Determinants of mechanical restraint in an acute psychiatric care unit

Background: Despite numerous attempts to reduce the use of mechanical restraint (MR), this technique continues to be widely applied in many acute psychiatric care settings. In order to reduce MR, a better understanding of the variables associated with its use and duration in different clinical environments is essential. Aim: To determine the proportion of patients subjected to MR and the duration thereof in two acute care psychiatric units; and to identify the variables associated with the use and duration of MR. Methods: Descriptive study of all patients admitted to the acute psychiatric units at the Parc de Salut Mar (Barcelona, Spain) in the year 2018. The number and percentage of patients subjected to MR, as well as the duration of each episode were assessed. The following data were also registered: sociodemographic characteristics, psychiatric diagnosis, and presence of cultural and/or language barriers. Multivariate analyses were performed to assess determinants of MR and its duration. Results: Of the 464 patients, 119 (25.6%) required MR, with a median of 16.4 h per MR. Two factors - a diagnosis of psychotic disorder [Odds ratios (OR) = 0.22; 95%CI: 0.06-0.62; P = 0.005] and the presence of a language barrier (OR = 2.13; 95%CI: 1.2-3.7; P = 0.007) - were associated with a significantly higher risk of MR. Male sex was associated with a longer duration of MR (B = -19.03; 95%CI: -38.06-0.008; P = 0.05). Conclusion: The presence of a language barrier and a psychotic disorder diagnosis are associated with a significantly higher risk of MR. Furthermore, male sex is associated with a longer duration of MR. Individualized restraint protocols that include the required tools are necessary to ultimately limit the use of mechanical restraint

Evaluación del nivel de salud mental positiva en pacientes con diagnóstico de salud mental, atendidos en el ámbito hospitalario de agudos

Introducción: La salud mental se considera un estado de salud y de bienestar general. Nuestro estudio se centró en el modelo multifactorial de salud mental positiva de Lluch, formado por 6 factores: satisfacción personal, actitud prosocial, autocontrol, autonomía, resolución de problemas y autoactualización y habilidades de relación interpersonal. Objetivo: Evaluar el nivel de salud mental positiva en pacientes con diagnóstico de salud mental atendidos en el ámbito hospitalario de agudos. Método: Se trata de un estudio con diseño descriptivo transversal. Para medir la salud mental positiva de los pacientes con diagnóstico de salud mental, se utilizó el cuestionario de salud mental positiva de Lluch y se realizó una evaluación global y de cada uno de los seis factores. Se recogieron variables sociodemográficas y clínicas y se realizaron análisis descriptivos y correlacionales. Resultados: La muestra estuvo formada por 61 participantes. La puntuación media del cuestionario de salud mental positiva fue de 96.16. Se observaron diferencias estadísticamente significativas en relación con variables sociodemográficas y clínicas a nivel individual de los 6 factores de salud mental positiva, pero no a nivel global. Conclusión: Los resultados globales del cuestionario de salud mental positiva obtenidos sugieren que los pacientes de nuestra muestra presentan niveles moderados. Conocer el nivel de salud mental positiva que tienen los pacientes durante su ingreso nos aporta información para diseñar intervenciones específicas para su mejora, ya que los niveles son más bajos en pacientes con trastornos mentales que en la población general

Postoperative outcomes in oesophagectomy with trainee involvement

BACKGROUND: The complexity of oesophageal surgery and the significant risk of morbidity necessitates that oesophagectomy is predominantly performed by a consultant surgeon, or a senior trainee under their supervision. The aim of this study was to determine the impact of trainee involvement in oesophagectomy on postoperative outcomes in an international multicentre setting. METHODS: Data from the multicentre Oesophago-Gastric Anastomosis Study Group (OGAA) cohort study were analysed, which comprised prospectively collected data from patients undergoing oesophagectomy for oesophageal cancer between April 2018 and December 2018. Procedures were grouped by the level of trainee involvement, and univariable and multivariable analyses were performed to compare patient outcomes across groups. RESULTS: Of 2232 oesophagectomies from 137 centres in 41 countries, trainees were involved in 29.1 per cent of them (n = 650), performing only the abdominal phase in 230, only the chest and/or neck phases in 130, and all phases in 315 procedures. For procedures with a chest anastomosis, those with trainee involvement had similar 90-day mortality, complication and reoperation rates to consultant-performed oesophagectomies (P = 0.451, P = 0.318, and P = 0.382, respectively), while anastomotic leak rates were significantly lower in the trainee groups (P = 0.030). Procedures with a neck anastomosis had equivalent complication, anastomotic leak, and reoperation rates (P = 0.150, P = 0.430, and P = 0.632, respectively) in trainee-involved versus consultant-performed oesophagectomies, with significantly lower 90-day mortality in the trainee groups (P = 0.005). CONCLUSION: Trainee involvement was not found to be associated with significantly inferior postoperative outcomes for selected patients undergoing oesophagectomy. The results support continued supervised trainee involvement in oesophageal cancer surgery

