Relación de la calidad de vida profesional y el burnout en médicos de atención primaria

ObjetivoConocer la relación, si es que la hay, entre la calidad de vida profesional (CVP) y burnout de facultativos de atención primaria.DiseñoEstudio transversal mediante cuestionario CVP-35 y MBI (Maslach Burnout Inventory), por correo postal.ÁmbitoTres centros urbanos y 3 zonas de atención rural. Participó un total de 131 profesionalesMedicionesDel CVP-35 se obtienen puntuaciones que van de 0 (mínimo) a 10 (máximo). El cuestionario Maslach clasifica en nivel alto, medio y bajo de cada dimensión.ResultadosContestó a la encuesta el 71,7%. La edad media era de 44 años y la media de tarjetas sanitarias, 1.339. El número de consultas/día fue de 37; en cuanto las visitas domiciliarias, realizaban una diaria. El valor medio de la CVP fue de 4,48 (intervalo de confianza [IC] del 95%, 4,08-4,88). La percepción de la demanda tuvo una puntuación de 5,9 (IC del 95%, 5,6-6,1); la motivación intrínseca del profesional se situó en 6,5 (IC del 95%, 6,2-6,7) y el apoyo de los directivos en 3,8 (IC del 95%, 3,6-4,1). En cuanto al cuestionario MBI, se observó una despersonalización alta en el 54,3%, cansancio emocional alto en un 56,2% y realización personal alta en el 9,3%. La correlación mayor fue entre las demandas en el puesto y el cansancio emocional (r=0,6; p<0,0001), la motivación intrínseca y la realización personal (r=0,46; p<0,0001) y la calidad de vida profesional frente al cansancio emocional (r=−0,4; p<0,0005).ConclusionesLa CVP y el burnout miden dimensiones diferentes pero relacionadas. Por tanto, su utilidad es diferente en función de los objetivos. Con estos instrumentos se pueden identificar elementos clave de la gestión de personas que pueden mejorar la calidad de vida profesional.ObjectiveTo know the relationship, if this exists, between the quality of professional life (CPL) and the burnout of primary health care staff.DesignTransversal study employing CVP-35 test and MBI (Maslach Burnout Inventory), both sent by postmail.Setting3 urban centers and 3 rural centers. Total: 131 professionals.MeasuresIn the CVP-35 test, scores from 0 (minimum) to 100 (maximum) are obtained. Maslach categorised each dimension into high, medium and low level.Results71.7% answered. Medium age 44 years, average of 1339 sanitary cards. The number of visits/day was 37, home visits 1 per day. The CVP average was 4.48 (95% CI, 4.08-4.88). The damage perception in the post 5.9 (95% CI, 5.6-6.1); the professional intrinsic motivation 6.5 (95% CI, 6.2-6.7), and the manager support 3.8 (95% CI, 3.6-4.1). MBI: high depersonalization 54.3%, emotional exhaustion (r=0.6; P<.0001), intrinsic motivation, and personal accomplishment (r=0.46; P<.0001) and profesional quality of life front emotional fatigue (r= −0.4; P<.0005).ConclusionsCPL and burnout measure different but related dimensions. Therefore, its utility is dependent on the objectives. Target elements, which can improve the quality of professional life, can be identified from these tools

