Factores de riesgo y protección del estrés traumático secundario en los cuidados intensivos: un estudio exploratorio en un hospital terciario de Madrid / Risk and protective factors of secondary traumatic stress in Intensive Care Units: An exploratory study in a hospital in Madrid (Spain)

OBJETIVO: Proponer un modelo de predictores del estrés traumático secundario. DISEÑO: Se trata de un diseño transversal descriptivo. Ámbito: El estudio se llevó a cabo en las unidades de cuidados intensivos de un hospital terciario de Madrid. PARTICIPANTES: La muestra estuvo formada por 103 profesionales sanitarios. INTERVENCIONES: Se creó una batería de cuestionarios que fue rellenada por los profesionales. Respecto al análisis de datos, se utilizó una metodología de redes y análisis de regresión jerárquica. Variables de interés: Se evaluaron variables sociodemográficas tales como género, años de experiencia y puesto, el estrés traumático secundario, la pasión por el trabajo, los estresores laborales, el esfuerzo emocional, la empatía, la autocompasión. RESULTADOS: Se establece: a) para la fatiga por compasión, los años de experiencia como factor de riesgo (β = 0,224 y p = 0,029) y la pasión armoniosa como protector (β = −0,363 y p = 0,001); b) para la sacudida de creencias, el esfuerzo emocional y la empatía como factores de riesgo (β = 0,304 y p = 0,004; β = 0,394 y p = 0,000, respectivamente) y c) para la sintomatología, los estresores laborales y la empatía como factores de riesgo (β = 0,189 y p = 0,039; β = 0,395 y p = 0,000, respectivamente) y los años de experiencia como protector (β = −0,266 y p = 0,002). CONCLUSIONES: Este modelo predictivo del estrés traumático secundario asienta factores protectores que podrían aumentarse, como la pasión armoniosa, y factores de riesgo que sería conveniente reducir, como la empatía y el esfuerzo emocional, con el fin de mejorar la calidad asistencial y de vida de los profesionales

AIM: To propose a predictive model of secondary traumatic stress. DESIGN: A descriptive cross-sectional study was carried out. Context: The study was conducted in the Intensive Care Units of a hospital in Madrid (Spain). PARTICIPANTS: The sample comprised 103 health professionals. INTERVENTIONS: A series of questionnaires were created and completed by the participants. Network analysis and multiple regression were used for data analysis. Variables of interest: Sociodemographic variables such as gender, years of experience and position, secondary traumatic stress, passion for work, work stressors, emotional effort, empathy and self-compassion were evaluated. RESULTS: The result identified the following: a) years of experience as a risk factor for compassion fatigue (β=0.224 and P=0.029), and harmonious passion as a protector (β=−0.363 and P=0.001); b) emotional effort and empathy as risk factors for shattered assumptions (β=0.304 and P=0.004; β=0.394 and P=0.000, respectively); and c), work stressors and empathy as risk factors for symptomatology (β=0.189 and P=0.039; β=0.395 and P=0.000, respectively), and years of experience as a protector (β=−0.266 and P=0.002). CONCLUSIONS: This predictive model of secondary traumatic stress identifies protective factors which could be reinforced, such as harmonious passion, and risk factors which should be reduced, such as empathy and emotional effort, with a view to promoting quality of care and quality of life among these professionals

Risk and protective factors of secondary traumatic stress in Intensive Care Units: An exploratory study in a hospital in Madrid (Spain). / Factores de riesgo y protección del estrés traumático secundario en los cuidados intensivos: un estudio exploratorio en un hospital terciario de Madrid.

AIM: To propose a predictive model of secondary traumatic stress. DESIGN: A descriptive cross-sectional study was carried out. CONTEXT: The study was conducted in the Intensive Care Units of a hospital in Madrid (Spain). PARTICIPANTS: The sample comprised 103 health professionals. INTERVENTIONS: A series of questionnaires were created and completed by the participants. Network analysis and multiple regression were used for data analysis. VARIABLES OF INTEREST: Sociodemographic variables such as gender, years of experience and position, secondary traumatic stress, passion for work, work stressors, emotional effort, empathy and self-compassion were evaluated. RESULTS: The result identified the following: a) years of experience as a risk factor for compassion fatigue (ß=0.224 and P=0.029), and harmonious passion as a protector (ß=-0.363 and P=0.001); b) emotional effort and empathy as risk factors for shattered assumptions (ß=0.304 and P=0.004; ß=0.394 and P=0.000, respectively); and c), work stressors and empathy as risk factors for symptomatology (ß=0.189 and P=0.039; ß=0.395 and P=0.000, respectively), and years of experience as a protector (ß=-0.266 and P=0.002). CONCLUSIONS: This predictive model of secondary traumatic stress identifies protective factors which could be reinforced, such as harmonious passion, and risk factors which should be reduced, such as empathy and emotional effort, with a view to promoting quality of care and quality of life among these professionals.

