Motivación para el cambio como predictor de la adherencia terapéutica en el dolor crónico

Los tratamientos psicológicos que enfatizan la autogestión han resultado comúnmente apropiados como alternativas a la intervención médica en el dolor crónico. Desafortunadamente esta aproximación a menudo falla en comprometer a una porción significativa de individuos hacia los tratamientos y considerables índices de abandono y de recaída. El objetivo de este estudio fue comprobar la validez predictiva del modelo de estadíos de cambio en el dolor crónico a través del Pain States of Change Questionnaire (PSOCQ) sobre la adherencia y los resultados terapéuticos. La muestra se compuso de 48 pacientes de dolor crónico, concretamente con trastorno de fibromialgia, reclutados en una unidad de dolor de un hospital público de Sevilla. La mitad de ellos siguió una intervención cognitivo-conductual, y la otra mitad un programa de autogestión guiado por pacientes entrenados. Los resultados avalan la capacidad predictiva del PSOCQ, en tanto en cuanto: a) se constató una probabilidad estadísticamente significativa de no completar el tratamiento cuanto menor fue la motivación para el cambio; b) la motivación para el cambio de los pacientes que completaron el tratamiento se incrementó de forma estadísticamente significativa; y, c) una menor motivación para el cambio tras el tratamiento se asoció a una mayor gravedad del trastorno. La discusión se centra en el interés de manejar la motivación para el cambio para mejorar la eficiencia terapéutica.Psychological treatments that emphasize the auto-management have turned out to be commonly adapted like alternative to the medical intervention in the chronic pain. Unfortunately this approximation often fails in compromising to a significant portion of individuals towards treatments and many abandons and relapses. The aim of this study was to verify the predictive validity of States of Change Model in chronic pain using the Pain States of Change Questionnaire (PSOCQ) to predict adherence and therapeutic results. The sampled consisted of 48 patients of chronic pains-fibromyalgia recruited in a public pain clinic of Seville (Spain). The half of them followed a cognitive-behavioral intervention, and another half a program of auto-management guided by expert patients. The results support the predictive validity of the PSOCQ, while in all that: a) patient with less change motivation had less probability of completing the treatment; b) change motivation increased as effect of the treatment; and c) a less change motivation was associated to more gravity of the disorder. The discussion centers of the interest of considering change motivation to improve therapeutic efficiency.Consejería de Salud de la Junta de Andalucí

Psychological therapies to treat chronic pain

A pesar de que existe abundante literatura que muestra la efectividad del tratamiento cognitivo-conductual del dolor crónico, en nuestro país, se carecía de un manual del mismo. Por este motivo, diseñamos un protocolo donde se describen las diferentes técnicas de dicha terapia. En el presente artículo, realizamos una detallada descripción del mismo. Antes de adentrarnos en la terapia cognitivo-conductual, presentamos una revisión de las principales terapias psicológicas que se emplean en el tratamiento del dolor crónico.Although there is abundant literature showing the effectiveness of cognitive treatment of chronic pain, in our country, there was no manual for it. For this reason, we designed a protocol that describes the various techniques of this therapy. In this article, we conducted a detailed description. Before dealing with cognitive-behavioral therapy, we present a review of the main psychological therapies used in the treatment of chronic pain.Ministerio de Sanidad y Consumo PI05196

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Eficacia comparada de la terapia cognitiva-conductual y la gestión personal en pacientes con fibromialgia

El trabajo que presentamos estudia, desde una perspectiva de intervención psicológica, el tratamiento de los problemas de adaptación psicosocial derivados del padecimiento de un proceso de enfermedad crónica. El estudio de las enfermedades crónicas se ha convertido en un desafío de las sociedades desarrolladas, sobre todo por sus consecuencias, el incremen ... to de su prevalencia y por los hallazgos epidemiológicos acerca de su origen multicausal, poniendo de relieve la importancia de una perspectiva bio-psico-social, que entiende la salud y la enfermedad como el resultado de la acción conjunta de factores biológicos, psicológicos y sociales. Es en este marco desde donde se debe estudiar el dolor crónico, como un grave problema de salud. Se calcula que una de cada diez personas en España sufre dolor crónico (Jano, 2004), así como que el 63 % de las personas con dolor crónico no manejan adecuadamente su dolor por confusión sobre las terapias (Jano, 2006), señalando la necesidad de realizar un mayor énfasis en la educación y acceso a tratamientos más eficaces. Los últimos datos de la encuesta europea de dolor (Breivik y cols., 2006) ponen de manifiesto que el dolor crónico afecta a uno de cada cinco (19 % de 46.000 encuestados) de los adultos, siendo una fuente de sufrimiento que impacta seriamente en su calidad de vida. Otros datos importantes que se desprenden del estudio muestran que dos de cada tres pacientes de dolor crónico informan que su control del dolor es a veces inadecuado. El informe destaca que el dolor es un síntoma que puede asumir enormes ramificaciones cuando se consideran las demandas en salud desde una perspectiva biopsicosocial. El dolor crónico es una enfermedad con entidad propia y como tal debe tratars

