Una experiencia de grupo de reflexión para el manejo de entrevistas clínicas difíciles / A reflection group’s experience in handling hard clinical encounters

Fundamento. Se presenta la experiencia de un grupo de reflexión para valorar si la metodología llevada a cabo, ayuda a los profesionales sanitarios a entenderlos encuentros difíciles (ED), a mejorar su satisfacción profesional y la comunicación con el paciente. Material y método. Se siguió una metodología de reestructuración cognitiva con registro escrito para analizar, primero individualmente, los ED con los pacientes y comentarlos luego en el grupo de reflexión. Resultados. Los ED se referían principalmente a: solicitudes vividas como inapropiadas, cuestionamiento de competencia profesional, y cambio inesperado de médico. Las emociones surgidas, antes y después de “volver a pensar”, cambiaron de intensidad de forma significativa (p<0,001). Los pensamientos irracionales se agruparon en 9 tipos de distorsiones cognitivas, siendo las más frecuentes “razonamiento emocional” y “falacias de control”. Las pautas explicativas constructivas que surgieron después de “volver a pensar”, en su mayoría estaban relacionados con la necesidad de mejorar la comunicación. El grupo reconoció muchas aportaciones positivas. Ni las encuestas utilizadas para valorar el desgaste profesional (MBI), ni la encuesta diseñada para la evaluación, presentaron diferencias significativas, comparando al inicio y final del trabajo. Conclusiones. El empleo conjunto de una metodología cognitivo-conductual en el marco de un grupo de reflexión, se complementan mutuamente, y posibilitan el trabajo engrupo sin precisar un conductor profesional. La reflexión escrita y el trabajo con los pensamientos irracionales y “volver a pensar” con la perspectiva de comentarlo en el grupo, es una experiencia aplicable en el contexto de Atención Primaria y ayuda al manejo de los encuentros difíciles (AU)

Background. We present the experience of a reflection group to evaluate whether the methodology carried out helps health professionals to understand difficult encounters and improve their professional satisfaction and communication with the patient. Method. We followed a cognitive restructuring methodology with a written record in order to analyze difficult encounters with patients, first individually and then followed by comments in the reflection group. Results. Difficult encounters mainly involved: requests felt to be inappropriate, questioning of professional competence, and unexpected change of doctor. The emotions arising, before and after “rethinking”, changed in intensity in a significant way (p<0.001). Irrational thoughts were grouped in 9 types of cognitive distortions, with the most frequent being “emotional reasoning” and “control fallacies”. The majority of constructive explanatory patterns that emerged after “rethinking” were related to the need for improving communication. The group recognized many positive contributions. Neither the surveys used to evaluate occupational burnout, nor the survey designed for the evaluation showed significant differences, comparing the beginning and end of the work. Conclusions. The joint use of a cognitive-behavioral methodology in the framework of a reflection group is mutually complementary, and enables group work without the need for professional direction. Written reflection and work with irrational thoughts and “rethinking” with the perspective of group comment is an experience that is applicable in the context of Primary Care and helps in handling difficult encounters (AU)

[A reflection group's experience in handling difficult clinical encounters]. / Una experiencia de grupo de reflexión para el manejo de entrevistas clínicas difíciles.

BACKGROUND: We present the experience of a reflection group to evaluate whether the methodology carried out helps health professionals to understand difficult encounters and improve their professional satisfaction and communication with the patient. METHOD: We followed a cognitive restructuring methodology with a written record in order to analyze difficult encounters with patients, first individually and then followed by comments in the reflection group. RESULTS: Difficult encounters mainly involved: requests felt to be inappropriate, questioning of professional competence, and unexpected change of doctor. The emotions arising, before and after "rethinking", changed in intensity in a significant way (p<0.001). Irrational thoughts were grouped in 9 types of cognitive distortions, with the most frequent being "emotional reasoning" and "control fallacies". The majority of constructive explanatory patterns that emerged after "rethinking" were related to the need for improving communication. The group recognized many positive contributions. Neither the surveys used to evaluate occupational burnout, nor the survey designed for the evaluation showed significant differences, comparing the beginning and end of the work. CONCLUSIONS: The joint use of a cognitive-behavioral methodology in the framework of a reflection group is mutually complementary, and enables group work without the need for professional direction. Written reflection and work with irrational thoughts and "rethinking" with the perspective of group comment is an experience that is applicable in the context of Primary Care and helps in handling difficult encounters.

[Attention to diversity in emergency care]. / La atención a la diversidad en urgencias.