Mental health, positive affectivity and wellbeing in prison: a comparative study between young and older prisoners.

OBJECTIVES: To explore sociodemographic, psychological and psychopathological characteristics, as well as to evaluate the behaviour in an inmate sample. MATERIALS AND METHODS: There is a total sample of 182 young and elderly inmates of the Madrid III Prison. The investigation has been carried out with a battery of self-report psychological questionnaires and objective measurements obtained through the prison files. Comparisons of means were made to see if there are significant differences between the two groups (young and elderly inmates) in the variables analysed. RESULTS: The analysis shows that there are no significant differences in wellbeing between young and elderly inmates. However, young people have higher levels of psychological distress, more presence of negative emotions and have a more maladjusted behaviour in prison (they consume more cannabis and have more disciplinary records). Older people better regulate their emotions, adopt better the perspectives of others, showing themselves to be friendlier. CONCLUSIONS: The elderly inmates in prison, compared with the youngest, have a better psychological adjustment, more internal resources and a better adaptation to the prison environment despite of no differences in related variables such as time in prison.

Trombectomía reolítica: una herramienta efectiva, versátil y segura / Rheolytic thrombectomy: An effective, versatile, and safe treatment

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Protocolo SANTIAGO. Planificación reparación endovascular de aorta (EVAR) en situaciones de urgencia / SANTIAGO protocol. Endovascular aortic repair planning in emergency situations

INTRODUCCIÓN: La reparación endovascular de los aneurismas de la aorta abdominal (EVAR) con éxito precisa la previa realización de una medición anatómica precisa basada en el estudio angio-TC aórtica. En situaciones de urgencia el tiempo para medición y planificación del caso es limitado y la disponibilidad del estudio en formato DICOM no siempre es posible. OBJETIVO: Presentar un protocolo de planificación desarrollado en nuestro centro que permite reducir el tiempo necesario para realizar las medidas en terapia EVAR de aneurismas de aorta abdominal (AAA) rotos en situaciones de urgencia y describir los resultados de nuestro centro antes y después de la aplicación de este protocolo. MÉTODO: Presentamos un análisis descriptivo de morbimortalidad a 30 días y a un año basado en un registro prospectivo de todos los casos de rotura de AAA admitidos de modo consecutivo (n = 32) en el servicio de urgencias de un hospital nacional de referencia durante el periodo enero del 2013 a mayo del 2015 (28 meses). El protocolo SANTIAGO es un acrónimo que describe (en lengua inglesa) 8 pasos que deben ser siempre tenidos en cuenta para una planificación EVAR: S (Size the aneurysms), A (Access), N (Neck), T (bifurcaTion), I (Iliacs), A (Angulations), G (LenGth-LonGitud) y O (OK for material). En nuestro centro, la terapia EVAR en rotura aórtica se realiza bajo anestesia local y de modo percutáneo si la situación clínica del paciente lo permite. RESULTADOS: Tras la aplicación del protocolo SANTIAGO en nuestro centro, desde junio del 2014, se consiguió reducir la mortalidad en el tratamiento urgente de aneurismas aórticos infrarrenales rotos. Fueron desestimados para ningún tipo de intervención por su elevada morbimortalidad 3 pacientes de los 32 (9,3%) admitidos en urgencias. La mortalidad total a 30 días en pacientes tratados disminuyó del 46,6% (7/15) preprotocolo frente al 35,7%(5/14) posprotocolo y en pacientes intervenidos mediante técnica endovascular pasó del 25% (1/4) preprotocolo frente a un 0%(0/6) de mortalidad posprotocolo. El 66,6% (4/6) de los pacientes tratados mediante EVAR tras el implante del protocolo fueron intervenidos de modo percutáneo y bajo anestesia local. La mortalidad al año, registrada en mayo del 2016, fue en el grupo EVAR del 10% (1/10), tasa de reintervención al año del 7,1% (1/9) por endofuga tipo ib, resuelta con éxito. En el grupo de cirugía abierta la morbimortalidad a 12 meses fue del 63,15% (12/19) de los pacientes intervenidos, con registro de un fallecimiento por IAM 7 meses postintervención y sin datos de reintervenciones mayores al año. CONCLUSIONES: Basados en la mejora de resultados observada en nuestro centro, consideramos que la existencia de un protocolo de planificación EVAR permite una planificación esquemática y reproducible que optimiza el tiempo necesario para afrontar una situación de urgencia crítica y propicia el éxito de la reparación. Asimismo, existe la tendencia progresiva en nuestro centro a considerar el tratamiento EVAR como primera opción terapéutica para pacientes con AAA-r. La posibilidad de realizar esta técnica con anestesia local y abordaje percutáneo podría ser considerada como un factor independiente que condiciona la menor morbimortalidad global del procedimiento

INTRODUCTION: Successful endovascular treatment of ruptured abdominal aortic aneurysms (R-EVAR) requires a detailed planning of the procedure, as planning is the key step. Nevertheless, in cases of emergency the limited time for planning and the non-availability of good quality scan images (DICOM format) are common issues that determine the final result. OBJECTIVE: The aim of this paper is to present the results of r-AAA survival before and after a fast protocol was implemented in our centre for measuring and sizing r-EVAR in emergency situations. METHOD: Morbidity and mortality at 30 days and 1 year was prospectively recorded in all consecutive cases of r-AAA admitted to the emergency department of our hospital (n = 32) from January 2013 to May 2015 (28 months). The «SANTIAGO planning & sizing protocol» was implemented in June 2014. It is a fast method to remember key steps in planning EVAR. With the word SANTIAGO being a mnemonic device in which 8 basic and mandatory steps in planning can be summarised: S: Size, A: Access N: Neck, T: Bifurcation I: Iliacs, A: Angulations, G: Length, O: Ok for material. R-EVAR is performed in this centre under local anaesthesia and using a percutaneous approach, if the patient tolerates it, since June 2014. RESULTS: After implementation of the SANTIAGO protocol in June 2014, the 30 day mortality was reduced from 46.6% (7/15) to 35.7% (5/14) in all patients treated in our centre for a ruptured AAA. The mortality recorded in the endovascular group was 25% (1/4) pre-protocol and 0% (0/6) after in the period analysed. A percutaneous approach and local anaesthesia was used in 66% (4/6) patients in the EVAR Group after the protocol was implemented. The 1 year mortality was 10% for all patients treated in the R-EVAR group, with a secondary intervention rate of 7.1% (1/9) due to a type Ib endoleak. In the open repair group, the 1 year morbidity/mortality was 63.15% (12/19), with a patient death at 7 months due to a myocardial infarction. CONCLUSIONS: Our first results suggest that a fast protocol for planning and sizing in emergency situations seems to be associated with a lower 30 day mortality. A higher trend for considering the patient candidate for r-EVAR has been observed in our centre. Local anaesthesia and percutaneous approach have a probable influence on the lower morbidity and mortality of the endovascular cases

Psychometric validation of the Spanish version of the Patient-Doctor Relationship Questionnaire (PDRQ).

INTRODUCTION: The main aim of this study was to make a Spanish adaption of the international Patient-Doctor Relationship Questionnaire (PDRQ) that assesses the quality of patient-doctor relationship in Spanish patients admitted to an Internal Medicine Service under conditions of regular clinical practice. METHOD: A total of 188 adult patients of 6 Internal Medicine physicians from a University Hospital in downtown Madrid were analyzed. Sociodemographic and clinical variables were collected and the PDRQ Spanish version questionnaire was administered. RESULTS: Results showed excellent psychometric data on reliability, factorial, and construct validity. Furthermore, based on scientific literature, criteria validity was determined, considering continuity of care as external criteria. Results ratify previous data related to positive relation between quality of doctor-patient relation and continuity of care. CONCLUSIONS: The Spanish 13 item version of the PDRQ (CREM-P in Spanish) proved to be a valid instrument for assessing the quality of patient-doctor relation in adult patients, with clinical and research value.

Validación psicométrica de la versión española del Cuestionario de Relaciones Médico-Paciente (CREM-P) / Psychometric validation of the Spanish version of the Patient-Doctor Relationship Questionnaire (PDRQ)

Introducción. El principal objetivo del presente estudio fue la adaptación del instrumento internacional Patient-Doctor Relationship Questionnaire (PDRQ) que evalúa la calidad de la relación médico-paciente a una muestra española de pacientes de Medicina Interna en condiciones de práctica clínica habitual. Método. Fueron evaluados 188 pacientes de 6 médicos especialistas en Medicina Interna de un Hospital Universitario de Madrid capital. Se recogieron información clínica y sociodemográfica y fue administrada la traducción española del cuestionario PDRQ. Resultados. Los resultados indicaron niveles altos en fiabilidad, validez factorial y validez de contenido. Asimismo, a partir de los resultados obtenidos en la literatura científica se procedió al estudio de la validez criterial utilizando como criterio externo la continuidad del cuidado. Los resultados refrendan datos previos sobre la relación positiva entre calidad de la relación médico-paciente y continuidad del cuidado. Conclusiones. El cuestionario final obtenido (CREM-P )de 13 ítems se muestra como un instrumento fiable, válido y de fácil cumplimentación, diseñado para permitir la evaluación tanto en contextos clínicos como de investigación (AU)