NGC 6705 a young α\alpha-enhanced Open Cluster from OCCASO data

The stellar [$\alpha$/Fe] abundance is sometimes used as a proxy for stellar age, following standard chemical evolution models for the Galaxy, as seen by different observational results. In this work we show that the Open Cluster NGC6705/M11 has a significant $\alpha$-enhancement [$\alpha$/Fe]$>0.1$ dex, despite its young age ($\sim$300 Myr), challenging the current paradigm. We use high resolution (R$>65,000$) high signal-to-noise ($\sim$70) spectra of 8 Red Clump stars, acquired within the OCCASO survey. We determine very accurate chemical abundances of several $\alpha$ elements, using an equivalent width methodology (Si, Ca and Ti), and spectral synthesis fits (Mg and O). We obtain [Si/Fe]=$0.13\pm0.05$, [Mg/Fe]=$0.14\pm0.07$, [O/Fe]=$0.17\pm0.07$, [Ca/Fe]=$0.06\pm0.05$ and [Ti/Fe]=$0.03\pm0.03$. Our results place these cluster within the group of young [$\alpha$/Fe]-enhanced field stars recently found by several authors in the literature. The ages of our stars have an uncertainty of around 50 Myr, much more precise than for field stars. By integrating the cluster's orbit in several non-axisymmetric Galactic potentials, we establish the M11's most likely birth radius to lie between 6.8-7.5 kpc from the Galactic center, not far from its current position. With the robust Open Cluster age scale, our results prove that a moderate [$\alpha$/Fe]-enhancement is no guarantee for a star to be old, and that not all $\alpha$-enhanced stars can be explained with an evolved blue straggler scenario. Based on our orbit calculations, we further argue against a Galactic bar origin of M11.Comment: 10 pages, 6 figures, accepted in A&

Arrhythmogenicity quantification of two genetic defects affecting IKr channel in AF patients

[EN] Atrial fibrillation (AF) is the most common cardiac arrhythmia characterized by disorganized electrical activations of the upper chambers of the heart, leading to uncoordinated contraction and compromising the pumping action of the organ. AF risk factors include cardiovascular pathologies, endocrine disorders, advanced age, obesity, smoking and heritability. Genetic mutations affecting gene encoding for ion channel protein structures are in fact considered as cause of fibrillatory events in individuals who do not present any other co-morbidities. In this work, two genetic mutations found in literature and affecting the alpha-subunit of the rapid delayed rectifier potassium channel are modelled, by reparametrizing the IKr current formulation and by fitting it to mutant experimental data. The modified potassium current was then incorporated into the Courtemanche-Ramirez-Nattel (CRN) model and single cell simulations have been performed to study the mutations¿ effects on action potential and current traces, as well as, restitution properties, in right and left atrium. Both mutations produced a shortening of the action potential duration at 90% of repolarization (APD90), a higher current peak and lower APD values in the restitution curves. T895M yielded also to a reduction in the maximum slope of restitution curve. Tissue patch simulations revealed that T895M and T436M provide a substrate to initiate and maintain re-entries during the 5 seconds of simulation. Rotor¿s meandering in T895M appears more stable with a less extended area and more regular pattern than in T436M. Investigation on 3D atria and torso models will be necessary to provide further insights in understanding the mechanisms behind these genetic mutations.I am grateful to the teams at GaTech, who helped me in the realization of this work. This project has been funded by the European Union's Horizon 2020 research and innovation programme under the Marie Sklodowska-Curie gran agreement No.766082 and by Generalitat Valenciana, Prometeo programme 2020/043.Belletti, R.; Martínez Mateu, L.; Romero Pérez, L.; Cherry, E.; Fenton, FH.; Saiz Rodríguez, FJ. (2020). Arrhythmogenicity quantification of two genetic defects affecting IKr channel in AF patients. Sociedad Española de Ingeniería Biomédica. 141-144. http://hdl.handle.net/10251/178268S14114

Multidisciplinary consensus statement on the clinical management of patients with pancreatic cancer

Pancreatic cancer (PC) remains one of the most aggressive tumors with an increasing incidence rate and reduced survival. Although surgical resection is the only potentially curative treatment for PC, only 15-20% of patients are resectable at diagnosis. To select the most appropriate treatment and thus improve outcomes, the diagnostic and therapeutic strategy for each patient with PC should be discussed within a multidisciplinary expert team. Clinical decision-making should be evidence-based, considering the staging of the tumor, the performance status and preferences of the patient. The aim of this guideline is to provide practical and evidence-based recommendations for the management of PC

Analytical model to predict the effect of a finite impedance surface on the propagation properties of a 2D Sonic Crystal

