Sobre l’elaboració del passat infantil en l’aquí i l’ara de la sessió

En aquest article es revisen alguns aspectes de la tècnica de Betty Joseph relacionats amb la seva forma de comprendrel’aquí i l’ara en el dia a dia de l’anàlisi. Amb la intenciód’il·lustrar aquest aspecte, es comenten uns fragments del’anàlisi d’una pacient que havia viscut una situaciótraumàtica a la infància. Finalment, es relaciona el materialclínic aportat amb diferents aspectes teòrics i tècnics de l’obrade Betty Joseph, en especial sobre l’ús del passat en la sessió

Metodología de la investigación y cine comercial: claves de una experiencia docente

Introducción: El cine se ha configurado, ya desde sus inicios, como una de las recreaciones humanas más extraordinarias que existen desde la perspectiva de la comunicación. Objetivo: El objetivo de este texto es presentar una experiencia docente en la que se empleó cine comercial (CC) en el desarrollo de la asignatura optativa"Investigación en salud: métodos y técnicas", que se imparte en la Escuela de Enfermería de la Universitat de Barcelona. Desarrollo: Los contenidos de esta asignatura son los habituales en los cursos de investigación, y lo más interesante fue el empleo del CC, que se convirtió en el material (objeto) de estudio. En el transcurso de la asignatura, el alumno debía realizar una serie de actividades: revisión bibliográfica, preparación de un cuestionario, selección y visualización de una película de la que debía elaborar la correspondiente ficha técnica y un informe sobre los aspectos referidos a la enfermedad, el paciente, los profesionales y los valores, sentimientos y emociones asociados al problema de salud. Conclusiones: La experiencia puso de manifiesto la importancia de la observación atenta de las escenas para captar los mensajes no verbales relacionados con el problema de salud; la necesidad de adquirir habilidades para el manejo de las bases de datos bibliográfi cas (Medline, CINAHL, etc.), y la conveniencia de una mayor formación en el lenguaje cinematográfico para un mejor aprovechamiento didáctico del CC

Predictors of Global Non-Motor Symptoms Burden Progression in Parkinson's Disease. Results from the COPPADIS Cohort at 2-Year Follow-Up

Malaltia de Parkinson; Símptomes no motors; ProgressióEnfermedad de Parkinson; Sintomas no motores; ProgresiónParkinson’s disease; Non-motor symptoms; ProgressionBackground and Objective: Non-motor symptoms (NMS) progress in different ways between Parkinson’s disease (PD) patients. The aim of the present study was to (1) analyze the change in global NMS burden in a PD cohort after a 2-year follow-up, (2) to compare the changes with a control group, and (3) to identify predictors of global NMS burden progression in the PD group. Material and Methods: PD patients and controls, recruited from 35 centers of Spain from the COPPADIS cohort from January 2016 to November 2017, were followed-up with after 2 years. The Non-Motor Symptoms Scale (NMSS) was administered at baseline (V0) and at 24 months ± 1 month (V2). Linear regression models were used for determining predictive factors of global NMS burden progression (NMSS total score change from V0 to V2 as dependent variable). Results: After the 2-year follow-up, the mean NMS burden (NMSS total score) significantly increased in PD patients by 18.8% (from 45.08 ± 37.62 to 53.55 ± 42.28; p < 0.0001; N = 501; 60.2% males, mean age 62.59 ± 8.91) compared to no change observed in controls (from 14.74 ± 18.72 to 14.65 ± 21.82; p = 0.428; N = 122; 49.5% males, mean age 60.99 ± 8.32) (p < 0.0001). NMSS total score at baseline (β = −0.52), change from V0 to V2 in PDSS (Parkinson’s Disease Sleep Scale) (β = −0.34), and change from V0 to V2 in NPI (Neuropsychiatric Inventory) (β = 0.25) provided the highest contributions to the model (adjusted R-squared 0.41; Durbin-Watson test = 1.865). Conclusions: Global NMS burden demonstrates short-term progression in PD patients but not in controls and identifies worsening sleep problems and neuropsychiatric symptoms as significant independent predictors of this NMS progression.This research was funded by Fundación Española de Ayuda a la Investigación en Parkinson y otras Enfermedades Neuro-degenerativa

