Validación de la Escala de Ansiedad Preoperatoria y de Información Ámsterdam (APAIS) en mujeres latinoamericanas con cáncer de mama: Estudio México - Costa Rica / Validation of the Amsterdam Pre-surgery Anxiety and Information Scale in Latino American women with breast cancer: Mexico - Costa Rica research

El tratamiento más frecuente contra el cáncer es la cirugía; sin embargo es un procedimiento invasivo que se ha asociado con la presencia de sintomatología psicológica hasta en el 76% de los pacientes. El estudio de la ansiedad ante la cirugía requiere de herramientas específicas adaptadas a las peculiaridades del constructo; entre ellas se encuentra la Escala de Ansiedad Preoperatoria y de Información Ámsterdam (APAIS) que ha sido validada en pacientes sometidos a diversas cirugías en múltiples países; mostrando consistentemente propiedades psicométricas adecuadas. Objetivo: Obtener la confiabilidad y validez de la APAIS en población oncológica para población latinoamericana. Método: Estudio transversal, no experimental, de análisis psicométrico que incluyó una muestra no probabilística de 117 mujeres con edades entre 25 y 75 años, todas diagnosticadas con cáncer de mama y programadas para cirugía en un hospital público de México (57 mujeres) o Costa Rica (63 mujeres). Resultados: Los seis reactivos de la Escala APAIS mostraron adecuada distribución de las contestaciones de las participantes entre las opciones de respuestas, tener capacidad de discriminación entre grupos extremos y contribuyeron a la consistencia interna del instrumento. El análisis factorial de máxima verosimilitud con rotación varimax mostró una estructura que explicó el 58,58% de la varianza con dos factores, la cual fue confirmada por análisis factorial confirmatorio; la escala total mostró una consistencia interna de α=0,816. Dicha escala mostró adecuada sensibilidad y especificidad con un punto de corte de 14 puntos. Conclusiones: La escala APAIS muestra propiedades psicométricas adecuadas para considerarla válida y confiable para evaluar ansiedad prequirúrgica en mujeres con cáncer de mama

Surgery is the most frequent and efficient treatment for cancer, however, it is an invasive procedure that has been associated with psychological symptoms in up to 76% of patients. Health professional require specific and adapted tools to evaluate anxiety related to surgery, but there are few instruments to evaluate it. An option is the Amsterdam Preoperative Anxiety and Information Scale (APAIS), which has been validated in multiple countries with patients undergoing different surgeries. Validations have shown APAIS has adequate psychometric properties. Aim: To obtain the reliability and validity of APAIS in the oncology population for the Latin American population. Method: Cross-sectional, non-experimental, psychometric analysis study that included a non-probabilistic sample of 117 women aged between 25 and 75 years, all patients have been diagnosed with breast cancer and have been scheduled for surgery in a public hospital in Mexico (57 women) or Costa Rica (63 women). Results: The six items of the APAIS Scale showed an adequate distribution of the responses of the participants among the response options, the ability to discriminate between extreme groups and contributed to the internal consistency of the instrument. The factor analysis of maximum likelihood with varimax rotation showed a structure that explained 58.58% of the variance with two factors, this structure was confirmed by a confirmatory factor analysis. The total scale showed an internal consistency of α = .816. This scale showed adequate sensitivity and specificity with a cut-off point of 14 points. Conclusions: The APAIS scale shows adequate psychometric properties to be considered valid and reliable to evaluate pre-surgical anxiety in patients with cancer

Open-label randomized controlled trial to compare wound dressings for patients undergoing hip and knee arthroplasty: study protocol for a randomized controlled trial.

