Impacto de intervención de psicoterapia aplicada por enfermería para el control de la ansiedad en pacientes oncológicos

INTRODUCCIÓN: La enfermería de la Unidad de Hospital de Día desarrolla un papel fundamental en el control de la ansiedad del paciente onco-hematológico sometido a tratamiento quimioterápico. OBJETIVOS: Tratamos de demostrar la eficacia de una intervención de psicoterapia de apoyo (IPA) aplicada por enfermería en Hospital de Día en la reducción del nivel de ansiedad en pacientes sometidos a quimioterapia. Además se valoró el grado de respuesta del nivel de ansiedad de los pacientes a la IPA en función de diferentes variables clínico-sociodemográficas por medio de diferentes análisis secundarios. METODOLOGÍA: Se seleccionaron 150 pacientes consecutivos sometidos a ciclos de quimioterapia en nuestra institución entre junio de 2010 y febrero de 2011, aleatorizados en 2 grupos homogéneos: 75 con IPA durante la administración de tratamiento y 75 controles. Fueron excluidos aquellos con antecedentes/tratamiento de síndrome ansioso y/o puntuaciones de escala STAI (State-Trait Anxiety Inventory) >30 puntos. La IPA se aplicó durante 4 ciclos de tratamiento consecutivos, siempre previamente a la administración del tratamiento con quimioterapia. Se obtuvo la puntuación de la escala de ansiedad de Hamilton (HAS) antes de la administración del tratamiento y tras cada uno de los sucesivos ciclos de quimioterapia en ambos grupos. Otras variables clínico-sociodemográficas estudiadas fueron: edad, diagnóstico oncológico, sexo, nivel sociocultural, estado civil y número de hijos. Finalmente, se identificaron factores predictores de la respuesta a la IPA que permitiesen seleccionar el subgrupo de mejores candidatos a dicha intervención. RESULTADOS: La puntuación HAS inicial se correlacionó significativamente con la edad (r=-0.683; p<0.0001), así como un número de hijos menor y un nivel sociocultural alto. No existieron diferencias significativas entre sexos en el nivel de ansiedad inicial, así como tampoco para los diferentes tipos de diagnóstico oncológico o el estado civil. La IPA redujo la puntuación HAS significativamente en el grupo intervención de forma sostenida en todos los ciclos (reducción global entre ciclos 1º a 4º: 8.70 ± 5.72 puntos vs. 6.42 ± 5.54 puntos; p<0.014). La evolución del nivel de ansiedad a lo largo de los cuatro ciclos demostró diferencias significativas en las variables sociodemográficas edad, nivel sociocultural, número de hijos y estado civil, con tendencias análogas a las anteriormente expresadas. Las diferencias entre sexos fueron ligeras aunque no significativas para un nivel de ansiedad mayor de la población femenina. No existieron diferencias estadísticamente significativas entre los diferentes tipos de enfermedad oncológica incluidos. Se desarrolló un modelo identificador de los pacientes mejor respondedores a IPA según las variables sociodemográficas preintervención. Sin embargo, la puntuación HAS al inicio del tratamiento se demostró como mejor predictor independiente de la respuesta a la IPA (valor predictivo global 94%). CONCLUSIONES: En nuestra experiencia, la IPA realizada por enfermería ha demostrado ser una medida eficaz y eficiente en el control de la ansiedad de los pacientes oncológicos sometidos a quimioterapia en Unidad de Hospital de Día. Fueron identificados como predictores de mejor respuesta a IPA: edad joven, limitado apoyo conyugal, nivel de ansiedad inicial elevado y nivel sociocultural alto. La incorporación del protocolo de estudio, o similares, a la práctica cotidiana de la Unidad de Hospital de Día podría mejorar la atención ofrecida a nuestro enfermos oncológicos permitiendo un mejor control de la ansiedad relacionada con la enfermedad.INTRODUCTION: Nursery of Day Hospital Unit develops a key role in the control of anxiety of the oncohematologic patient undergoing chemotherapy treatment. AIMS: We sought to demonstrate the effectiveness of a support psychotherapy intervention (SPI) performed by nursery in a Day Hospital Unit controlling anxiety in patients undergoing chemotherapy treatment. Furthermore, the degree response patient’s anxiety level to SPI was assessed regarding different clinical and sociodemographic variables by means of secondary analysis. METHODS: One hundred and fifty consecutive patients receiving chemotherapy treatment were selected from our institution between June 2010 and February 2011. They were randomized into 2 homogeneous groups: 75 undergoing SPI during treatment and 75 controls. Those patients with background/treatment for anxiety and/or STAI (State-Trait Anxiety Inventory) scale score >30 points were excluded. SPI was performed during 4 consecutive cycles, always before starting chemotherapy treatment. Hamilton anxiety scale (HAS) score was obtained before the administration of the treatment and after each cycle of treatment in both groups. Other clinical and sociodemographic variables studied were: age, oncologic diagnose, gender, sociocultural level, marital status and number of children. Finally, different predicting factors of the response to SPI were identified in order to be able to select a subgroup of the best candidates to undergo this intervention. RESULTS: Initial HAS score was significantly correlated to age (r=-0.683; p<0.0001). A lower number of children and a higher sociocultural level were also related significantly to higher degrees of anxiety. No statistical differences were found among gender, type of oncologic diagnosis or marital status for the initial HAS score. SPI reduced sustained and significantly the HAS score along the different cycles of treatment (global reduction from cycle 1st to 4th: 8.70 ± 5.72 vs. 6.42 ± 5.54; p<0.014). The evolution of the anxiety level along the four cycles showed significative differences in sociodemogaphic variables age, sociocultural level, number of children and marital status, with analogue tendencies to the formerly expressed. Differences between genders were slight but not statistically significative with a sustained higher level of anxiety for female population. No statistically significative differences were found among the different oncologic diagnosis included. A model to identify those patients with better response to SPI was developed regarding the preintervention sociodemographic variables. However, initial HAS score showed to be the best independent predictor of the response to SPI (global predictive value 94%). CONCLUSIONS: In our experience, SPI performed by nursery has shown to be an effective and efficient measure in the control of anxiety in oncologic patients undergoing chemotherapy treatment in Day Hospital Unit. Predictors of better response to SPI were identified: younger age, limited marital support, higher initial anxiety levels and higher sociocultural level. The application of protocol study, or similar ones, to daily practice in Day Hospital Unit may improve attention offered to our oncologic patients allowing a better control of disease-related anxiety

