Health professionals facing bad news: learning to communicate

Comunicación oral presentada en la Segunda Conferencia Internacional de Comunicación en Salud, celebrada el 23 de octubre de 2015 en la Universidad Carlos III de MadridIntroducción: la comunicación es el único proceso por el que el profesional de la salud puede trasmitir la información de estado/situación al paciente y/o familiares, favoreciendo la alianza terapéutica. Sin embargo nos encontramos con situaciones en el que la comunicación se dificulta por la información a trasmitir: malas noticias. La forma de realizarla puede ser muy variada, pero el que sea la adecuada depende de la situación y de la persona que trasmite como la que recibe. Objetivos: identificar y determinar los métodos utilizados por los profesionales de la salud, ante la comunicación de las malas noticias, así como plantear mejoras de actuación mediante la creación de protocolos generalistas ante la transmisión de las mismas. Metodología: revisión bibliográfica de publicaciones comprendidas entre 1998 y 2015. Resultados y discusión: análisis de 20 artículos. Profesionales, caso de enfermería, van ganando terreno en la comunicación de malas noticias. Sin embargo, dentro del Área de la Salud, existen otros profesionales también capacitados para la comunicación de malas noticias, apostando para ello por un trabajo multidisciplinar. Se han encontrado protocolo de actuación ante la comunicación de malas noticias como son el “SPIKES” y el “ABCDE”, así como otros adaptados. Conclusiones: actualmente es un desafío para los profesionales de la salud la comunicación de malas noticias, tarea exclusiva de los médicos, ello no exentos de controversias. No podemos obviar que los familiares y pacientes pasan más tiempo con otros profesionales, creándose lazos de bienestar, apoyo, confianza y recibiendo una continuidad de cuidados; profesionales capacitados y formados para comunicar las malas noticias. Un planteamiento desde un prisma multidisciplinar, evitándose el enfoque paternalista, respetando derechos del paciente, resaltando la importancia que el proceso de comunicación profesional-paciente y por ende reduciendo las consecuencias del modelo actual: reclamaciones y sentencias legales por no realizarse de la manera adecuada

Reduced heart rate variability predicts fatigue severity in individuals with chronic fatigue syndrome/myalgic encephalomyelitis

Heart rate variability (HRV) is an objective, non-invasive tool to assessing autonomic dysfunction in chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). People with CFS/ME tend to have lower HRV; however, in the literature there are only a few previous studies (most of them inconclusive) on their association with illness-related complaints. To address this issue, we assessed the value of different diurnal HRV parameters as potential biomarker in CFS/ME and also investigated the relationship between these HRV indices and self-reported symptoms in individuals with CFS/ME. In this case-control study, 45 female patients who met the 1994 CDC/Fukuda definition for CFS/ME and 25 age- and gender-matched healthy controls underwent HRV recording-resting state tests. The intervals between consecutive heartbeats (RR) were continuously recorded over three 5-min periods. Time- and frequency-domain analyses were applied to estimate HRV variables. Demographic and clinical features, and self-reported symptom measures were also recorded. CFS/ME patients showed significantly higher scores in all symptom questionnaires (p < 0.001), decreased RR intervals (p < 0.01), and decreased HRV time- and frequency-domain parameters (p < 0.005), except for the LF/HF ratio than in the healthy controls. Overall, the correlation analysis reached significant associations between the questionnaires scores and HRV time- and frequency-domain measurements (p < 0.05). Furthermore, separate linear regression analyses showed significant relationships between self-reported fatigue symptoms and mean RR (p = 0.005), RMSSD (p = 0.0268) and HFnu indices (p = 0.0067) in CFS/ME patients, but not in healthy controls. Our findings suggest that ANS dysfunction presenting as increased sympathetic hyperactivity may contribute to fatigue severity in individuals with ME/CFS. Further studies comparing short- and long-term HRV recording and self-reported outcome measures with previous studies in larger CFS/ME cohorts are urgently warranted

