ABSTRACT
Antecedentes La satisfacción laboral, el burnout y la calidad de vida profesional de los fisioterapeutas es clave para mantener la calidad de los servicios prestados en los pacientes. Objetivos Describir la satisfacción laboral, el burnout y la calidad de vida profesional de los fisioterapeutas de Atención Hospitalaria de la Sanidad pública de Castilla y León (SACYL); identificar las diferencias existentes en la satisfacción laboral, el burnout y el nivel de calidad de vida profesional en los mismos; determinar la relación existente entre las tres variables. Materiales y métodos Se realizó un estudio descriptivo transversal, con muestreo de conveniencia, en fisioterapeutas de Castilla y León que trabajan en atención hospitalaria. Se recogieron datos de la satisfacción laboral (Font Roja), el burnout (Maslach Burnout Inventory) y la calidad de vida profesional (CVP-35) en su puesto de trabajo. Se llevó a cabo un análisis descriptivo y relacional de las variables analizadas. Resultados Participaron 72 fisioterapeutas, siendo 75% mujeres, con una media de edad de 42,8 ± 8,37 años. El nivel de burnout resultó medio-alto en las dimensiones de agotamiento emocional y despersonalización, bajo en realización personal y la satisfacción laboral baja (SMG = -0,04). Los valores de calidad de vida profesional alcanzan una puntuación de notable (7,15 ± 1,43). Conclusiones Los fisioterapeutas de atención hospitalaria del SACYL presentan una elevada motivación intrínseca, a pesar del escaso apoyo directivo que reciben. La mejora de ambas dimensiones conlleva un aumento de la satisfacción laboral y de la calidad de vida profesional, y un descenso de los niveles de burnout (especialmente en el agotamiento emocional y la despersonalización). (AU)
Background Job satisfaction, burnout and professional quality of life of physiotherapists is key to maintaining the quality of services provided to patients. Objectives To describe job satisfaction, burnout and professional quality of life of physiotherapists in hospital care in the public health system of Castilla y León (SACYL); to identify the existing differences in job satisfaction, burnout and the level of professional quality of life among them; to determine the relationship between the three variables. Materials and methods A cross-sectional descriptive study was carried out, with convenience sampling, in physiotherapists from Castilla y León working in hospital care. Data were collected on job satisfaction (Font Roja), burnout (Maslach Burnout Inventory) and professional quality of life (CVP-35) in the workplace. A descriptive and relational analysis of the variables analysed was carried out. Results Seventy-two physiotherapists participated, 75% of whom were women, with an average age of 42.8 ± 8.37 years. The level of burnout was medium-high in the dimensions of emotional exhaustion and depersonalisation, low in personal fulfilment and low in job satisfaction (SMG = −0.04). Professional quality of life values reach a score of remarkable (7.15 ± 1.43). Conclusions Hospital care physiotherapists of the SACYL present high intrinsic motivation, despite the low managerial support they receive. The improvement of both dimensions leads to an increase in job satisfaction and professional quality of life, and a decrease in burnout levels (especially in emotional exhaustion and depersonalisation). (AU)
Subject(s)
Humans , Physical Therapists , Job Satisfaction , Burnout, Psychological , Burnout, Professional , Quality of Life , Cross-Sectional StudiesABSTRACT
Antecedentes La satisfacción laboral, el burnout y la calidad de vida profesional de los fisioterapeutas es clave para mantener la calidad de los servicios prestados en los pacientes. Objetivos Describir la satisfacción laboral, el burnout y la calidad de vida profesional de los fisioterapeutas de Atención Hospitalaria de la Sanidad pública de Castilla y León (SACYL); identificar las diferencias existentes en la satisfacción laboral, el burnout y el nivel de calidad de vida profesional en los mismos; determinar la relación existente entre las tres variables. Materiales y métodos Se realizó un estudio descriptivo transversal, con muestreo de conveniencia, en fisioterapeutas de Castilla y León que trabajan en atención hospitalaria. Se recogieron datos de la satisfacción laboral (Font Roja), el burnout (Maslach Burnout Inventory) y la calidad de vida profesional (CVP-35) en su puesto de trabajo. Se llevó a cabo un análisis descriptivo y relacional de las variables analizadas. Resultados Participaron 72 fisioterapeutas, siendo 75% mujeres, con una media de edad de 42,8 ± 8,37 años. El nivel de burnout resultó medio-alto en las dimensiones de agotamiento emocional y despersonalización, bajo en realización personal y la satisfacción laboral baja (SMG = -0,04). Los valores de calidad de vida profesional alcanzan una puntuación de notable (7,15 ± 1,43). Conclusiones Los fisioterapeutas de atención hospitalaria del SACYL presentan una elevada motivación intrínseca, a pesar del escaso apoyo directivo que reciben. La mejora de ambas dimensiones conlleva un aumento de la satisfacción laboral y de la calidad de vida profesional, y un descenso de los niveles de burnout (especialmente en el agotamiento emocional y la despersonalización). (AU)
