Moral Distress Healthcare Providers in Spain: Observational Study

Marta Mellides González,1 Marta Elena Losa Iglesias,2 Inmaculada Corral-Liria,2 Ricardo Becerro-de-Bengoa-Vallejo,3 Eva Maria Martinez-Jimenez,3 Sandra Fares-Medina,2 Sara González-Martín,2 Marta San-Antolín,4 Raquel Jiménez-Fernández2 1Hospital Universitario 12 de Octubre, Usera, Madrid, 28041, Spain; 2Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922, Spain; 3Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, Madrid, 28040, Spain; 4Department of Psychology, Universidad de Valladolid, Valladolid, 47002, SpainCorrespondence: Inmaculada Corral-Liria, Faculty of Health Sciences, Universidad Rey Juan Carlos, Alcorcon, 28922, Spain, Email [email protected]: To evaluate the moral distress (MD)in health professionals of pediatric and adult units to show how the complexity of care in the pediatric field causes the professionals who carry out their activity in these units to present a higher level of moral distress and a worse climate ethical.Design: Observational study with health professionals who currently work in Spanish Hospitals.Methods: A 58-item questionnaire was electronically distributed which included sociodemographic and employment characteristics, the Spanish version of the Measure of Moral Unrest for Healthcare Professionals (MMD-HP-SPA) and the Hospital Ethical Climate Survey (HECS).Results: A total of 169 health professionals completed the questionnaire. The moral distress was significantly higher among nurses than among physicians and nursing assistant care technicians. Focusing on the type of unit, moral distress it was only significantly higher for those physicians treating adult patients compared to those treating pediatric patients. Regarding the total score of the HECS survey, the medical group shows higher scores compared to the nursing group.Conclusion: Statistically significant differences have been found only in the medical group that treats adult patients, presenting a higher level of moral unrests than the pediatrician group. The MMD-HP-SPA questionnaire is a valid and useful instrument to detect MD in our hospital units in order to be able to implement strategies/interventions that improve the ethical climate and other factors that can mitigate and prevent this MD.Keywords: moral unrest, ethical climate, surveys, questionnaires, pediatric

Galician consensus on management of cardiotoxicity in breast cancer: risk factors, prevention, and early intervention

This Galician consensus statement is a joint oncologists/cardiologists initiative indented to establish basic recommendations on how to prevent and to manage the cardiotoxicity in breast cancer with the aim of ensuring an optimal cardiovascular care of these patients. A clinical screening of the patients before treatment is recommended to stratify them into a determined risk group based on their intrinsic cardiovascular risk factors and those extrinsic arose from breast cancer therapy, thereby providing individualized preventive and monitoring measures. Suitable initial and ongoing assessments for patients with low and moderate/high risk and planned treatment with anthracyclines and trastuzumab are given; also, measures aimed at preventing and correcting any modifiable risk factor are pointed out .TEVA Farma Españ

Optically triggered infrared photodetector

We present and demonstrate experimentally a new kind of semiconductor device: the Optically Triggered Infrared Photodetector. This IR photodetector exhibits the following distinctive features: (1) It can be optically commuted ON and OFF by means of an external light bias, and (2) it does not require electrical power supply. The operation principle of the OTIP is as follows. External high-energy (higher than the semiconductor bandgap) light produces photocurrent in the device. Part of this current is lost as recombination through an intermediate band (IB) [1] within the bandgap of the semiconductor. The addition of IR light reduces such recombination and can be, therefore, measured as an increase in current. This new detector concept can be implemented by including quantum dots (QDs) in-between a p-n junction [2]. We demonstrate the operation of the OTIP in an InAs/AlGaAs QD-based device. Our experimental device shows response to normally incident light in the 2?6 ?m range when externally biased by a 590-nm light emitting diode (LED). It also exhibits IR detection driven by a continuous range of photon energies above the bandgap of the device. Furthermore, we demonstrate an increase in detection gain with increasing light-bias intensity. For high intensities the photo-detection seems to saturate. In our experiments, the increase in detection gain did not come with an increase in the measurement noise; hence, it can be understood as an increase in the detectivity. The novel features of the OTIP opens up possibilities for new device applications, for instance, in optical communications

Percutaneous mitral valve repair : Outcome improvement with operator experience and a second-generation device

Background and aim: Recent randomized data comparing percutaneous mitral valve repair (PMVR) versus optimal medical treatment in patients with functional MR (FMR) seemed to highlight the importance of the learning curve not only for procedural outcomes but also for patient selection. The aim of the study was to compare a contemporary series of patients undergoing PMVR using a second-generation Mitraclip device (Mitraclip NT) with previous cohorts treated with a first-generation system. Methods: This multicenter study collected individual data from 18 centers between 2012 and 2017. The cohort was divided into three groups according to the use of the first-generation Mitraclip during the first (control-1) or second half (control-2) or the Mitraclip NT sys-tem. Results: A total of 545 consecutive patients were included in the study. Among all, 182 (33.3%), 183 (33.3%), and 180 (33.3%) patients underwent mitral repair in the control-1, control-2, and NT cohorts, respectively. Procedural success was achieved in 93.3% of patients without differences between groups. Major adverse events did not statistically differ among groups, but there was a higher rate of pericardial effusion in the control-1 group (4.3%, 0.6%, and 2.6%, respectively; p = 0.025). The composite endpoint of death, surgery, and admission for congestive heart failure (CHF) at 12 months was lower in the NT group (23.5% in control-1, 22.5% in control-2, and 8.3% in the NT group; p = 0.032). Conclusions: The present paper shows that contemporary clinical outcomes of patients undergoing PMVR with the Mitraclip system have improved over time

