Funcionamiento familiar y adaptación psicológica en oncología.

The cancer experience is a process that affects the family, which is the primary support system and is disturbed to its normal performance, resulting psychological distress associated with cancer development. The screening process of emotional distress in relatives of cancer patients, involves the use of assessment strategies both quantitative and qualitative for determining whether the family support system has the knowledge, skills and attitudes necessary to provide care and maintain both patient herself. The study of relationship between family functioning and psychological adjustment was aimed to analyze how the functioning and family support would influence to its adaptation to the disease; for this goal, we analyzed the family type, its structure and psychological adjustment. The procedure is based on the application of a Questionnaire of social and demographic information, and test: Hospital Anxiety and Depression Scale, Family Relationship Index, Self-report Family Inventory and the APGAR-F. Study results let identified higher levels of emotional involvement in relatives group. As for family screening tests, there is considerable similarity in the results, to be seen in the three test that is a small percentage, the group of families that with characteristics of dysfunctional systems. Functional families had lower emotional involvement.La experiencia de la enfermedad oncológica es un proceso que afecta también al grupo familiar, que constituye el sistema de apoyo primario y que se ve perturbado en su normal funcionamiento previo, asociado al malestar psicológico consecuente con la aparición del cáncer. El proceso de screening de malestar emocional en familiares de pacientes oncológicos, implica el uso de estrategias evaluativas tanto cuantitativas, como cualitativas que permiten determinar si el sistema de apoyo familiar dispone del conocimiento, las habilidades y las actitudes necesarias para ofrecer y mantener cuidados tanto al paciente como a ella misma. El estudio de Relación entre Funcionamiento Familiar y Adaptación Psicológica, tuvo como objetivo analizar de qué manera el funcionamiento y el apoyo social de la familia influiría en la adaptación al proceso oncológico, para ello se analizó el tipo de familia, su estructura y el nivel de ajuste psicológico. El procedimiento se basó en la aplicación de una Encuesta de Información Sociodemográfica, y de los test: Escala de Ansiedad y Depresión Hospitalaria, Indice de Relaciones Familiares, Inventario Familiar de Autoinforme y el APGAR-F. Los resultados del estudio han permitido verificar niveles más elevados de afectación emocional en familiares. En cuanto a los test de screening familiar, existe bastante similitud en los resultados, al apreciarse en los tres test que es un porcentaje pequeño, el grupo de familias que cumple con las características de los sistemas disfuncionales. Las familias funcionales presentaron menor afectación emocional

Valoración de la eficacia de una terapia grupal cognitivoconductual en la imagen corporal, autoestima, sexualidad y malestar emocional (ansiedad y depresión) en pacientes de cáncer de mama

El cáncer de mama influye, al igual que su tratamiento, de manera significativa en aspectos psicológicos de las personas que han sido diagnosticadas y tratadas por esta enfermedad. Dentro de estos aspectos, cabe destacar los cambios que se producen en la imagen corporal, la autoestima y la sexualidad. El objetivo de este estudio es valorar la eficacia de un tratamiento psicológico grupal cognitivo-conductual en la triada imagen corporal autoestima-sexualidad, en el estado de ánimo y en la sintomatología ansiosa. Se evaluó a 38 mujeres libres de enfermedad que acuden a consultas de revisión del Hospital Universitario 12 de Octubre. Estas 38 mujeres se asignaron aleatoriamente al grupo experimental de tratamiento grupal y a una condición control sin tratamiento. Se llevó a cabo una evaluación pre y postratamiento en dos grupos, uno experimental y otro control, y se midieron las siguientes variables con los siguientes instrumentos: Depresión (Inventario de Depresión de Beck, —BDI—), Ansiedad de Estado (Cuestionario de Ansiedad Estado -STAI-E-), Autoestima (Escala de Autoestima de Rosenberg), e imagen corporal (Escala de Imagen Corporal de Hopwood), presencia/ausencia de problemas sexuales y la satisfacción sexual (tres preguntas de respuesta cerrada). El tratamiento grupal se compone de 9 sesiones con frecuencia semanal y con una duración de una hora y media cada una. Estas 9 sesiones fueron divididas en cuatro bloques de tratamiento: un módulo de estado de ánimo (2 sesiones), un módulo de imagen corporal y autoestima (4 sesiones), un módulo de sexualidad (2 sesiones) y un cuarto módulo de despedida donde se recogió la medida postratamiento. Los resultados muestran que el tratamiento produjo mejoras significativas en comparación con el grupo control en las puntuaciones del BDI (p=0,005), STAI-E (p=0,002), autoestima (p=0,001) e imagen corporal (p=0,014). Por lo tanto, se demuestra la eficacia del tratamiento cognitivo-conductual en grupo para la mejora de la autoestima, la imagen corporal y la sexualidad después de haber pasado por un cáncer de mama

Family functioning and psychological distress in oncology

The cancer experience is a process that affects the family, which is the primary support system and is disturbed to its normal performance, resulting psychological distress associated with cancer development. The screening process of emotional distress in relatives of cancer patients, involves the use of assessment strategies both quantitative and qualitative for determining whether the family support system has the knowledge, skills and attitudes necessary to provide care and maintain both patient herself. The study of relationship between family functioning and psychological adjustment was aimed to analyze how the functioning and family support would influence to its adaptation to the disease; for this goal, we analyzed the family type, its structure and psychological adjustment. The procedure is based on the application of a Questionnaire of social and demographic information, and test: Hospital Anxiety and Depression Scale, Family Relationship Index, Self-report Family Inventory and the APGAR-F. Study results let identified higher levels of emotional involvement in relatives group. As for family screening tests, there is considerable similarity in the results, to be seen in the three test that is a small percentage, the group of families that with characteristics of dysfunctional systems. Functional families had lower emotional involvement

Anti-Spike antibodies 3 months after SARS-CoV-2 mRNA vaccine booster dose in patients on hemodialysis: the prospective SENCOVAC study

Background: Patients on hemodialysis are at high-risk for complications derived from coronavirus disease 2019 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity 3 months after the booster dose. Methods: This is a multicentric and prospective study assessing immunoglobulin G anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results: A total of 711 patients [67% male, median age (range) 67 (20-89) years] were included. Of these, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, P =. 001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, P =. 693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated with mRNA-1273 booster (P =. 001), lower time from booster (P =. 043) and past breakthrough SARS-CoV-2 infection (P <. 001). Conclusions: In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated with mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infectionThe present project has been supported by Fresenius Medical Care, Diaverum, Vifor Pharma, Vircell, Fundación Renal Iñigo Álvarez de Toledo and ISCIII FEDER funds RICORS2040 (RD21/0005

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Atención al trauma grave : proceso asistencial integrado. 2ª ed

YesEl Proceso Asistencial Integrado (PAI) se ha reafirmado como una herramienta de mejora continua y ordenado los diferentes flujos de trabajo, integrando el conocimiento actualizado y mejorando los resultados en salud, gracias todo ello a la implicación de los profesionales y a su capacidad para introducir la idea de mejora continua en la calidad de sus procesos