The impact of breast reconstruction on self-esteem and body image in patients with breast cancer

El tratamiento quirúrgico del cáncer de mama puede alterar el aspecto físico de las pacientes y producirles importantes secuelas psicológicas. Para comprobar si el nivel de satisfacción con el resultado estético, así como la autoestima o la imagen corporal de estas pacientes difería según el tipo de cirugía realizada (mastectomía unilateral o reconstrucción mamaria), se estudiaron un total de 72 pacientes. Para ello, se emplearon una Encuesta Psicosocial, la Escala de Autoestima de Rosenberg (EAR), el Cuestionario de Calidad de Vida de la EORTC (QLQ-BR23) y el Test de Medición del Grado de Satisfacción Corporal. En general, las pacientes reconstruidas mostraron una mayor satisfacción estética, así como una mayor autoestima y un menor deterioro de su imagen corporal.The surgical treatment of breast cancer can change patients’ physical appearance and lead to important physical sequelae. Therefore, in order to ascertain whether the level of satisfaction with the aesthetic outcome, as well as with regard to self-esteem or the body image in these patients, differs depending on the kind of surgery undergone (unilateral mastectomy or breast reconstruction), a total of 72 patients were studied. To this end, a Psychosocial Survey, the Rosenberg Self-Esteem (RSE) Scale, the EORTC Quality of Life Questionnaire (QLQ-BR23), and the Test for the Measurement of Body Satisfaction were used. In general, patients who underwent reconstruction showed a higher degree of aesthetic satisfaction, as well as greater self-esteem and a lower degree of dissatisfaction regarding their body imag

Diferencias psicológicas en pacientes con cáncer de mama, según el tipo de cirugía mamaria

Las pacientes con cáncer de mama pueden experimentar importantes secuelas psicológicas producidas por la mastectomía, considerándose la reconstrucción mamaria como un procedimiento reversivo de las mismas. Para conocer si la sintomatología ansiosa y depresiva, las estrategias de afrontamiento empleadas o la calidad de vida manifestada por las pacientes, difiere de unas a otras según el tipo de cirugía realizada (mastectomía unilateral o reconstrucción mamaria) se estudiaron 2 grupos. Un primer grupo formado por 36 pacientes sometidas a mastectomía unilateral (simple o radical modificada) y un segundo grupo constituido por 36 mujeres con reconstrucción mamaria postmastectomía (inmediata o diferida). Para la evaluación psicológica se empleó una Encuesta Psicosocial, junto a la Escala de Ansiedad y Depresión en Hospital (HAD), la Escala de Afrontamiento del Cáncer (MAC) y el Cuestionario de Calidad de Vida para Cáncer de la EORTC (QLQ-C30). En general, las pacientes mastectomizadas presentaron una mayor presencia de sintomatología ansiosa y depresiva que las pacientes con reconstrucción mamaria postmastectomía. Igualmente, las pacientes con reconstrucción mamaria emplearon estrategias de afrontamiento más eficaces y gozaron de una mayor calidad de vida que las mujeres mastectomizadas.Breast cancer patients could experiment an important reduction in psychological adjustment due to mastectomy. So, breast reconstruction is considered a procedure to reverse the sequels of breast mastectomy. Two groups were evaluated in order to determine if anxiety and depression symptoms, coping style and quality of life in breast cancer patients are different for each kind of patient, according to the type of surgery (mastectomy or breast reconstruction). A first group was made up of 36 patients with breast cancer who had undergone unilateral mastectomy (simple or modified radical) and the second group was formed by 36 patients with breast reconstruction postmastectomy (immediate or delayed). This study used a psychosocial survey, the Hospital Anxiety and Depression Scale (HAD), Mental Adjustment to Cancer Scale (MAC), and The EORTC QLQ-C30 for the evaluation. In general, mastectomy patients showed higher symptoms of anxiety and depression than the breast reconstruction patients. In the same way, breast reconstruction patients develops more effective coping strategies and reports better quality of life than breast mastectomy patients