Correlation between clinical parameters characterising peri-implant and periodontal health : a practice-based research in Spain in a series of patients with implants installed 4-5 years ago

Objectives: To explore peri-implant health (and relation with periodontal status) 4-5 years after implant insertion. Study D esign: A practice-based dental research network multicentre study was performed in 11 Spanish centres. The first patient/month with implant insertion in 2004 was considered. Per patient four teeth (one per quadrant) showing the highest bone loss in the 2004 panoramic X-ray were selected for periodontal status assessment. Bone losses in implants were calculated as the differences between 2004 and 2009 bone levels in radiographs. Results: A total of 117 patients were included. Of the 408 teeth considered, 73 (17.9%) were lost in 2009 (losing risk: >50% for bone losses ?7mm). A total of 295 implants were reviewed. Eight of 117 (6.8%) patients had lost implants (13 of 295 implants installed; 4.4%). Implant loss rate (quadrant status) was 1.4% (edentulous), 3.6% (preserved teeth), and 11.1% (lost teeth) (p=0.037). The percentage of implant loss significantly (p<0.001) increased when the medial/distal bone loss was ?3 mm. The highest (p?0.001) pocket depths were found in teeth with ?5mm and implants with ?3mm bone losses, with similar mean values (?4mm), associated with higher rates of plaque index and bleeding by probing. Conclusions: The significant bi-directional relation between plaque and bone loss, and between each of these two parameters/signs and pocket depths or bleeding (both in teeth and implants, and between them) together with the higher percentage of implants lost when the bone loss of the associated teeth was ?3 mm suggest that the patient?s periodontal status is a critical issue in predicting implant health/lesion

Fases de ocupación y estratigrafía del asentamiento neolítico de Les Guixeres de Vilobí (Sant Martí Sarroca, Barcelona)

El yacimiento al aire libre de Les Guixeres de Vilobí (Sant Martí Sarroca, Penedès, Barcelona) tiene una extensión aproximada de 2500m2 de los cuales se han excavado algo más del 10%. Tiene la particularidad de que cuenta con una estratigrafía de 4 fases en las que se han documentado ocupaciones del Neolítico antiguo Cardial, Neolítico antiguo Epicardial, Neolítico Postcardial y Neolítico final. Estas se caracterizan por niveles arqueológicos más o menos extensos y por la presencia de numerosas estructuras negativas: agujeros de poste, cubetas, estructuras de combustión, fosas-contenedor y silos. La fase del Neolítico Cardial no sólo es la más rica en cuanto a cantidad de material, sino que se han hallado tres ámbitos que proponemos como unidades habitacionales. Por su parte, se presentan también 9 dataciones radiocarbónicas (7 inéditas) que permiten inferir que las ocupaciones han sido muy continuadas en el tiempo, entre 5600-5200 cal BC para la fase A, c. 5000-4700 cal BC para la fase B, c. 4650-4450 cal BC para la fase C y c. 3350-3100 cal BC para la fase D. Para complementar estos datos cronológicos, se muestran los resultados preliminares sobre el análisis de la cultura material del yacimiento. Por último, estos datos son comparados con especial atención con la información derivada de las estructuras de hábitat entre el Neolítico antiguo y el Neolítico final

Internal migration dynamics in Spain: Winners and losers from the recent economic recession

This paper analyses the impact of the 2008 economic crisis on the spatial distribution of interprovincial migration in Spain, with a particular focus on changes in provinces' relative attractiveness. First, the paper examines the distribution of the net migration rate across provinces over the period 2002-2013. Next, by comparing the precrisis (2002-2007) and crisis (2008-2013) periods, the paper investigates which provinces became more attractive locations for migrants during the crisis and explores some of the factors behind it. The empirical evidence unveils two key results. First, major changes took place in spatial patterns of migration flows in Spain in the wake of the 2008 recession. Second, the rich provinces that best weathered the economic downturn, especially those with a relatively small construction sector and a good performance of industry and services, became appealing destinations during the crisis

Deep-sequencing reveals broad subtype-specific HCV resistance mutations associated with treatment failure

A percentage of hepatitis C virus (HCV)-infected patients fail direct acting antiviral (DAA)-based treatment regimens, often because of drug resistance-associated substitutions (RAS). The aim of this study was to characterize the resistance profile of a large cohort of patients failing DAA-based treatments, and investigate the relationship between HCV subtype and failure, as an aid to optimizing management of these patients. A new, standardized HCV-RAS testing protocol based on deep sequencing was designed and applied to 220 previously subtyped samples from patients failing DAA treatment, collected in 39 Spanish hospitals. The majority had received DAA-based interferon (IFN) a-free regimens; 79% had failed sofosbuvir-containing therapy. Genomic regions encoding the nonstructural protein (NS) 3, NS5A, and NS5B (DAA target regions) were analyzed using subtype-specific primers. Viral subtype distribution was as follows: genotype (G) 1, 62.7%; G3a, 21.4%; G4d, 12.3%; G2, 1.8%; and mixed infections 1.8%. Overall, 88.6% of patients carried at least 1 RAS, and 19% carried RAS at frequencies below 20% in the mutant spectrum. There were no differences in RAS selection between treatments with and without ribavirin. Regardless of the treatment received, each HCV subtype showed specific types of RAS. Of note, no RAS were detected in the target proteins of 18.6% of patients failing treatment, and 30.4% of patients had RAS in proteins that were not targets of the inhibitors they received. HCV patients failing DAA therapy showed a high diversity of RAS. Ribavirin use did not influence the type or number of RAS at failure. The subtype-specific pattern of RAS emergence underscores the importance of accurate HCV subtyping. The frequency of “extra-target” RAS suggests the need for RAS screening in all three DAA target regions