Background Job satisfaction, burnout and professional quality of life of physiotherapists is key to maintaining the quality of services provided to patients. Objectives To describe job satisfaction, burnout and professional quality of life of physiotherapists in hospital care in the public health system of Castilla y León (SACYL); to identify the existing differences in job satisfaction, burnout and the level of professional quality of life among them; to determine the relationship between the three variables. Materials and methods A cross-sectional descriptive study was carried out, with convenience sampling, in physiotherapists from Castilla y León working in hospital care. Data were collected on job satisfaction (Font Roja), burnout (Maslach Burnout Inventory) and professional quality of life (CVP-35) in the workplace. A descriptive and relational analysis of the variables analysed was carried out. Results Seventy-two physiotherapists participated, 75% of whom were women, with an average age of 42.8 ± 8.37 years. The level of burnout was medium-high in the dimensions of emotional exhaustion and depersonalisation, low in personal fulfilment and low in job satisfaction (SMG = −0.04). Professional quality of life values reach a score of remarkable (7.15 ± 1.43). Conclusions Hospital care physiotherapists of the SACYL present high intrinsic motivation, despite the low managerial support they receive. The improvement of both dimensions leads to an increase in job satisfaction and professional quality of life, and a decrease in burnout levels (especially in emotional exhaustion and depersonalisation). (AU)
Subject(s)
Humans , Physical Therapists , Job Satisfaction , Burnout, Psychological , Burnout, Professional , Quality of Life , Cross-Sectional StudiesABSTRACT
BACKGROUND: There have been few studies carried out into empathy in physiotherapists. Burnout can debilitate the quality of care and the efficacy of treatment as the empathetic capacity of the professional diminishes. OBJECTIVE: The objective of the study was to examine the association between the construct burnout, empathy and sociodemographic aspects in Spanish physiotherapists. METHODS: A cross-sectional electronic survey including the Maslach Burnout Inventory (for burnout assessment), the Interpersonal Reactivity Index (for empathy assessment) and sociodemographic data was answered by 461 Spanish physical therapists. A descriptive, bivariate and lineal regression analysis was performed. RESULTS: There was an association between burnout and empathy. Specifically, higher levels of burnout are associated with lower levels of empathy, whilst years of work experience is associated with lower levels of burnout. CONCLUSIONS: The results of this study contribute to a greater understanding of the relationship between the level of burnout and the dimensions of empathy in physiotherapists. The influence of burnout, which causes difficulties in the mobilization of the professional towards the establishment of a quality therapeutic relationship, is highlighted.KEY MESSAGESEmotional exhaustion is associated to greater personal discomfort and less empathy.The depersonalization is associated to personal discomfort and less empathy.Depersonalization is negatively associated to the lack of perspective.
Subject(s)
Burnout, Professional , Physical Therapists , Burnout, Professional/epidemiology , Burnout, Professional/psychology , Burnout, Psychological , Cross-Sectional Studies , Empathy , Humans , Physical Therapists/psychologyABSTRACT
Head and neck cancer is one of the most frequent malignances worldwide. Despite the site-specific multimodality therapy, up to half of the patients will develop recurrence. Treatment selection based on a multidisciplinary tumor board represents the cornerstone of head and neck cancer, as it is essential for achieving the best results, not only in terms of outcome, but also in terms of organ-function preservation and quality of life. Evidence-based international and national clinical practice guidelines for head and neck cancer not always provide answers in terms of decision-making that specialists have to deal with in their daily practice. This is the first Expert Consensus on the Multidisciplinary Approach for Head and Neck Squamous Cell Carcinoma (HNSCC) elaborated by the Spanish Society for Head and Neck Cancer and based on a Delphi methodology. It offers a number of specific recommendations based on the available evidence and the expertise of our specialists to facilitate decision-making of all health-care specialists involved.