Self-reported psychological development in cosmetic breast surgery patients

Cosmetic breast surgery is the only therapeutic alternative for psychological and physical complications associated with micromasty, breast ptosis, and macromasty. We analyzed the effects of 2 variables, time, and type of cosmetic breast surgery, on anxiety symptomatology and quality of life. Following a mixed 3x4 design, 3 groups of women with breast augmentation (n=63), mastopexy (n=42), and breast reduction (n=30) were selected and evaluated using the State-Trait Anxiety Inventory and the 12-Item Short-Form Health Survey at 4 different times, the preoperative stage, and at 1, 6, and 12 months postoperative. Pearson’s chi square, Welch’s U, Games-Howell tests, mixed analysis of variance, and Cohen’s d and w for effect size were calculated. Results relating to anxiety (state and trait) showed that the time factor was significant (P<0.001) with differences between the preoperative stage (higher anxiety levels) and the 3 postoperative stages: at 1 month (P<0.001), 6 months (P<0.001), and 12 months (P<0.001). In quality of life, type of surgery and time factors were found to have interactive effects on vitality (P=0.044) and role-emotional (P=0.023) dimensions. Compared to the other 2 groups, women who had undergone mastopexy felt worse (vitality) at 1 month since surgery than in the other stages, and better at 6 months since surgery (role-emotional). In the rest of the dimensions, and focusing on the most relevant effect sizes, the type of surgery made a difference in the physical functioning (P=0.005) and role-physical (P=0.020) dimensions, where women who had had breast reduction felt worse than those who had had augmentation. Time also resulted in differences in the physical functioning (P<0.001), role-physical (P<0.001), and bodily pain (P<0.001) dimensions, where women felt worse at 1 month since surgery than during the rest of the stages, as well as in the social functioning dimension (P<0.001) at 1 month, compared to 6 months postoperative. We conclude that in the long term, women who have cosmetic breast surgery recover their physical and psychological well-bein

Hemocultivos…, ¿Qué te han contado y qué haces?.

Aims:Main aim: To ascertain differences in nurses at the Hospital General Nuestra Señora del Prado, in blood extraction and blood culture techniques.Specific aims: To determine the asepsis/sterility conditions of the technique; to establish the use (disinfection, filling order, volume, needle change) of the blood culture vials.Method:Transversal descriptive study made at the Hospital General Nuestra Señora del Prado. A self-completion questionnaire including quantitative and qualitative variants was delivered to nursing professionals.Results:52.9% of the questionnaires were collected from the 363 DUE´s at the hospital. Mena working experience was 12.9 years [DE±7,9]. 57,8% believe sterile technique for the procedure was not necessary. 94.7% use a single antiseptic. 78.6% stated that they discard the first 10 cc extracted from the central vein.Conclusions:We consider that the response is high, with over 40% of the questionnaires being completed. We observed that most DUE´s use aseptic techniques and in the protocols studied there was no consensus about the use of sterilization and septic techniques. The study reveals that the majority of the DUE´s use a single antiseptic, even though most protocols recommend the use of alcohol, followed by povidone.iodine to disinfect the skin.Objetivo:Objetivo principal: Conocer la variabilidad práctica de los enfermeros/as (DUE´s) del Hospital General Nuestra Señora del Prado, sobre la técnica para la extracción de hemocultivo.Objetivos específicos: Determinar las condiciones de asepsia/ esterilidad de la técnica. Establecer la utilización (desinfección, orden de llenado, volumen, cambio de aguja) de los frascos de hemocultivos.Método: Estudio descriptivo transversal realizado en el Hospital General Nuestra Señora del Prado. Ha consistido en la entrega de un cuestionario para autocumplimentación a los profesionales de enfermería, donde se han incluido variantes tanto cuantitativas como cualitativas.Resultados: Se ha recogido 52,9% encuestas de los 363 DUE´s del centro hospitalario, con una experiencia profesional media de 12,9 años [DE±7,9]. El 57,8% cree que no es necesario técnica estéril para el procedimiento. 94,7% utiliza un único antiséptico. 78,6% afirman que en la extracción de acceso venoso central desecha los primeros 10cc que extrae.Conclusiones: Consideramos un alto índice de respuesta,  ya que es superior al 40% para cuestionarios autocumplimentados. Hemos observado que la mayoría de DUE´s utilizan técnica aséptica y en los protocolos estudiados no existe un consenso entre la utilización de técnica estéril y aséptica. Este estudio nos revela que la mayoría de los DUE´s utilizan un único antiséptico, sin embargo la mayoría de los protocolos recomiendan la utilización primero de alcohol y luego povidona yodada para la desinfección de la piel

Enhanced mitochondrial activity reshapes a gut microbiota profile that delays NASH progression