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Estudio comparativo de eficiencia energética en comunidades de regantes

The government of Spain has developed an energy strategy that includes a campaign of energy audits in water users associations (WUAs) in order to improve energy efficiency in irrigation. A guideline for energy audits has been developed, standardizing the audit process in WUAs. This guideline has been implemented in 22 WUAs in the Castilla-La Mancha, Valencia, and Murcia Regions. In this paper, an analysis of the indicators proposed in the guideline is performed, and the indicators that most represent energy efficiency of WUAs are identified. Also, the suitability of the proposed indicators and classifications under different conditions are discussed. In addition, a cluster analysis is performed on WUAs to classify them according to their energetic aspects. Results show that indicators global energy efficiency (GEE) and active energy consumed per hectare (EacSr) are not adequate for analysing the evolution of energy consumption in a WUA. The most representative energy indicators are those expressing ratios between energy consumption and water volume supplied to the users as the indicators active energy consumed per volume unit (EacVs) and energy cost per volume unit (CENVs). It is conclude that using the current methodology for calculate the supply energy efficiency indicator (SEE), GEE is not an adequate indicator for energy classification of WUAs, and also that the results of the energy analysis must be used to propose measures for energy conservation and energy cost reduction.El gobierno de Espa&ntilde;a ha desarrollado una estrategia de ahorro y eficiencia energ&eacute;tica que incluye una campa&ntilde;a de realizaci&oacute;n de auditorias energ&eacute;ticas en Comunidades de Regantes para la mejora de la eficiencia energ&eacute;tica en el sector del regad&iacute;o. Con este fin se desarroll&oacute; un protocolo de auditorias energ&eacute;ticas que estandariza el proceso de auditor&iacute;a en Comunidades de Regantes. Este protocolo se ha implementado en 22 Comunidades de Regantes de Castilla-La Mancha, Valencia y Murcia. En este art&iacute;culo se presenta un an&aacute;lisis de los indicadores propuestos en el protocolo, identificando los que mejor representan la eficiencia energ&eacute;tica de las comunidades de regantes, se analiza la idoneidad de los indicadores y clasificaciones propuestas y se realiza un an&aacute;lisis cluster sobre las Comunidades de Regantes analizadas, clasific&aacute;ndolas respecto a variables de tipo energ&eacute;tico. Los resultados muestran que la eficiencia energ&eacute;tica general (GEE) y la energ&iacute;a activa consumida por hect&aacute;rea (EacSr) no son indicadores adecuados para estudiar la evoluci&oacute;n del consumo de energ&iacute;a en una comunidad de regantes. Los indicadores energ&eacute;ticos m&aacute;s representativos son el consumo de energ&iacute;a activa por unidad de volumen (EacVs) y el coste de energ&iacute;a por unidad de volumen (CENVs). Finalmente se concluye indicando que con la metodolog&iacute;a actual de c&aacute;lculo de la eficiencia de suministro energ&eacute;tico (SEE), GEE no es un indicador adecuado para calificar energ&eacute;ticamente las comunidades de regantes, as&iacute; como que los resultados de los an&aacute;lisis energ&eacute;ticos se deben tener en cuenta para proponer medidas de ahorro energ&eacute;tico y econ&oacute;mico

Abdominal mass as an expression of a wandering spleen

[eng] Background: Wandering spleen and splenic cyst are rare conditions caused by the absence or abnormal accompanying splenic laxity, due to congenital or acquired causes. Case Report: A 30-year-old girl, mother recently, presented a mobile abdominal mass in the left upper quadrant associated with mild abdominal pain. The diagnosis of nonparasitic cyst in a wandering spleen was confirmed by computerized tomography and negative serological test. Due to its characteristics and anatomical position, a laparotomy with simple extirpation and splenic preservation was performed. The postoperative course did not present any problems. The pathological anatomical result was pseudocyst. Conclusions: In the differential diagnosis of an abdominal mass the splenic pseudocysts need to be taken into consideration. Like in children, as well as in adults the treatment of a wandering spleen associated with a cyst should aim at the extirpation of the pseudocyst, the prevention of vascular accidents and at conservation of the spleen