The use of Sonic Crystals as environmental noise barriers has certain advantages from the acoustical and the constructive point of view with regard to conventional ones. One aspect do not studied yet is the acoustic interaction between the Sonic Crystals and the ground due to, up to now, this latter is not included in the analytical models used to characterize these Sonic Crystals. We present here an analytical model, based on multiple scattering theory, to study this interaction considering the ground as a finite impedance surface. Using this model we have obtained interesting conclusions that allow to design more effectively noise screens based on Sonic Crystals. The obtained results have been compared with experimental and numerical, finding a good agreement between them

Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis

The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was funded by a Fondo de Investigación Sanitaria (FIS-FEDER) (grants PI16-01673 and PI19/00593) and an Interlaken Research Award Programme (2012-12094537).Background: Myasthenic crisis (MC) is a potentially life-threatening complication of myasthenia gravis. Its precipitating factors include surgical procedures, particularly thymectomy. The role of preoperative intravenous immunoglobulin (IVIg) in preventing MC in patients scheduled for thymectomy and other surgery with general anaesthesia is unknown. Our objective was to test the hypothesis that preoperative IVIg is effective in preventing myasthenic crisis in patients with myasthenia gravis scheduled for surgery under general anaesthesia, including thymectomy. Methods: A prospective, randomized, double-blind, single-centre study was conducted over a 4-year period. The treatment group received IVIg, 0.4 g/kg/day preoperatively for 5 consecutive days, and the placebo group received saline solution under the same conditions. The two groups were age-matched, with similar functional status, and Myasthenia Gravis Foundation of America class. All patients had well-controlled myasthenia gravis with minimal manifestations before surgery. The primary outcome measured was MC. Intubation times, time in the recovery room, number of postoperative complications, and days of hospitalization were the secondary outcomes measured. Results: A total of 47 patients were randomized, 25 to the IVIg group and 22 to placebo. There were 19 men and 28 women, with a mean age of 58.6 years, mean body mass index of 27.8 kg/m, and mean acetylcholine receptor antibodies of 12.9 nmol/l. The mean forced vital capacity was 84.4%. The mean quantitative myasthenia gravis sum score was 6.3. Ten patients (five in each arm) had a history of MC. Thymectomy was performed in 16 patients. Only one patient in the placebo group presented with MC requiring non-invasive ventilation (but no reintubation) for 6 days. Neither differences between groups in the univariate analysis nor risk factors for MC in the multivariate analysis were found. Conclusions: Preoperative IVIg to prevent MC does not appear to be justified in well-controlled myasthenia gravis patients. This study provides class I evidence that preparation with IVIg to prevent MC is not necessary in well-controlled myasthenia gravis patients scheduled for surgery with general anaesthesia

Intravenous immunoglobulin to prevent myasthenic crisis after thymectomy and other procedures can be omitted in patients with well-controlled myasthenia gravis