Efectos de la intervención psicológica en dolor y el estado emocional de personas con fibromialgia

Objective: This work tries to evaluate the effectiveness of a protocol of group psychological treatment, cognitive-behavioral direction in patients with fibromyalgia (SFM). Method: Forty-eight women with SFM completed an initial evaluation and final "Interview to Patients of Pain" adapted Phillips (1988) "Inventory of Anxiety of Beck" from Beck et al. (1988); "Inventory of Depression of Beck" from Beck et al. (1961) adaptation from Count et al. (1976); "Questionnaire of Reinforcements" from Phillamy and Lewinsohn (1971), adaptation from Cheek et al. (1979); "Visual Analogical Scale of the Pain"; "Inventory of the Concept of Itself" from McKay and Fanning (1987). Results: The data show significant differences after the intervention, in values of anxiety, depression, and pain and show an increase of activities in the daily life. Conclusions: These data support the validity of the psychological intervention in the boarding of the fibromyalgia.Objetivo: Este trabajo ha evaluado la efectividad de un protocolo de tratamiento psicológico grupal, orientación cognitivo-conductual en pacientes con fibromialgia (SFM). Método: Cuarenta y ocho mujeres con SFM completaron una evaluación inicial y final "Entrevista a Pacientes de Dolor" adaptada de Phillips (1988) "Inventario de Ansiedad de Beck"de Beck y cols. (1988); "Inventario de Depresión de Beck" de Beck y cols. (1961) adaptación de Conde y cols. (1976); "Cuestionario de Refuerzos" de Phillamy y Lewinsohn (1971), adaptación de Carrillo y cols. (1979); "Escala Analógica Visual del Dolor"; "Inventario del Concepto de Sí Mismo" de McKay y Fanning (1987). Resultados: Los datos muestran diferencias significativas después de la intervención, en valores de ansiedad, depresión, dolor y un incremento de actividades en la vida diaria. Conclusiones: Estos datos apoyan la validez de la intervención psicológica en el abordaje de la fibromialgia

Evaluación y preparación psicológicas de los pacientes candidatos a terapias implantables para tratamiento del dolor crónico

Electric neurostimulation techniques along with intrathecal drugs infusión techniques are of choice for the treatment of chronic pain refractory to other therapies. An indiscriminate selection of patients, or their incomplete assessment, leads to increase the rate of implantation failure, and therefore of therapeutic failures. Most of experts agreed that psychological factors of the patient with chronic pain should be evaluated as part of the interventional pain management before and after to carry out the implant in the frame of a multidisciplinary approach. In this article, we propose to perform not only the psychological assessment but also a training of the patients so they face up this particular situation and that permit them to obtain better therapeutic results. Why is important to accomplish a psychological assessment, when and how should has to be done, and which are the particular profile for each one of the techniques, are other topics discussed here. We have reasons to believe that psychological training for the patient with chronic pain candidate to interventional therapy with implantable systems could be an important goal to bear in mind before and after to perform the implant for those patients with better adaptative prognostic profile.Las técnicas de neuroestimulación eléctrica Junto con las técnicas de infusión intratecal de fármacos, son el abordaje de elección para el tratamiento del dolor crónico refractario a otras terapias. La selección indiscriminada de pacientes, o la evaluación incompleta de éstos, conduce a un mayor número de fracasos del implante y por tanto de la terapia. La mayoría de expertos coinciden en que los factores psicológicos del paciente con dolor crónico deberían ser evaluados como parte de la intervención terapéutica antes y después de la realización de técnica en el marco de un abordaje multidisciplinar. En este artículo proponemos que además de la valoración se debería realizar la preparación psicológica de los pacientes para que afronten esta situación y obtener un mayor beneficio terapéutico. Se aborda también el papel que desempeña el psicólogo dentro del equipo, por qué es importante realizar una evaluación psicológica, cómo y cuándo debería tener lugar, así como las características específicas de ambas técnicas de neuromodulación. Creemos que la preparación psicológica del paciente con dolor crónico candidato al tratamiento mediante sistemas implantables podría ser un objetivo importante a tener en cuenta antes y después de las técnicas de implante para aquellos pacientes con mejor pronóstico de adaptación

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit