[The worst year of my life. Emotional exhaustion and burnout due to COVID-19 in nursing home professionals. RESICOVID study]. / El peor año de mi vida. Agotamiento emocional y burnout por la COVID-19 en profesionales de residencias. Estudio RESICOVID.

INTRODUCTION: The COVID-19 pandemic has led to major changes in the day-to-day operations of residential care facilities. Little is known about the impact it has had on professionals working in nursing homes in Spain. This research arose from the need to explore the situation experienced during the pandemic and to delve into the experiences as narrated by professionals working in nursing homes. The aim of the RESICOVID study was to analyze the effects on professionals of the measures taken in response to the COVID-19 pandemic in nursing homes. MATERIAL AND METHOD: 31 professionals (mean age: 32.9 years; 83.8% women, in various areas of care) were interviewed. Seventy-one percent of the sample presented a diagnosis of COVID-19. The analysis was performed with the Atlas-ti v8 program. RESULTS: From the analysis of the interviews, 128 quotations were extracted, coded in the following dimensions: 1. experience of confinement; 2. perception of changes; 3. health problems; 4. cognitive and functional changes; 5. loneliness. CONCLUSIONS: Burnout, overload, lack of resources and uncertainty caused by the COVID-19 pandemic have generated feelings of fear, exhaustion, anxiety, frustration and sadness in professionals who continue to this day without sufficient resources to face the situation. The design of contingency plans for future health crises should take into account this impact on care professionals.

El peor año de mi vida. Agotamiento emocional y burnout por la COVID-19 en profesionales de residencias. Estudio RESICOVID / The worst year of my life. Emotional exhaustion and burnout due to COVID-19 in nursing home professionals. RESICOVID study

Introducción: La pandemia por la COVID-19 ha generado grandes cambios en el funcionamiento diario de los centros residenciales; poco se sabe del impacto que ha tenido en los profesionales que trabajan en residencias de personas mayores en España. Esta investigación surge por la necesidad de explorar cuál ha sido la situación vivida durante la pandemia y profundizar en las experiencias tal y como son narradas por los profesionales que trabajan en las residencias para personas mayores. El objetivo del estudio RESICOVID ha sido analizar los efectos en los profesionales de las medidas que se tomaron en las residencias frente a la pandemia por COVID-19.Material y métodos: Se realizaron entrevistas a 31 profesionales del cuidado (media edad: 34,31 años, DS: 9,56; 83,8% mujeres). El 71% de los participantes tuvieron diagnóstico de COVID-19. El análisis fue realizado con el programa Atlas-ti v8.Resultados: Del análisis de las entrevistas se extrajeron 128 citas que fueron codificadas en las siguientes dimensiones: 1. vivencia del confinamiento; 2. percepción de cambios; 3. problemas de salud; 4. cambios en el área cognitiva y funcional; 5. soledad.Conclusiones: La sobrecarga, la falta de recursos y la incertidumbre causada por la pandemia por COVID-19 ha generado sentimientos de miedo, desgaste, ansiedad, frustración y tristeza en los profesionales que continúan a día de hoy sin recursos suficientes para encarar la situación. El diseño de planes de contingencia para futuras crisis sanitarias deberá tener en cuenta este impacto en los profesionales del cuidado. (AU)

Introduction: The COVID-19 pandemic has led to major changes in the day-to-day operations of residential care facilities. Little is known about the impact it has had on professionals working in nursing homes in Spain. This research arose from the need to explore the situation experienced during the pandemic and to delve into the experiences as narrated by professionals working in nursing homes. The aim of the RESICOVID study was to analyze the effects on professionals of the measures taken in response to the COVID-19 pandemic in nursing homes.Material and method: 31 professionals (mean age: 32.9 years; 83.8% women, in various areas of care) were interviewed. Seventy-one percent of the sample presented a diagnosis of COVID-19. The analysis was performed with the Atlas-ti v8 program.Results: From the analysis of the interviews, 128 quotations were extracted, coded in the following dimensions: 1. experience of confinement; 2. perception of changes; 3. health problems; 4. cognitive and functional changes; 5. loneliness.Conclusions: Burnout, overload, lack of resources and uncertainty caused by the COVID-19 pandemic have generated feelings of fear, exhaustion, anxiety, frustration and sadness in professionals who continue to this day without sufficient resources to face the situation. The design of contingency plans for future health crises should take into account this impact on care professionals. (AU)

Atypical Presentation of Periprosthetic Joint Infection After Total Knee Arthroplasty due to Parvimonas micra.

There is limited literature reporting the oral pathogen Parvimonas micra as the causative organism of periprosthetic joint infection. Previous reports demonstrate septic arthritis in native or prosthetic joints due to P. micra in elderly or immunocompromised patients associated with tooth abscess and periodontal disease. Our case report is unique because it describes a healthy individual with recurrent gingivitis developing periprosthetic joint infection after total knee arthroplasty as the result of isolated P. micra. Her clinical symptom presented early and manifested as progressive stiffness only. Timely aspiration resulted in early diagnosis, but the patient still underwent 2-stage revision with a more constrained implant. To prevent the risk of infection by oral pathogens such as P. micra, dental history should be thoroughly investigated, and any lingering periodontal infection should be addressed before any arthroplasty operation.

Dificultades en terapia inhalada: la complejidad de lo sencillo / Difficulties With Inhaled Therapy: A Complex Simple Technique

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The effect of intra-articular epinephrine lavage on blood loss following total knee arthroplasty.

The purpose of this study was to examine the effects of intra-articular epinephrine lavage on blood loss following total knee arthroplasty (TKA). Our retrospective study involved 189 patients who had primary cemented TKA by 1 of 2 surgeons. Surgeon 1 performed 41 procedures without and 53 with the epinephrine lavage. Surgeon 2 performed 41 procedures without and 54 with the epinephrine lavage. We compared calculated blood loss (CBL) for the patients in all 4 groups. We found no significant differences in CBL among the patients in the 4 patient groups. Our results show that an intra-articular epinephrine lavage does not affect blood loss after TKA.

[Cognitive markers to discriminate between mild cognitive impairment and normal ageing]. / Discriminación mediante marcadores cognitivos del deterioro cognitivo leve frente a envejecimiento normal.

INTRODUCTION: mild cognitive impairment (MCI) has been characterized as a transitional stage between normal ageing and dementia. The aim of the present study was to examine differences between normal ageing and MCI in the performance of several cognitive tests. These differences might serve as differential markers. MATERIAL AND METHODS: we performed a longitudinal study (24 months) with two evaluations at 12-monthly intervals using the CAMCOG-R and a verbal learning test [test de aprendizaje verbal España-Complutense (TAVEC)]. The sample was composed of 25 persons aged more than 50 years old (five men and 20 women), distributed into two groups: the control group and the MCI group. To assign persons to either of the two groups, Petersen's MCI criteria were applied to Mini-Mental State Examination (MMSE) scores. RESULTS: repeated measures ANOVA (2 groups x 2 assessment) showed significant differences between the MCI and control group in the CAMCOG-R scores in orientation, language, memory, abstract thinking, executive function and global score and in the TAVEC scores for immediate recall and short- and long-term free and clued recall. No significant differences were found between the first and second assessment or in the interaction group assessment. CONCLUSIONS: the results of the present study confirm that the CAMCOG-R and the TAVEC effectively discriminate between normal ageing and MCI and can be used complementarily.

Discriminación mediante marcadores cognitivos del deterioro cognitivo leve frente a envejecimiento normal / The final week of life in an acute care hospital: review of 401 consecutive patients

Introducción: el deterioro cognitivo leve (DCL) se ha caracterizado como un estadio de transición entre el envejecimiento normal y la demencia. La presente investigación se propone estudiar las diferencias entre el envejecimiento normal y el DCL en la ejecución de varias pruebas cognitivas que puedan servir como marcadores discriminativos. Material y métodos: presentamos un estudio longitudinal (24 meses), con dos evaluaciones cada 12 meses en las que se aplicaron 2 pruebas, Cambridge Cognitive Assessment-Revised (CAMCOG-R) y test de aprendizaje verbal España-Complutense (TAVEC). La muestra fue de 25 sujetos, mayores de 50 años, 5 varones y 20 mujeres. Se formaron 2 grupos, control y DCL. Para la asignación de cada sujeto a cada grupo se aplicó el criterio de Petersen para el DCL a la puntuación obtenida en el Mini- Mental State Examination (MMSE). Resultados: los ANOVA de medidas repetidas (2 grupo × 2 evaluación) mostraron diferencias significativas entre los grupos DCL y control en las áreas de orientación, lenguaje, memoria, pensamiento abstracto, función ejecutiva y puntuación total en el CAMCOG, y en las variables sobre recuerdo inmediato, recuerdo libre y recuerdo con claves a corto y largo plazo del TAVEC. No aparecieron diferencias significativas entre la primera y la segunda evaluación, ni en la interacción grupo por evaluación. Conclusiones: tanto el CAMCOG-R como el TAVEC se confirman como buenos instrumentos para discriminar entre el envejecimiento normal y el DCL, y pueden utilizarse de forma complementaria

Introduction: mild cognitive impairment (MCI) has been characterized as a transitional stage between normal ageing and dementia. The aim of the present study was to examine differences between normal ageing and MCI in the performance of several cognitive tests. These differences might serve as differential markers. Material and methods: we performed a longitudinal study (24 months) with two evaluations at 12-monthly intervals using the CAMCOG-R and a verbal learning test [test de aprendizaje verbal España-Complutense (TAVEC)]. The sample was composed of 25 persons aged more than 50 years old (five men and 20 women), distributed into two groups: the control group and the MCI group. To assign persons to either of the two groups, Petersen¿s MCI criteria were applied to Mini-Mental State Examination (MMSE) scores. Results: repeated measures ANOVA (2 groups × 2 assessment) showed significant differences between the MCI and control group in the CAMCOG-R scores in orientation, language, memory, abstract thinking, executive function and global score and in the TAVEC scores for immediate recall and short- and longterm free and clued recall. No significant differences were found between the first and second assessment or in the interaction group assessment. Conclusions: the results of the present study confirm that the CAMCOG-R and the TAVEC effectively discriminate between normal ageing and MCI and can be used complementarily

Inhalation injury in the burn patient.

Patients who survive to hospital admission after bums with inhalation injury face a difficult and potentially prolonged course of treatment in the burn center. Continuing survival and especially functional outcome hinges on the patient's receiving comprehensive, well-coordinated care from an interdisciplinary team of skilled health care providers. The best care plan combines close monitoring of vital organ/tissue perfusion indicators, aggressive management of pulmonary compromise, and scrupulous attention to all details of nursing care. Many patients suffer complications from their injuries or treatment, and not all survive. Those who do may face prolonged and painful therapies on the way to recovery. The expert nurse managing and caring for this unfortunate population faces tremendous clinical challenges but also has the opportunity and satisfaction of helping each patient achieve the best possible outcome.

Investigation of polymorphisms in the CREM gene in panic disorder.

Clinical and animal studies suggest a role for pathways regulated by cyclic-AMP in anxiety. Mouse gene deletion studies, our own linkage findings on chromosome 10, and a recently published genetic association study by Domschke et al. [2003: Am J Med Genet 117B:70-78] suggest that the cAMP responsive element modulator (CREM) may be involved in panic disorder. We have employed a family-based design to investigate the role of DNA sequence variations in the gene for CREM in panic disorder. We have genotyped 613 individuals in 70 panic disorder pedigrees, as well as 42 parent/offspring triads. Subjects were genotyped at two informative single nucleotide polymorphisms (SNPs) and three polymorphic microsatellites in the CREM genomic region; and the data were analyzed for genetic association and linkage. Linkage analysis employing several diagnostic/genetic models produced a maximum lod score of 0.63 for SNP-1, located in the 5' UTR of CREM, under a dominant model with a broad diagnostic definition of panic disorder. Non-parametric analysis, using the NPL statistic or FBAT, also did not support any linkage or association between the markers and panic disorder. All five markers (spanning 77 kb) used in the study showed modest, but significant linkage disequilibrium. Analysis of 2-, 3-, 4-, or 5-marker haplotypes using TRANSMIT failed to find any globally significant results; however, individual haplotypes containing a single allele of MS-3 were nominally associated with panic disorder. These findings provide little additional evidence for a susceptibility locus for panic disorder either within the CREM gene or in a nearby region of chromosome 10p11 in our sample.

Vitalism revitalized.... Vulnerable populations, prejudice, and physician-assisted death.

One of the most potent arguments against physician-assisted death hinges on the worry that people with disabilities will be subtly coerced to accept death prematurely. The argument is flawed. There is nothing new in PAD: the risk of coercion is already present in current policies about end of life care. And to hold that any such risk is too much is tacitly to endorse vitalism and to deny that people with disabilities are capable of choosing authentically.

Movement disorders in hereditary ataxias.

Movement disorders are well known features of some dominant hereditary ataxias (HA), specially SCA3/Machado-Joseph disease and dentatorubropallidolusyan atrophy. However, little is known about the existence and classification of movement disorders in other dominant and recessive ataxias. We prospectively studied the presence of movement disorders in patients referred for HA over the last 3 years. Only those patients with a confirmed family history of ataxia were included. We studied 84 cases of HA, including 46 cases of recessive and 38 cases of dominant HA. Thirty out of 46 cases of recessive HA could be classified as: Friedreich ataxia (FA), 29 cases; vitamin E deficiency, 1 case. Twenty-three out of 38 cases of dominant HA could be classified as: SCA 2, 4 cases; SCA 3, 8 cases; SCA 6, 4 cases; SCA 7, 6 cases and SCA 8, 1 case. We observed movement disorders in 20/38 (52%) patients with dominant HA and 25/46 (54%) cases with recessive HA, including 16 patients (16/29) with FA. In general, postural tremor was the most frequent observed movement disorder (27 cases), followed by dystonia (22 cases). Five patients had akinetic rigid syndrome, and in 13 cases, several movement disorders coexisted. Movement disorders are frequent findings in HA, not only in dominant HA but also in recessive HA.