Subject(s)
Carcinoma, Squamous Cell/therapy , Head and Neck Neoplasms/therapy , Carcinoma, Squamous Cell/pathology , Combined Modality Therapy , Consensus , Delphi Technique , Head and Neck Neoplasms/pathology , Humans , Spain , Squamous Cell Carcinoma of Head and NeckABSTRACT
Gemcitabine is indicated for the treatment of nonmicrocytic lung, breast, pancreatic, bladder and ovarian cancer. Mild dyspnea has been reported but the incidence of severe lung damage is low. We report the case of a 58-year-old woman diagnosed with locally advanced infiltrating ductal carcinoma of the breast who received gemcitabine as part of neoadjuvant chemotherapy and suffered from severe pulmonary toxicity. We reviewed the cases published in the literature and conclude that although Gemcitabine is generally well tolerated, pulmonary toxicity requires high level of suspicion and prompt treatment to prevent an unfavourable outcome (AU)
Subject(s)
Humans , Female , Middle Aged , Antineoplastic Agents/adverse effects , Antineoplastic Agents/therapeutic use , Breast Neoplasms/drug therapy , Carcinoma/drug therapy , Breast Neoplasms/pathology , Breast Neoplasms , Carcinoma/pathology , Carcinoma , Smoking/adverse effects , Tomography, X-Ray/methods , Tomography, X-RayABSTRACT
Factors influencing the collection of autologous peripheral blood stem cells (PBSCs) were studied in 182 mobilization procedures performed on 145 consecutive patients with acute myeloblastic leukemia (AML; n=67) and with various non-myeloid malignancies (NMM; n=78). PBSC were collected following mobilization with chemotherapy, treatment with granulocyte colony-stimulating factor (G-CSF) or chemotherapy plus G-CSF. Fewer colony-forming unit granulocyte-macrophages (CFU-GMs) were collected from patients with AML than from patients with NMM (P<0.0001), although there were no differences in the numbers of CD34+ cells collected between both groups. Multiple regression analysis showed that chemotherapy alone was predictive of a low CD34+ yield in patients with NMM (regression coefficient (RC)=-2.1; P=0.003). In addition, the interactions "diagnosis mutliple myeloma (MM)xmobilization with chemotherapy" (RC=2.9; P=0.004) and "diagnosis MMxmobilization with chemotherapy plus G-CSF" (RC=2.1; P=0.04) also remained in the model, both showing a favorable influence. In AML, mobilization with chemotherapy plus G-CSF was associated with higher CD34+ yields (P=0.003). In this subgroup of patients, multiple regression analysis identified the number of cycles of previous chemotherapy (< or =2 cycles; RC=1.3; P=0.03) and peripheral blood counts (WBC > or =1.5 x 10(9)/l and monocytes >20%; RC=0.8; P=0.02) as the factors most predictive of CD34+ cell yield. These findings emphasize the need to optimize harvesting technique to enhance safety and minimize morbidity and costs of this valuable procedure.