Introduction. The main aim of this study was to make a Spanish adaption of the international Patient-Doctor Relationship Questionnaire (PDRQ) that assesses the quality of patient-doctor relationship in Spanish patients admitted to an Internal Medicine Service under conditions of regular clinical practice. Method. A total of 188 adult patients of 6 Internal Medicine physicians from a University Hospital in downtown Madrid were analyzed. Sociodemographic and clinical variables were collected and the PDRQ Spanish version questionnaire was administered. Results. Results showed excellent psychometric data on reliability, factorial, and construct validity. Furthermore, based on scientific literature, criteria validity was determined, considering continuity of care as external criteria. Results ratify previous data related to positive relation between quality of doctor-patient relation and continuity of care. Conclusions. The Spanish 13 item version of the PDRQ (CREM-P in Spanish) proved to be a valid instrument for assessing the quality of patient-doctor relation in adult patients, with clinical and research value (AU)

El Burnout médico: la ansiedad y los procesos de afrontamiento como factores intervinientes / The Medical Burnout: anxiety and doping process as relevant factors

Actualmente, no existen muchas investigaciones donde se consideren variables tanto ambientales como de personalidad en el estudio del burnout como proceso. La presente investigación plantea dos objetivos centrales: evaluar el nivel de significación de la ansiedad y las estrategias de afrontamiento en el proceso de burnout, y clarificar la relación empírica entre ellas. En una muestra de 130 profesionales médicos de ocho hospitales públicos de Madrid se les administró los cuestionarios Maslach Burnout Inventory (Maslach y Jackson, 1986), State-Trait Anxiety Inventory (Spielberger, Gorsuch y Lushene, 1988), Ways of Coping Checklist (Lazarus y Folkman, 1984) y el Cuestionario de Afrontamiento Médico Situacional (Moreno-Jiménez y Seminotti, 1998). Las variables independientes fueron: género, estado civil, grupo médico, experiencia clínica, edad y especialidad. Los resultados mostraron una relación significativa entre las variables dependientes y el género, grupo médico y la edad mediante análisis multivariante MANOVA. El análisis de regresión por pasos mostró resultados relevantes para determinar un modelo teórico situacional del proceso de Burnout

To date there are not many studies focused on burnout like a process, where both environment and personality variables are considered. The present study had two central aims: to test what variables significantly effect the burnout process, and to clarify the empirical relationship between anxiety, coping styles and burnout. The Maslach Burnout Inventory (Maslach y Jackson, 1986), the State-Trait Anxiety Inventory (Spielberger, Gorsuch y Lushene, 1988), the Ways of Coping Checklist (Lazarus y Folkman, 1984) and the Situational Medical Coping (Moreno-Jimenez y Seminotti, 1998) were administered to a sample of 130 physicians who work in eight public hospitals in Madrid. The independent variables were gender, marital status, medical group, clinical experience, age and speciality. Results showed a strong relationship among the dependent variables in gender, medical group and age through the GLM Multivariate MANOVA. A stepwise regression analysis provided relevant results to determine the theoretical situational model in Burnout process

La evaluacion del burnout profesional. Factoriallzacion del MBI-GS. Un análisis preliminar / The assessment of bournout in work settings: MBI-GS factor preliminary analysis

Los estudios efectuados con el MBI-HSS (Maslach Sumont Inventory; Human Services Survey) han mostrado repetidamente problemas en su aplicación a trabajos no asistenciales, especialmente en lo que respecta a la subescala de Despersonalización. La aparición en 1996 del MBI-GS (Maslach Burnont Inventory; General Survey; Maslach, Jackson y Leiter, 1996) suplia esas deficiencias en ámbitos laborales no asistenciales y enriquecía el modelo teórico. El presente artículo porpone adaptar al castellano el MBI-GS y comprobar sus características psicométricas en una versión en castellano mediante su aplicación a una muestra de 114 administrativos. Los análisis factoriales y de consistencia efectuados indican que los datos encontrados se corresponden con bastante exactitud al modelo teórico presentado (AU)

Previous studies using MBI-HSS(Maslach Burnout lnventory; Human Services Survey) have repeatedly shown problems with its application to non-assistant works, in particular referring the depersonalisation scale. The 1996 MBI-GS theoretical scale (Maslach Burnout Inventory; General Survey; Maslach, Jackson y Leiter, 1996) was able to overcome the deficiencies previously experienced in the non-assistant labour field even improving the theoretical model. This article focuses on the adaption of the MBI-GS scale to a Spanish audience and examines its psychometric characteristics in a sample of 114 administrative workers. The factorial and consistancy anaIysis have showed that the findings produced in this study are similar to those produced by the orginal theoretical model (AU)