BACKGROUND: Surgical wounds are covered to prevent bleeding, absorb the exudates, and provide a barrier against external contamination. Currently, in our hospital, after orthopedic surgery, traditional occlusive dressing of sterile gauze and non-woven hypoallergenic adhesive tape is placed. Some of the newest dressings have been shown to reduce the incidence of blisters compared with traditional dressing or colloid adhesive dressings. However, there are no comparative evaluations between the different types of dressings and their contribution to the overall results of the healing process. METHODS/DESIGN: This is a randomized, controlled, open-label trial to compare five types of dressings used in total knee and hip arthroplasty surgical wounds. A total of 550 patients will be randomly allocated to one of the following dressings: (1) traditional occlusive dressing, (2) Aquacel Surgical®, (3) Mepilex® Border Post-Op, (4) OpSite Post-Op Visible, or (5) UrgoTul® Absorb Border. The dressing assigned is placed right after surgery. Patients will be followed up to 14 days after surgery when the dressing is definitively removed and will be tracked up to 3 months to record any late complications. During the immediate postoperative period and patient hospitalization and at the ambulatory visits after discharge, every time that the dressing is changed, nurses perform the study assessments. The main study outcome will be the percentage of patients with skin integrity at all times when the dressing has been changed. Skin integrity is a composite of the absence of blisters, erosion, erythema, maceration, swelling, wound dehiscence, and purulent exudates. Secondary outcomes include time to first change of dressing; percentage of patients with presence/absence of blisters, erosion, erythema, maceration, swelling, wound dehiscence, and purulent exudates; number of dressing changes needed; days of hospital stay; and nurse and patient satisfaction. Differences in the main variable between each treatment group and group 1 will be tested by means of a chi-squared test or Fisher's exact test. Subgroup analyses of diabetic and non-diabetic patients, patients with a body mass index of more than 30 or not more than 30, and type of surgery (hip or knee) are planned. DISCUSSION: The results of this study will be useful for clinical decision making by giving information on the contribution of the dressings studied to the outcome of the wound and may also show which dressing offers better results depending on the characteristics of patients. TRIAL REGISTRATION: This trial has been registered at ClinicalTrials.gov ( NCT03190447 ). Retrospectively registered on 16 June 2017.

[Quality of life in patients with bone tumors, a comparison between different treatments]. / Calidad de vida en pacientes con tumores oseos, una comparacion entre diferentes tratamientos.

INTRODUCTION. Previously, amputation was the only treatment option for patients with malignant bone tumors. Due to technological, medical and surgical advances, the number of survivors and years of survival has been increasing, and thus, the interest in evaluating the impact of this disease on quality of life. OBJECTIVE. To evaluate the health related quality of life reported by patients with bone tumors undergoing different treatments (no surgery/amputation/salvage). MATERIAL AND METHODS. Patients (n = 85) with bone tumors over the age of 18, both sexes, from the Instituto Nacional de Rehabilitación of Mexico City were included, divided into three groups according to type of treatment. The study design was cross-sectional, descriptive of a nonrandom sample. Quality of life was assessed with the Inventory of Quality of Life and Health (InCaViSa). Data were analyzed using descriptive statistics, comparisons between patients with different treatments were evaluated with multivariate analysis of covariance and Sidak post hoc tests. RESULTS. Statistically significant differences were detected in six of the twelve areas of quality of life that are assessed by the scale: physical functioning, isolation, body perception, treatment attitude leisure time and daily life. Health related quality of life in the study group is best for those patients who received amputation compared with the other treatments, while patients limb salvage procedures are those with greater impairment.

Evaluación de la efectividad y tolerancia de la combinación amoxicilina-sulbactam en el tratamiento de la exacerbación de la bronquitis crónica / Efficacy and tolerance of amoxicillin-sulbactam combination in exacerbation of chronic bronchitis

Objetivo del estudio: Comparar la eficacia clínica de dos esquemas de dosificación de amoxicilina (500 mg) más sulbactam (500 mg) en casos con bronquitis crónica exacerbada. Diseño: Estudio abierto de casos consecutivos. Lugar: Consulta externa de neumología de un hospital general para población abierta. Material y métodos: Se estudiaron dos grupos de pacientes, I con 20 casos con un esquema de amoxicilina-sulbactam cada 8 horas y II con 19 casos con esquema de cada 12 horas. Se cultivó la expectoración y se evaluó la respuesta clínica al tratamiento. Resultados: Se aislaron microorganismos patógenos en 29 casos, en 10 los cultivos fueron negativos. La respuesta clínica se evaluó en 36 de los 39 pacientes, siendo satisfactoria en 94.1 por ciento en el grupo I y en 84.2 por ciento en el grupo II, mejorando la disnea, la tos y la expectoración. La erradicación bacteriológica, en los casos positivos se obtuvo en 11/14 en el grupo I y en 10/15 en el grupo II. La tolerancia a los medicamentos fue mejor cuando éstos se administraron cada 12 horas. Cabe mencionar que las bacterias patógenas encontradas en nuestros pacientes, Staphylococcus aureus y coliformes, difieren de las reconocidas internacionalmente como principales causantes de la patología que nos ocupa (Haemophylus influenzae y Streptococcus pneumoniae); probablemente esto se deba a que una gran parte de la población del estudio es habitante de zonas cercanas a la Ciudad de México con importantes problemas de higiene. Conclusión: La administración de amoxicilina-sulbactam es útil en el tratamiento de la bronquitis crónica exacerbada, no se encontraron diferencias estadísticamente significativas entre los esquemas de dosificación de cada ocho horas y de cada 12 horas.