Subject(s)
Antineoplastic Agents/pharmacology , Granulocyte Colony-Stimulating Factor/pharmacology , Hematopoietic Stem Cell Mobilization , Leukemia, Myeloid/blood , Neoplasms/blood , Peripheral Blood Stem Cell Transplantation , Acute Disease , Adolescent , Adult , Aged , Blood Cell Count , Bone Marrow/drug effects , Bone Marrow/radiation effects , Colony-Forming Units Assay , Drug Synergism , Female , Hematopoietic Stem Cell Mobilization/methods , Humans , Leukapheresis/instrumentation , Leukapheresis/methods , Leukemia, Myeloid/therapy , Male , Middle Aged , Neoplasms/therapy , Radiotherapy/adverse effects , Regression Analysis , Retrospective Studies , Safety , Treatment OutcomeABSTRACT
Factors influencing hematopoietic recovery (HR) after autologous blood stem cell transplantation (ABSCT) were analyzed in 73 patients with various non-myeloid malignancies (NMM), and in 58 patients with acute myeloblastic leukemia (AML). Peripheral blood stem cells were collected following mobilization with chemotherapy, granulocyte colony-stimulating factor (G-CSF), or chemotherapy plus G-CSF. The conditioning regimen used consisted of either chemotherapy alone (112 cases) or chemotherapy plus total body irradiation (19 cases). The median number of colony-forming units granulocyte-macrophage (CFU-GM) was similar in both groups of patients, with the median number of CD34(+) cells infused being higher in the AML group (5.4 vs 4 x 10(6)/kg; P = 0.03). Median time neutrophils >0.5 x 10(9)/l was 13 days in both groups, and median time to a platelet count >20 x 10(9)/l was longer in AML patients (14 vs 12 days; P = 0.01). In multivariate analysis, the only factors affecting neutrophil recovery in the NMM group were the CD34+ cell number (continuous model) and the CFU-GM dose (categorized model) infused, whereas for platelet recovery, previous chemotherapy also remained significant. In the AML group, the only factors significantly affecting the speed of neutrophil recovery were dose of CD34+ cells administered and the patient's age. As for platelet recovery, only the progenitor dose administered remained significant. In the NMM group, the most discriminating cut-off values for a rapid neutrophil and platelet recovery were 1.5 x 10(6) and 2.5 x 10(6) CD34+ cells/kg, respectively, and for AML patients these figures were 1.5 x 10(6) and 4 x 10(6) CD34+ cells/kg, respectively. Our results confirm the slower HR after ABSCT in AML, and highlight the importance of progenitor cell dose in accelerating HR after ABSCT.
Subject(s)
Hematopoiesis , Hematopoietic Stem Cell Transplantation , Leukemia, Myeloid, Acute/therapy , Neoplasms/therapy , Adolescent , Adult , Aged , Breast Neoplasms/pathology , Breast Neoplasms/therapy , Colony-Forming Units Assay , Female , Hodgkin Disease/pathology , Hodgkin Disease/therapy , Humans , Leukemia, Myeloid, Acute/pathology , Lymphoma, Non-Hodgkin/pathology , Lymphoma, Non-Hodgkin/therapy , Male , Middle Aged , Multiple Myeloma/pathology , Multiple Myeloma/therapy , Neoplasms/pathology , Transplantation, AutologousABSTRACT
Leukemic relapse remains the most frequent reason for treatment failure in patients with acute myeloblastic leukemia (AML) treated with autologous blood stem cell transplantation (ABSCT). The aim of this study was to evaluate the possible role of autologous bone marrow transplant (ABMT) in patients with AML who relapse after ABSCT. Eighteen consecutive patients were enrolled in the study. At ABMT, 17 patients were in untreated relapse and one was in third complete remission (CR). The preparative regimen was BAVC, and consisted of BCNU 800 mg/m2 on day -6, M-AMSA 150 mg/m2/day on days -5 to -3, VP-16 150 mg/m2/day on days -5 to -3 and Ara-C 300 mg/m2/day on days -5 to -3. There were two regimen-related deaths (11%). Thirteen out of 17 patients in untreated relapse before ABMT achieved CR (76%). The cumulative risk of relapse was 58 +/- 13% at 3 years. Seven patients are in CR between 7+ and 53+ months, with a disease-free survival (DFS) probability of 36 +/- 12% at 3 years. The probability of DFS after ABMT was clearly higher in those patients relapsing later than 7 months after the first autograft (52%) than in patients relapsing earlier (20%)(P = 0.02). In a significant proportion of patients, remission duration was clearly longer after ABMT than ABSCT. We conclude that BAVC conditioning followed by ABMT is associated with a low treatment-related toxicity and results in prolonged DFS in a substantial number of AML patients who relapse after ABSCT. Until better therapeutic options become available, ABMT in untreated relapse is a useful alternative in this group of very poor-risk patients.
