombia”. The results show that, despite the reduction of statistics associated with homicides and victimization in all cities analyzed, these results have had little or none influence the perception of the inhabitants of the analyzed cities.Este artículo centra su atención en la dicotomía existente entre los componentes objetivos y subjetivos de la seguridad personal. Para ello, se analizan las estadísticas de Homicidios, Victimización y la Percepción sobre seguridad personal de los habitantes de Barranquilla, Bogotá, Bucaramanga, Cali, Cartagena, Ibagué, Manizales, Medellín y Pereira, todas pertenecientes a la Red Colombiana de Ciudades Cómo Vamos, cuya misión consiste en analizar las percepciones que tienen los ciudadanos sobre diferentes aspectos de la ciudad -seguridad, movilidad, institucionalidad, entre otros-. Los resultados muestran que, a pesar de la reducción, en promedio, de las estadísticas asociadas a los homicidios y a la victimización en todas las ciudades analizadas, estos resultados poco o nada han logrado impactar en la percepción de sus habitantes

Effects of Music on the Quality of Life of Family Caregivers of Terminal Cancer Patients: A Randomised Controlled Trial

The aim of this study was to investigate the effects of listening to self-chosen music on the quality of life of family caregivers of cancer patients receiving palliative home care. A total of 82 family caregivers were assigned either to the intervention group (n = 41) or to the control group (n = 41) in this double-blind, multicentre, randomised controlled clinical trial. The recruitment period was between July 2020 and September 2021. The intervention group received individualised pre-recorded music in daily 30 min sessions for 7 consecutive days. The control group was given a recorded repetition of the basic therapeutic training education also in 30 min sessions for 7 consecutive days. The primary endpoint assessed was the caregivers’ quality of life (Quality of Life Family Version and European Quality of Life visual analogue scale) before and after the intervention. The secondary endpoint was their perceived satisfaction with the intervention (Client Satisfaction Questionnaire). The music intervention was successful, producing a tangible improvement in the caregivers’ quality of life (p < 0.01) and satisfaction with the care provided (p = 0.002). The intervention was not only effective but produced no adverse effects. This study encourages the use of self-chosen music as a complementary intervention in nursing care for family caregivers of palliative cancer patients.Partial funding for open access charge: Universidad de Málag

Análisis sobre las demoras en el proceso de selección y constante rotación de personal en la empresa Activos S.A.

En la empresa ACTIVOS S.A. se está presentando la problemática de demoras en el proceso de selección y constante rotación de personal, de allí el objetivo principal de este proyecto es analizar el proceso de selección del personal de la organización para identificar puntualmente las falencias y así poder definir un plan de mejora donde se especifiquen las ventajas y oportunidades. La investigación se realizará bajo el enfoque mixto (Cualitativa y cuantitativa), donde se buscará describir y enumerar los eventos que causan las problemáticas. Para la recolección de la información se aplicó una encuesta a una muestra de 15 trabajadores activos de la empresa. Como resultado al estudio se encontraron varias causas de las cuales la de mayor incidencia fue que los procesos de selección de personal de la empresa ACTIVOS S.A. no son oportunos ocasionando un alto porcentaje de deserción laboral seguido de la falta de incentivos y compromiso por parte del departamento de talento humano.In the company ACTIVOS S.A. the problem of delays in the selection process and constant rotation of personnel is being presented, hence the main objective of this project is to analyze the selection process of the organization's personnel to promptly identify the shortcomings and thus be able to define an improvement plan where the advantages and opportunities are specified. The research will be carried out under the mixed approach (qualitative and quantitative), where the events that cause the problems will be described and listed. For the collection of information, a survey was applied to a sample of 15 active workers of the company. As a result of the study, several causes were found, of which the one with the highest incidence was that the personnel selection processes of the company ACTIVOS S.A. they are not timely, causing a high percentage of job desertion followed by the lack of incentives and commitment on the part of the human talent department

Differences in the yield of the implantable loop recorder between secondary and tertiary centers

Background: The implantable loop recorder (ILR) is a useful tool for diagnosis of syncope or palpitations. Its easy use and safety have extended its use to secondary hospitals (those without an Electrophysiology Lab). The aim of the study was to compare results between secondary and tertiary hospitals. Methods: National prospective and multicenter registry of patients with an ILR inserted for clinical reasons. Data were collected in an online database. The follow-up ended when the first diagnostic clinical event occurred, or 1 year after implantation. Data were analyzed according to the center of reference; hospitals with Electrophysiology Lab were considered Tertiary Hospi­tals, while those hospitals without a lab were considered Secondary Hospitals. Results: Seven hundred and forty-three patients (413 [55.6%] men; 65 ± 16 year-old): 655 (88.2%) from Tertiary Centers (TC) and 88 (11.8%) from Secondary Centers (SC). No differences in clinical characteristics between both groups were found. The electrophysi­ologic study and the tilt table test were conducted more frequently in Tertiary Centers. Fol­low-up was conducted for 680 (91.5%) patients: 91% in TC and 94% in SC. There was a higher rate of final diagnosis among SC patients (55.4% vs. 30.8%; p &lt; 0.001). Tertiary Hospital patients showed a trend towards a higher rate of neurally mediated events (20% vs. 4%), while bradyarrhythmias were more frequent in SC (74% vs. 60%; p = 0.055). The rate of deaths and adverse events was similar in both populations. Conclusions: Patients with an ILR in SC and TC have differences in terms of the use of complementary tests, but not in clinical characteristics. There was a higher rate of diagnosis in Secondary Hospital patients.

The Effects of Parenteral K1 Administration in Pseudoxanthoma Elasticum Patients Versus Controls. A Pilot Study

Introduction: Pseudoxanthoma elasticum (PXE) is a rare disease caused by mutations in the ABCC6 gene. Vitamin K1 is involved in the posttranslational carboxylation of some proteins related to inhibition of the calcification process. Our aim was to investigate, in patients affected by PXE, baseline levels of vitamin K1-dependent proteins and -metabolites and whether parenteral administration of phytomenadione was effective in modulating their levels. Methods: We included eight PXE patients with typical clinical symptoms (skin, retina, and vascular calcification) and two ABCC6 causative mutations; 13 clinically unaffected first-degree patients' relatives (9 carrying one ABCC6 mutation and 4 non-carriers). We assessed urinary vitamin K1 metabolites and serum Glu- and Gla-OC, Gas6 and undercaboxylated prothrombin (PIVKA-II), at baseline and after 1 and 6\u2009weeks after a single intramuscular injection of 10\u2009mg vitamin K1. Results: Comparison of PXE patients, heterozygous, and non-carriers revealed differences in baseline levels of serum MK-4 and of urinary vitamin K metabolites. The response to phytomenadione administration on vitamin K-dependent proteins was similar in all groups. Conclusion: The physiological axis between vitamin K1 and vitamin K-dependent proteins is preserved; however, differences in the concentration of vitamin K metabolites and of MK-4 suggest that vitamin K1 metabolism/catabolism could be altered in PXE patients