Predictors of clinically significant quality of life impairment in Parkinson’s disease

Parkinson's disease; Quality of lifeEnfermedad de Parkinson; Calidad de vidaMalaltia de Parkinson; Qualitat de vidaQuality of life (QOL) plays an important role in independent living in Parkinson’s disease (PD) patients, being crucial to know what factors impact QoL throughout the course of the disease. Here we identified predictors of QoL impairment in PD patients from a Spanish cohort. PD patients recruited from 35 centers of Spain from the COPPADIS cohort from January 2016, to November 2017, were followed up during 2 years. Health-related QoL (HRQoL) and global QoL (GQoL) were assessed with the 39-item Parkinson’s disease Questionnaire (PDQ-39) and the EUROHIS-QOL 8-item index (EUROHIS-QOL8), respectively, at baseline (V0) and at 24 months ± 1 month (V2). Clinically significant QoL impairment was defined as presenting an increase (PDQ-39SI) or decrement (EUROHIS-QOL8) at V2 ≥ 10% of the score at baseline (V0). A comparison with a control group was conducted for GQoL. GQoL did not change significantly in PD patients (N = 507; p = 0.686) or in the control group (N = 119; p = 0.192). The mean PDQ-39SI was significantly increased in PD patients (62.7 ± 8.5 years old; 58.8% males; N = 500) by 21.6% (from 16.7 ± 13 to 20.3 ± 16.4; p < 0.0001) at V2. Ninety-three patients (18.6%) presented a clinically significant HRQoL impairment at V2. To be younger (OR = 0.896; 95% CI 0.829–0.968; p = 0.006), to be a female (OR = 4.181; 95% CI 1.422–12.290; p = 0.009), and to have a greater increase in BDI-II (Beck Depression Inventory-II) (OR = 1.139; 95% CI 1.053–1.231; p = 0.001) and NMSS (Non-Motor Symptoms Scale) (OR = 1.052; 95% CI 1.027–1.113; p < 0.0001) total scores from V0 to V2 were associated with clinically significant HRQoL impairment at the 2-year follow-up (Hosmer–Lemeshow test, p = 0.665; R 2 = 0.655). An increase in ≥5 and ≥10 points of BDI-II and NMSS total score at V2 multiplied the probability of presenting clinically significant HRQoL impairment by 5 (OR = 5.453; 95% CI 1.663–17.876; p = 0.005) and 8 (OR = 8.217; 95% CI, 2.975–22.696; p = 0.002), respectively. In conclusion, age, gender, mood, and non-motor impairment were associated with clinically significant HRQoL impairment after the 2-year follow-up in PD patients

Voriconazole Use in Children : Therapeutic Drug Monitoring and Control of Inflammation as Key Points for Optimal Treatment

Voriconazole plasma concentrations (PC) are highly variable, particularly in children. Dose recommendations in 2-12-year-old patients changed in 2012. Little data on therapeutic drug monitoring (TDM) after these new recommendations are available. We aimed to evaluate voriconazole monitoring in children with invasive fungal infection (IFI) after implementation of new dosages and its relationship with safety and effectiveness. A prospective, observational study, including children aged 2-12 years, was conducted. TDM was performed weekly and doses were changed according to an in-house protocol. Effectiveness, adverse events, and factors influencing PC were analysed. A total of 229 PC from 28 IFI episodes were obtained. New dosing led to a higher rate of adequate PC compared to previous studies; still, 35.8% were outside the therapeutic range. In patients aged < 8 years, doses to achieve therapeutic levels were higher than recommended. Severe hypoalbuminemia and markedly elevated C-reactive protein were related to inadequate PC. Therapeutic PC were associated with drug effectiveness and safety. Higher doses in younger patients and a dose adjustment protocol based on TDM should be considered. Voriconazole PC variability has decreased with current updated recommendations, but it remains high and is influenced by inflammatory status. Additional efforts to control inflammation in children with IFI should be encouraged