Immunoglobulin; Myasthenia; ThymectomyInmunoglobulina; Miastenia; TimectomíaImmunoglobulina; Miastènia; TimectomiaBACKGROUND: Myasthenic crisis (MC) is a potentially life-threatening complication of myasthenia gravis. Its precipitating factors include surgical procedures, particularly thymectomy. The role of preoperative intravenous immunoglobulin (IVIg) in preventing MC in patients scheduled for thymectomy and other surgery with general anaesthesia is unknown. Our objective was to test the hypothesis that preoperative IVIg is effective in preventing myasthenic crisis in patients with myasthenia gravis scheduled for surgery under general anaesthesia, including thymectomy. METHODS: A prospective, randomized, double-blind, single-centre study was conducted over a 4-year period. The treatment group received IVIg, 0.4 g/kg/day preoperatively for 5 consecutive days, and the placebo group received saline solution under the same conditions. The two groups were age-matched, with similar functional status, and Myasthenia Gravis Foundation of America class. All patients had well-controlled myasthenia gravis with minimal manifestations before surgery. The primary outcome measured was MC. Intubation times, time in the recovery room, number of postoperative complications, and days of hospitalization were the secondary outcomes measured. RESULTS: A total of 47 patients were randomized, 25 to the IVIg group and 22 to placebo. There were 19 men and 28 women, with a mean age of 58.6 years, mean body mass index of 27.8 kg/m2, and mean acetylcholine receptor antibodies of 12.9 nmol/l. The mean forced vital capacity was 84.4%. The mean quantitative myasthenia gravis sum score was 6.3. Ten patients (five in each arm) had a history of MC. Thymectomy was performed in 16 patients. Only one patient in the placebo group presented with MC requiring non-invasive ventilation (but no reintubation) for 6 days. Neither differences between groups in the univariate analysis nor risk factors for MC in the multivariate analysis were found. CONCLUSIONS: Preoperative IVIg to prevent MC does not appear to be justified in well-controlled myasthenia gravis patients. This study provides class I evidence that preparation with IVIg to prevent MC is not necessary in well-controlled myasthenia gravis patients scheduled for surgery with general anaesthesia.This work was funded by a Fondo de Investigacion Sanitaria (FIS-FEDER) (grants PI16-01673 and PI19/00593) and an Interlaken Research Award Programme (2012-12094537

Sodium–Gold Binaries: Novel Structures For Ionic Compounds From An Ab Initio Structural Search

Intermetallic compounds made of alkali metals and gold have intriguing electronic and structural properties that have not been extensively explored. We perform a systematic study of the phase diagram of one binary system belonging to this family, namely NaxAu1−x, using the ab initio minima hopping structural prediction method. We discover that the most stable composition is NaAu2, in agreement with available experimental data. We also confirm the crystal structures of NaAu2 and Na2Au, that were fully characterized in experiments, and identify a candidate ground-state structure for the experimental stoichiometry NaAu. Moreover, we obtain three other stoichiometries, namely Na3Au2, Na3Au and Na5Au, that could be thermodynamically stable. We do not find any evidence for the existence of the experimentally proposed composition NaAu5. Finally, we perform phonon calculations to check the dynamical stability of all reported phases and we simulate x-ray diffraction spectra for comparison with future experimental data

Non-parametric deprojection of NIKA SZ observations: Pressure distribution in the Planck-discovered cluster PSZ1 G045.85+57.71

The determination of the thermodynamic properties of clusters of galaxies at intermediate and high redshift can bring new insights into the formation of large-scale structures. It is essential for a robust calibration of the mass-observable scaling relations and their scatter, which are key ingredients for precise cosmology using cluster statistics. Here we illustrate an application of high resolution $(< 20$ arcsec) thermal Sunyaev-Zel'dovich (tSZ) observations by probing the intracluster medium (ICM) of the \planck-discovered galaxy cluster \psz\ at redshift $z = 0.61$, using tSZ data obtained with the NIKA camera, which is a dual-band (150 and 260~GHz) instrument operated at the IRAM 30-meter telescope. We deproject jointly NIKA and \planck\ data to extract the electronic pressure distribution from the cluster core ($R \sim 0.02\, R_{500}$) to its outskirts ($R \sim 3\, R_{500}$) non-parametrically for the first time at intermediate redshift. The constraints on the resulting pressure profile allow us to reduce the relative uncertainty on the integrated Compton parameter by a factor of two compared to the \planck\ value. Combining the tSZ data and the deprojected electronic density profile from \xmm\ allows us to undertake a hydrostatic mass analysis, for which we study the impact of a spherical model assumption on the total mass estimate. We also investigate the radial temperature and entropy distributions. These data indicate that \psz\ is a massive ($M_{500} \sim 5.5 \times 10^{14}$ M$_{\odot}$) cool-core cluster. This work is part of a pilot study aiming at optimizing the treatment of the NIKA2 tSZ large program dedicated to the follow-up of SZ-discovered clusters at intermediate and high redshifts. (abridged)Comment: 16 pages, 10 figure