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Structural and functional analysis of yeast Crh1 and Crh2 transglycosylases

Covalent cross-links between chitin and glucan at the yeast cell wall are created by the transglycosylase activity of redundant proteins Crh1 and Crh2, with cleavage of β-1,4 linkages of the chitin backbone and transfer of the generated molecule containing newly created reducing end onto the glucan acceptor. A three-dimensional structure of Crh1 was generated by homology modeling based on the crystal structure of bacterial 1,3-1,4-β-d-glucanase, followed by site-directed mutagenesis to obtain molecular insights into how these enzymes achieve catalysis. The residues of both proteins that are involved in their catalytic and binding activities have been characterized by measuring the ability of yeast cells expressing different versions of these proteins to transglycosylate oligosaccharides derived from β-1,3-glucan, β-1,6-glucan and chitin to the chitin at the cell wall. Within the catalytic site, residues E134 and E138 of Crh1, as well as E166 and E170 of Crh2, corresponding to the nucleophile and general acid/base, and also the auxiliary D136 and D168 of Crh1 and Crh2, respectively, are shown to be essential for catalysis. Mutations of aromatic residues F152, Y160 and W219, located within the carbohydrate-binding cleft of the Crh1 model, also affect the transglycosylase activity. Unlike Crh1, Crh2 contains a putative carbohydrate-binding module (CBM18) of unknown function. Modeling and functional analysis of site-directed mutant residues of this CBM identified essential amino acids for protein folding and stability, as well as residues that tune the catalytic activity of Crh2.Ministerio de Economía, Comercio y EmpresaAgency for Science VEGA (Slovakia)Ministerio de Ciencia, Innovación y UniversidadesComunidad Autónoma de MadridDepto. de Microbiología y ParasitologíaFac. de FarmaciaTRUEpu

Macroevolution and climate changes: a global multi-family test supports the resource-use hypothesis in terrestrial mammals

Elisabeth S. Vrba’s resource-use hypothesis suggests that speciation in biomes subjected to successive expansion-contraction-fragmentation during periods of climatic change generates high frequency of species restricted to a single biome (stenobiomic species). We compiled biome occupation for all terrestrial mammals and, using Monte Carlo simulations, demonstrated that patterns of biome occupation are congruent with those predicted by the resource-use hypothesis. Biome specialists are much more speciose than expected by chance, while there are fewer moderate biome generalists than expected. Despite their scarcity, extreme eurybiomic lineages show significant overrepresentation, which suggests they are seldom affected by climate-related extinction processes. Additionally, stenobiomic species are concentrated in biomes placed at the extremes of the climatic gradient, such as equatorial rainforest, subtropical desert, steppe, and tundra. Although this pattern is fairly maintained across different mammalian families, highlighting its universality, our analysis also found great variability. Exceptions to the predictions of the resource-use hypothesis seem to be associated to biome climatic or geographical heterogeneity, which favours vicariance in some biomes not placed in extremes of the climatic gradient (tropical deciduous woodland, sclerophyllous woodland-shrubland), as well as life-history differences across taxa, which generates a stronger trend to specialisation in small body size lineages than in larger mammals

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study (Intensive Care Medicine, (2021), 47, 2, (160-169), 10.1007/s00134-020-06234-9)

The original version of this article unfortunately contained a mistake. The members of the ESICM Trials Group Collaborators were not shown in the article but only in the ESM. The full list of collaborators is shown below. The original article has been corrected