Family background of students at risk of early school leaving by family typology

La problemática del Abandono Escolar Temprano (AET) es actualmente una de las mayores preocupaciones para las distintas administraciones educativas españolas. En este artículo pretendemos dar a conocer la percepción que tiene el alumnado en riesgo o no de abandono escolar temprano sobre las competencias personales del padre y de la madre, la supervisión educativa así como de la comunicación con ellos. Asimismo examinaremos qué dimensiones del contexto familiar predicen el riesgo de abandono escolar temprano según la tipología familiar. Esto nos va a permitir poner en marcha en los centros escolares programas de educación parental, basados en evidencias, que promuevan en los padres y las madres las competencias parentales y contribuya a disminuir el riesgo de AET. La muestra se compone de un total de 3574 alumnos/as de Educación Secundaria Obligatoria de las Islas Canarias y de 2229 familias de estos alumnos/as. Para la recogida de datos se han empleado en esta investigación diferentes escalas: competencias parentales, comunicación padres-madres/hijos-hijas y supervisión parental. De los resultados obtenidos acerca de cómo percibe el alumnado las competencias parentales tanto del padre como de la madre, se constata que el alumnado en riesgo de AET, a diferencia del que no lo está, informa que ambos progenitores tienen menos competencias en desarrollo personal y resiliencia y en organización del escenario educativo familiar y competencia educativa. Asimismo, dicho alumnado también señala que tiene una mayor comunicación violenta con ambos padres, así como una menor comunicación abierta con la madre. Por su parte, los padres y las madres de los/las hijos/as que están en riesgo de AET, informan de llevar a cabo una menor supervisión educativa sobre sus hijos/as. Finalmente, mostramos dos modelos explicativos que predicen la continuidad escolar o el AET a través del rendimiento académico según la tipología familiar, tanto para familias heteroparentales como monoparentales. Para dar una respuesta educativa eficaz en la prevención del riesgo de AET, proponemos la implementación en los centros escolares de programas grupales de educación parental, que sigan una metodología experiencial y que estén basados en evidencias.The problem of Early School Leaving (ESL) is currently one of the biggest concerns for the different Spanish educational authorities. This article aims to present the perception of the students at risk of ESL on the personal skills of father and mother, the educational supervision and communication with them. Also we examine what variables of the family context predict the risk of early school leavers according to family typology. This will allow us to implement parent education programs in schools, evidence-based, to promote parenting skills of fathers and mothers and help reduce the risk of ESL. The sample consists of a total of 3574 students of Secondary Education of the Canary Islands and 2229 families of these students. For data collection they have been used in this research different scales: parenting skills, communication parents / children and parental supervision. In relation to the perception of students about parenting skills, students at risk of ESL reports that both parents have fewer skills and personal development resilience and organization of family educational setting and educational competence. Students have also a more violent communication with both parents, as well as less open communication with the mother. Meanwhile, parents of students who are at risk of ESL report conducting lower educational supervision over their children. Finally, we show two explanatory models predicting educational continuity or ESL through academic performance, according to family typology, both heteroparental as single parents. To provide an effective educational response in prevention of ESL, we propose the implementation in schools of group parent education programs; these programs are based on an experiential methodology and on evidences.Universidad de Granada. Departamento de Didáctica y Organización Escolar. Grupo FORCE (HUM-386

Convolution-based free-form deformation for multimodal groupwise registration

Producción CientíficaRecently, an efficient implementation of convolution-based free form deformations (FFD) has been proposed for both groupwise 3D monomodal and 2D pairwise multimodal registrations. However, there is still an unmet need in the field for groupwise -D multimodal registration with L > 2. In this correspondence, we address this need and present a solution for achieving accurate registration using two popular metrics: Renyi entropy and PCA2.Ministerio de Economía, Industria y Competitividad (TEC2017-82408-R and PID2020-115339RB-I00)ESAOTE Ltd. (18IQBM

Efficient convolution-based pairwise elastic image registration on three multimodal similarity metrics

Producción CientíficaThis paper proposes a complete convolutional formulation for 2D multimodal pairwise image registration problems based on free-form deformations. We have reformulated in terms of discrete 1D convolutions the evaluation of spatial transformations, the regularization term, and their gradients for three different multimodal registration metrics, namely, normalized cross correlation, mutual information, and normalized mutual information. A sufficient condition on the metric gradient is provided for further extension to other metrics. The proposed approach has been tested, as a proof of concept, on contrast-enhanced first-pass perfusion cardiac magnetic resonance images. Execution times have been compared with the corresponding execution times of the classical tensor product formulation, both on CPU and GPU. The speed-up achieved by using convolutions instead of tensor products depends on the image size and the number of control points considered, the larger those magnitudes, the greater the execution time reduction. Furthermore, the speed-up will be more significant when gradient operations constitute the major bottleneck in the optimization process.Ministerio de Economía, Industria y Competitividad (grants TEC2017-82408-R and PID2020-115339RB-I00)ESAOTE Ltd (grant 18IQBM

Fast 4D elastic group-wise image registration. Convolutional interpolation revisited