[EN] Background and Aims: Recent studies suggest that mitochondrial dysfunction promotes progression to NASH by aggravating the gut-liver status. However, the underlying mechanism remains unclear. Herein, we hypothesized that enhanced mitochondrial activity might reshape a specific microbiota signature that, when transferred to germ-free (GF) mice, could delay NASH progression. Approach and Results: Wild-type and methylation-controlled J protein knockout (MCJ-KO) mice were fed for 6 weeks with either control or a choline-deficient, L-amino acid–defined, high-fat diet (CDA-HFD). One mouse of each group acted as a donor of cecal microbiota to GF mice, who also underwent the CDA-HFD model for 3 weeks. Hepatic injury, intestinal barrier, gut microbiome, and the associated fecal metabolome were then studied. Following 6 weeks of CDA-HFD, the absence of methylation-controlled J protein, an inhibitor of mitochondrial complex I activity, reduced hepatic injury and improved gut-liver axis in an aggressive NASH dietary model. This effect was transferred to GF mice through cecal microbiota transplantation. We suggest that the specific microbiota profile of MCJ-KO, characterized by an increase in the fecal relative abundance of Dorea and Oscillospira genera and a reduction in AF12, Allboaculum, and [Ruminococcus], exerted protective actions through enhancing short-chain fatty acids, nicotinamide adenine dinucleotide (NAD+) metabolism, and sirtuin activity, subsequently increasing fatty acid oxidation in GF mice. Importantly, we identified Dorea genus as one of the main modulators of this microbiota-dependent protective phenotype. Conclusions: Overall, we provide evidence for the relevance of mitochondria–microbiota interplay during NASH and that targeting it could be a valuable therapeutic approach.S

C-Reactive Protein and Serum Albumin Ratio: A Feasible Prognostic Marker in Hospitalized Patients with COVID-19

Background: C-reactive protein (CRP) and albumin are inflammatory markers. We analyzed the prognostic capacity of serum albumin (SA) and CRP for an outcome comprising mortality, length of stay, ICU admission, and non-invasive mechanical ventilation in hospitalized COVID-19 patients. (2) Methods: We conducted a retrospective cohort study based on the Spanish national SEMI-COVID-19 Registry. Two multivariate logistic models were adjusted for SA, CRP, and their combination. Training and testing samples were used to validate the models. (3) Results: The outcome was present in 41.1% of the 3471 participants, who had lower SA (mean [SD], 3.5 [0.6] g/dL vs. 3.8 [0.5] g/dL; p < 0.001) and higher CRP (108.9 [96.5] mg/L vs. 70.6 [70.3] mg/L; p < 0.001). In the adjusted multivariate model, both were associated with poorer evolution: SA, OR 0.674 (95% CI, 0.551-0.826; p < 0.001); CRP, OR 1.002 (95% CI, 1.001-1.004; p = 0.003). The CRP/SA model had a similar predictive capacity (honest AUC, 0.8135 [0.7865-0.8405]), with a continuously increasing risk and cutoff value of 25 showing the highest predictive capacity (OR, 1.470; 95% CI, 1.188-1.819; p < 0.001). (4) Conclusions: SA and CRP are good independent predictors of patients hospitalized with COVID-19. For the CRP/SA ratio value, 25 is the cutoff for poor clinical course

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 17

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 17 de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada, de acceso abierto a todas las áreas del conocimiento, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico. Con esta colección, se aspira contribuir con el cultivo, la comprensión, la recopilación y la apropiación social del conocimiento en cuanto a patrimonio intangible de la humanidad, con el propósito de hacer aportes con la transformación de las relaciones socioculturales que sustentan la construcción social de los saberes y su reconocimiento como bien público

Gestión del conocimiento: perspectiva multidisciplinaria. Volumen 12

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 12, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro cuenta con el apoyo de los grupos de investigación: Universidad Sur del Lago “Jesús María Semprúm” (UNESUR), Zulia – Venezuela; Universidad Politécnica Territorial de Falcón Alonso Gamero (UPTAG), Falcón – Venezuela; Universidad Politécnica Territorial de Mérida Kleber Ramírez (UPTM), Mérida – Venezuela; Universidad Guanajuato (UG) - Campus Celaya - Salvatierra - Cuerpo Académico de Biodesarrollo y Bioeconomía en las Organizaciones y Políticas Públicas (C.A.B.B.O.P.P), Guanajuato – México; Centro de Altos Estudios de Venezuela (CEALEVE), Zulia – Venezuela, Centro Integral de Formación Educativa Especializada del Sur (CIFE - SUR) - Zulia - Venezuela, Centro de Investigaciones Internacionales SAS (CIN), Antioquia - Colombia.y diferentes grupos de investigación del ámbito nacional e internacional que hoy se unen para estrechar vínculos investigativos, para que sus aportes científicos formen parte de los libros que se publiquen en formatos digital e impreso

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