Las conductas negativas y el acoso psicológico: antecedentes y consecuentes en personal de enfermería y el papel de los testigos

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Psicología, Departamento de Psicología Biológica y de la Salud. Fecha de lectura 13 de diciembre de 201

Falta de Civismo no sítio de trabalho: um novo fator de estresse de trabalho

El siguiente trabajo presenta una revisión sobre el constructo "incivismo" en el lugar de trabajo. Se retoma el origen de este constructo, las definiciones, conceptos, diferencias con otros constructos de comportamientos contraproducentes en el trabajo, el proceso de escalada en forma de espiral que se puede dar para transformarse en otras formas más severas de conflicto laboral como mobbing, entre otros. Igualmente, se hace mención de las características personales y organizacionales que fomentan el "incivismo" en el lugar de trabajo, las estrategias organizacionales para prevenirlo y los instrumentos y estudios relacionados con el tema hasta el momento. Por último, se hace referencia del impacto de este nuevo constructo sobre el bienestar de la persona y la organización al considerársele como un nuevo factor de estrés laboral

Incivismo y Comunicación Disfuncional: un riesgo para el paciente

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: En esta comunicación se pretende exponer la relevancia que tiene en el ámbito asistencial la presencia de inicivismo y la comunicación disfuncional entre profesionales sanitarios, así como las repercusiones que pueden tener en la seguridad del paciente, tal y como están poniendo de manifiesto algunos estudios en los últimos años. Objetivos: Conocer la prevalencia existente en personal sanitario de conductas negativas (de estudios propios y de otros equipos) y las explicaciones que los expertos ofrecen a esos datos; Entender la influencia (directa e indirecta) entre esas conductas negativas y la calidad del trabajo con el pacien; Explicar los procesos que intervienen en la posible afectación a la seguridad del paciente; Destacar la importancia de no descuidar el fomento de la relación y comunicación adecuada entre profesionales sanitarios. Metodología: Se presentará una revisión acerca de la presencia de conductas disruptivas y comunicación inadecuada entre profesionales, y de su posible influencia de la seguridad del paciente, ofreciendo datos de investigaciones propias y de otros equipos de investigación. Resultados y conclusiones: El personal sanitario, sometido a un trabajo complejo técnica y emocionalmente, es muy vulnerable a involucrarse en estilos de comunicación inadecuados entre sí. Las consecuencias que de ello se derivan trascienden a su propia persona y repercuten en la calidad de su desempeño. Bien mediante procesos cognitivos que consuman sus valiosos recursos, o bien mediante el deterioro o interrupción de los procesos adecuados de comunicación, la calidad de su trabajo se verá afectada, y con ello la seguridad del paciente. Por eso la toma de conciencia del problema a nivel individual y de la organización resulta imprescindible

Current trends on the early diagnosis of Alzheimer\u27s Disease by means of neural computation methods

The prevalence of dementia is expected to increment in the next decades as the elderly population grows and ages. Hence, Alzheimer’s Disease (AD), as the most frequent dementia, will be more problematic from a socioeconomic point of view. Different diagnostic criteria have been proposed by clinicians for the early diagnosis of AD. After discarding the longitudinal and prognosis articles, a selection of articles from the last decade and based on Artificial Neural Networks (ANNs) was collated from the PubMed database, and complemented with researches extracted from others. The latest trends on this field were discovered in these selected articles, which were later discussed. Only articles based whether on shallow ANNs, Deep Learning (DL) or a mix of both were included. The total number of cross-sectional articles that complied with our selection criteria was 154. Convolutional Neural Networks (CNNs) combined with neuroimaging has been the most popular approach, yielding very good performance results. Approaches based on non- neuroimaging techniques, such as gait, genetics, speech and neuropsychological tests, were less common but have their own advantages. Multimodality solutions may become even more prevalent in the near future. Similarly, novel diagnostic criteria will appear and the popularity of currently not-so-common ones will expand. A new proposal emerged from these trends, which is based on ontogenetic ANNs

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

Physico-chemical, biological and geological study of an underwater volcano in a degassing stage: Island of El Hierro

El objetivo principal del proyecto “Physico-chemical, biological and geological study of an underwater volcano in a degassing stage: Island of El Hierro”, (VULCANO-II) es estudiar, desde un punto de vista totalmente interdisciplinar, la fase de desgasificación activa del único volcán submarino monitoreado desde su nacimiento en aguas españolas. De esta forma, se pretende además, dar continuidad a los estudios multidisciplinares realizados sobre el volcán submarino de la isla de El Hierro en el contexto del proyecto del Plan Nacional VULCANO-I, (CTM2012-36317) y VULCANA (Vulcanología Canaria Submarina, IEO). Para ello, se realizará la monitorización de las propiedades físico-químicas, biológicas y geológicas del proceso eruptivo submarino de la isla de El Hierro y otros puntos sensibles, como el volcán de Enmedio entre Gran Canaria y Tenerif

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

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

Workplace incivility : a new factor of job stress.

El siguiente trabajo presenta una revisión sobre el constructo “incivismo” en el lugar de trabajo. Se retoma el origen de este constructo, las definiciones, conceptos, diferencias con otros constructos de comportamientos contraproducentes en el trabajo, el proceso de escalada en forma de espiral que se puede dar para transformarse en otras formas más severas de conflicto laboral como mobbing, entre otros. Igualmente, se hace mención de las características personales y organizacionales que fomentan el “incivismo” en el lugar de trabajo, las estrategias organizacionales para prevenirlo y los instrumentos y estudios relacionados con el tema hasta el momento. Por último, se hace referencia del impacto de este nuevo constructo sobre el bienestar de la persona y la organización al considerársele como un nuevo factor de estrés laboral.The following paper presents a review about the construct of Workplace Incivility. The origin of this construct, its definitions, concepts and differences with other counterproductive work behavior constructs are analyzed, as well as the process of its escalation in the form of a spiral that can be transformed into other forms of job conflict such as mobbing. This article, also examines the personal and organizational characteristics that foment Workplace Incivility, the organizational strategies for preventing it and the instruments and studies related to the topic that have been developed up to the present. Finally, this review describes the impact that this new construct is having on the person’s and the organizational well-being as a new factor of job distress