Background and Objective:This paper proposes a new and highly efficient implementation of 3D+t groupwise registration based on the free-form deformation paradigm. Methods:Deformation is posed as a cascade of 1D convolutions, achieving great reduction in execution time for evaluation of transformations and gradients. Results:The proposed method has been applied to 4D cardiac MRI and 4D thoracic CT monomodal datasets. Results show an average runtime reduction above 90%, both in CPU and GPU executions, compared with the classical tensor product formulation. Conclusions:Our implementation, although fully developed for the metric sum of squared differences, can be extended to other metrics and its adaptation to multiresolution strategies is straightforward. Therefore, it can be extremely useful to speed up image registration procedures in different applications where high dimensional data are involved.MEC-TEC2017-82408-

Pandemic and post-pandemic Influenza A (H1N1) infection in critically ill patients

Background: There is a vast amount of information published regarding the impact of 2009 pandemic Influenza A (pH1N1) virus infection. However, a comparison of risk factors and outcome during the 2010-2011 post-pandemic period has not been described. Methods: A prospective, observational, multi-center study was carried out to evaluate the clinical characteristics and demographics of patients with positive RT-PCR for H1N1 admitted to 148 Spanish intensive care units (ICUs). Data were obtained from the 2009 pandemic and compared to the 2010-2011 post-pandemic period. Results: Nine hundred and ninety-seven patients with confirmed An/H1N1 infection were included. Six hundred and forty-eight patients affected by 2009 (pH1N1) virus infection and 349 patients affected by the post-pandemic Influenza (H1N1)v infection period were analyzed. Patients during the post-pandemic period were older, had more chronic comorbid conditions and presented with higher severity scores (Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA)) on ICU admission. Patients from the post-pandemic Influenza (H1N1)v infection period received empiric antiviral treatment less frequently and with delayed administration. Mortality was significantly higher in the post-pandemic period. Multivariate analysis confirmed that haematological disease, invasive mechanical ventilation and continuous renal replacement therapy were factors independently associated with worse outcome in the two periods. HIV was the only new variable independently associated with higher ICU mortality during the post-pandemic Influenza (H1N1)v infection period. Conclusion: Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection

Relationship Between Bone Mineral Density and Angiotensin Converting Enzyme Polymorphism in Hypertensive Postmenopausal Women

Producción CientíficaThe purpose of this study was to assess the relationship between bone mineral density and insertion/ deletion (I/D) angiotensin converting enzyme polymorphism (ACE) in hypertensive postmenopausal women.2015-09-0

Experimental Techniques to Measure Hypnotic Levels During Surgery

[Abstract] The administration of anesthetics during a surgical procedure has been done historically in a manual way with the anesthesiologist deciding what amounts and at what rates to use. Over the last few decades there has been a rapid increase in the automation of many medical areas including anesthesiology, with that increased level of automation have also appeared new ways to measure the level of sedation in patients. Historically, one of the most frequently index used has been the BIS, which has proven rather reliable as an indicator. More recently, another index called PSI has attracted interest of practitioners. In this article a comparison of these two indexes was performed. Data recording BIS and PSI values from surgical operations for several patients were collected and analyzed. The results seem to indicate that it is to be expected that in 95% of the cases the correlation between the BIS and PSI index will be at least 0.6866.This work has been supported by the grant DPI2010-18278 of the Spanish Governmenthttps://doi.org/10.17979/spudc.978849749808

Risk factors for recurrence after robot-assisted radical hysterectomy for early-stage cervical cancer: a multicenter retrospective study

This retrospective analysis aimed to assess the risk factors for recurrence in patients diagnosed with early-stage cervical cancer (≤IB1 or IIA1, FIGO 2009) undergoing robot-assisted radical hysterectomy in Spain and Portugal between 2009 and 2018. A second primary objective was to audit the oncological outcomes according to quality indicators (QI) proposed by the European Society of Gynecology Oncology (ESGO). The study population included 239 women. After a median follow-up of 51 months, recurrence occurred in 26 patients (10.9%). Independent factors for recurrence were clinical tumor size > 20 mm (hazard ratio (HR) 2.37), adenocarcinoma as histological type (HR 2.51), positive pelvic lymph nodes (HR 4.83), tumor grade 2 (HR 4.99), tumor grade 3 (HR 8.06), and having not performed sentinel lymph node biopsy (SLNB) (HR 4.08). All 5 QI selected were surpassed by our results. In patients with early-stage cervical cancer undergoing robotic radical hysterectomy, clinicians should be aware that tumor grade 2 and 3, tumor size > 20 mm, adenocarcinoma, positive pelvic nodes, and lack of performance of SLNB are risk factors for recurrence. Fulfillment of QI targets of the ESGO might be considered as an objective oncological outcome indicator supporting the minimally invasive approach for early-stage cervical cancer treatment. KEYWORDS: early-stage cervical cancer; oncological outcome; radical hysterectomy; recurrence; robotic surgery