Biliopancreatic Diversion in the Surgical Treatment of Morbid Obesity: Long-Term Results and Metabolic Consequences

[eng] Purpose In the multidisciplinary therapeutic approach to obesity, bariatric surgery is considered the most effective treatment in weight reduction and the decrease in associated comorbidities. The objective of this work is to describe the long-term clinical and metabolic results in obese patients undergoing biliopancreatic diversion (BPD) according to Scopinaro's technique. Materials and Methods Patients undergoing surgery were followed by the same multidisciplinary team in a study period of 15 years (1999-2015). A retrospective study based on a prospective database was designed, where data on the evolution of obesity-related diseases and nutritional parameters were studied. Results Two hundred seventy-seven patients were collected; 75.5% were women. The preoperative body mass index (BMI) decreased from 52.5 kg/m2 to 34.9 kg/m2 10 years after surgery. A resolution or improvement of diabetes has been observed in 85.38% of the patients; a decrease in arterial hypertension and obstructive sleep apnea syndrome were in 65.61% and 89.14%, respectively. Throughout the monitoring of the sample, protein malnutrition increased, from 1.8% after the first year of surgery to 4.5% 10 years after the operation. Conclusion Even if Scopinaro's technique is beginning to be replaced by other malabsorptive techniques, it can still be considered as an effective surgical procedure in terms of weight loss, quality of life, and evolution of obesity-related diseases. In order to avoid nutritional deficiencies, the operated patients need a strict follow-up and a supplementation adjusted to the technique

Perception of the use of humour by nurses and patients at Mental Health Units Percepción del uso del humor por parte de enfermeras y pacientes en los servicios de salud mental

Objetivo: conocer, en función de la literatura disponible, el significado del sentido del humor entre enfermeras y pacientes en el contexto de servicios de salud mental, así como determinar los factores que facilitan o dificultan el uso del sentido del humor en las unidades de salud mental. Métodos: se llevó a cabo una revisión narrativa en el periodo 2022-2023. Las búsquedas se realizaron en Pubmed, PsycINFO, LILACS y CINAHL, usando los descriptores: “Nurse-patient relations”, “mental health”, “wit and humor as topic”, "psychiatric nursing”. Se incluyeron todo tipo de documentos que abordaran el tema según los objetivos, publicados desde 2012 hasta noviembre de 2022 en inglés, español o portugués. Se añadió un artículo traducido del coreano por su relevancia. Resultados: se incluyeron 10 manuscritos en la revisión. Los hallazgos sugieren que el sentido del humor se percibe como una herramienta esencial para fortalecer la relación entre enfermeras y pacientes en entornos psiquiátricos. No obstante, se destaca la existencia de factores que podrían conducir a un uso inapropiado del humor, llevando a la deshumanización de la atención y la posible ruptura del vínculo terapéutico. Conclusiones: es importante considerar cuidadosamente el empleo del humor en el contexto de la salud mental, para garantizar su efectividad sin comprometer la calidad asistencial

Impact of histological tumor grade on the behavior and prognosis of squamous cell carcinoma of the oral cavity

Introduction: Unlike other types of cancers, the prognostic value of histological tumor grade is not well determined for oral squamous cell carcinoma (OSCC). This study therefore aimed to evaluate the impact of tumor differentiation on prognosis and overall survival of patients affected by squamous cell carcinoma of the oral cavity. Materials and method: A retrospective analysis was conducted using the records of patients diagnosed with squamous cell carcinoma of the oral cavity between 2010 and 2015. The study included 162 patients treated with a tumorectomy and selective neck dissection. The influence of histological tumor grade on several prognostic factors such as T-Stage, N-stage, recurrence rate, perineural invasion, vascular invasion, surgical margins, and overall survival was analyzed. Results: Histological grade strongly correlated with N-stage, recurrence rate, perineural invasion, vascular invasion, surgical margins, and overall survival. Overall survival was 71.6% in patients with well-differentiated tumors and 43.2% in those with moderately and poorly differentiated tumors. Conclusions: Histological grade represents an important prognostic factor for OSCC. Therefore, various treatment strategies based on this histological parameter could improve the overall survival rate of patients affected by oral squamous cell carcinoma