Subject(s)
Bone Marrow Transplantation , Hematopoietic Stem Cell Transplantation , Leukemia, Myeloid/therapy , Acute Disease , Adult , Amsacrine/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Bone Marrow Transplantation/adverse effects , Carmustine/administration & dosage , Combined Modality Therapy , Cytarabine/administration & dosage , Disease-Free Survival , Etoposide/administration & dosage , Female , Humans , Leukemia, Myeloid/drug therapy , Leukemia, Myeloid/mortality , Leukemia, Myeloid/pathology , Life Tables , Male , Middle Aged , Recurrence , Risk , Salvage Therapy , Transplantation Conditioning/adverse effects , Transplantation, Autologous , Treatment OutcomeABSTRACT
Hepatic veno-occlusive disease (VOD) is a common cause of morbidity and mortality after BMT. Although treatment of VOD is primarily supportive, some success has been obtained recently with fibrinolytic therapy. However, for critically ill patients liver transplantation may be the only therapeutic option. Nevertheless, this procedure is associated with high mortality and can only be performed in a minority of cases. The transjugular intrahepatic portosystemic stent-shunt (TIPS) is a non-surgical, side-to-side shunt consisting of an intraparenchymal duct between a main branch of the portal vein and a hepatic vein. In this report we describe a patient who underwent TIPS placement for severe VOD following autologous PBPC transplant. No complications developed and gradual improvement in clinical status and liver function was observed early after this therapy. Nine months after TIPS, the patient is asymptomatic with normal liver function. TIPS provides an interesting alternative to invasive therapies for patients with severe VOD after bone marrow or PBPC transplants.
Subject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Hepatic Veno-Occlusive Disease/surgery , Portasystemic Shunt, Transjugular Intrahepatic , Hepatic Veno-Occlusive Disease/etiology , Humans , Male , Middle AgedABSTRACT
The absence of an effective therapy for most patients with leukemia who relapse after allogeneic BMT has generated interest in new strategies. We present our experience on the use of filgrastim 5 micrograms/kg/day s.c., in four patients with leukemia (three with AML and one with CLL) who relapsed after allogeneic transplantation. One patient with AML achieved CR after 55 days of treatment. No response was observed in the remaining three. The patient who responded developed extensive chronic GVHD but relapsed 10 months later. In one of the unresponsive patients a dramatic increase in bone marrow infiltration and WBC count followed administration of filgrastim. We conclude that filgrastim can occasionally induce CR in leukemic patients who relapse after BMT.
Subject(s)
Bone Marrow Transplantation , Granulocyte Colony-Stimulating Factor/therapeutic use , Leukemia/therapy , Adolescent , Adult , Bone Marrow/pathology , Bone Marrow Transplantation/adverse effects , Female , Filgrastim , Graft vs Host Disease/etiology , Granulocyte Colony-Stimulating Factor/administration & dosage , Granulocyte Colony-Stimulating Factor/adverse effects , Humans , Leukemia/blood , Leukemia/pathology , Leukemia, Myeloid, Acute/blood , Leukemia, Myeloid, Acute/pathology , Leukemia, Myeloid, Acute/therapy , Male , Recombinant Proteins , Recurrence , Transplantation, HomologousABSTRACT
A 25-year-old man with AML, who relapsed 21 months after his first allogeneic bone marrow transplant (BMT), underwent a second transplant with peripheral blood progenitor cells (PBPC) obtained from his HLA-identical sibling. The donor cells were collected through four aphereses after G-CSF mobilization with 5 micrograms/kg/d for 5 days. The patient received BAVC conditioning regimen followed by non-T cell-depleted PBPC. Successful engraftment occurred with rapid hematopoietic recovery (time to reach 0.5 x 10(9)/L neutrophils and 50 x 10(9) platelets/L was 15 and 19 days, respectively). A bone marrow aspirate on day +19 showed trilineage engraftment. Erythrocyte phenotype showed that erythropoiesis was of donor origin. The patient developed grade II acute GVHD that responded to prednisone. Seven months after PBPC transplantation he remains in complete remission, alive and well, with just limited chronic GVHD. Allogeneic peripheral blood progenitor cell transplantation may be considered a suitable alternative to marrow transplant.