The immigrant population in general uses the health services less frequently than the native population. No significant differences are found between immigrants and natives in the use of emergency services. However, the perception of professionals who attend to the emergency services is that there is a greater use of these services by the immigrant population. Perhaps this is because difficulties of language and cultural understanding might require more effort and time in the care given to the immigrant patient. The doctor, who treats the immigrant population, as well as tourists and Spanish overseas voluntary workers, must become familiar with a series of pathologies, some of which might be exceptional among the native Spanish population, but which are endemic on some of the countries of origin of the immigrant population, frequently due to their lower socio-economic development. Some aspects to bear in mind in treating the immigrant patient might be as follows: avoiding the risk of minimising psychic complaints and explaining them away to uprootedness; if a diet or medicine is to be prescribed, the type of food and religious beliefs of the patient's country should be taken into account. The level of respect and the capacity to detect religious and cultural differences in relation to health care are fundamental tasks that the health professionals must assume with the greatest commitment in order to achieve care that is culturally appropriate in the face of diversity.

La atención a la diversidad en urgencias / Attention to diversity in emergency care

La población inmigrante en general utiliza con menorfrecuencia que la autóctona la mayoría de los serviciossanitarios. En la frecuentación de las urgencias generalesno se encuentran diferencias significativas entreautóctonos e inmigrantes. Sin embargo la percepción delos profesionales que atienden las urgencias es la mayorutilización de este servicio por la población inmigrante.Quizás esto sea debido a la dificultad idiomática y decompresión cultural puede requerir más esfuerzo y mástiempo en la atención al paciente inmigrante.El médico que atiende a población inmigrante, asícomo a turistas y cooperantes españoles, debe familiarizarsecon una serie de patologías, algunas de las cualespueden resultar excepcionales entre la población autóctona,pero que son endémicas en algunos de los paísesde procedencia de la población inmigrante, frecuentementedebido a su menor desarrollo socioeconómico.Algunos aspectos a tener en cuenta en la atenciónal paciente inmigrante pueden ser entre ellos el evitarel riesgo de minimizar las quejas psíquicas y achacarlastodas al desarraigo, o si se ha de prescribir una dietao algunos fármacos, tener en cuenta el tipo de alimentacióndel país del paciente y las creencias religiosas.El nivel de respeto y la capacidad de detección delas diferencias religiosas o culturales en relación conel cuidado de la salud, es una tarea fundamental quelos profesionales sanitarios deben asumir con el mayorcompromiso para lograr una atención culturalmenteapropiada ante la diversidad(AU)

The immigrant population in general uses thehealth services less frequently than the native population.No significant differences are found between immigrantsand natives in the use of emergency services.However, the perception of professionals who attend tothe emergency services is that there is a greater use ofthese services by the immigrant population. Perhapsthis is because difficulties of language and cultural understandingmight require more effort and time in thecare given to the immigrant patient.The doctor, who treats the immigrant population,as well as tourists and Spanish overseas voluntary workers,must become familiar with a series of pathologies,some of which might be exceptional among the nativeSpanish population, but which are endemic on someof the countries of origin of the immigrant population,frequently due to their lower socio-economic development.Some aspects to bear in mind in treating the immigrantpatient might be as follows: avoiding the riskof minimising psychic complaints and explaining themaway to uprootedness; if a diet or medicine is to beprescribed, the type of food and religious beliefs of thepatient’s country should be taken into account. Thelevel of respect and the capacity to detect religiousand cultural differences in relation to health care arefundamental tasks that the health professionals mustassume with the greatest commitment in order toachieve care that is culturally appropriate in the faceof diversity(AU)

[The immigrant in primary care consultations]. / El inmigrante en la consulta de atención primaria.

In consultations at health centres, the GP, the paediatrician and the nursing staff have faced, above all since the end of the XIX century and so far in the XXI century, the fact of having to attend to a numerous population formed of people uprooted from their community, without close relatives in the majority of cases, with different languages and cultures, and with a different way of understanding health and illness. This article analyses this phenomenon and aims to improve the understanding of health professionals and contribute to improving care for the immigrant patient.

El inmigrante en la consulta de atención primaria / The immigrant in primary care consultations

En las consultas de los centros de salud, el médico de familia, el pediatra y el personal de enfermería se han encontrado, sobre todo desde finales del s. XIX y en lo que va del s. XXI, con la realidad de tener que atender a una numerosa población compuesta de personas desarraigadas de su comunidad, la mayoría de las veces sin familia cercana, con unas lenguas y culturas diferentes, con un modo distinto de entender la salud y la enfermedad. Este artículo pretende ser una aproximación al análisis de este fenómeno y contribuir a que los profesionales sanitarios puedan entender y mejorar la atención al paciente inmigrante

In consultations at health centres, the GP, the paediatrician and the nursing staff have faced, above all since the end of the XIX century and so far in the XXI century, the fact of having to attend to a numerous population formed of people uprooted from their community, without close relatives in the majority of cases, with different languages and cultures, and with a different way of understanding health and illness. This article analyses this phenomenon and aims to improve the understanding of health professionals and contribute to improving care for the immigrant patient

Preparation of single cell detritus from Laminaria saccharina as a hatchery diet for bivalve mollusks.

A high-yield technique is described for the elaboration of single cell detritus (SCD) from Laminaria saccharina, based on the sequential action of C1H, enzymes (endoglucanases and cellulases) and 2 bacteria showing a high degree of cellobiotic, proteolytic, and alginolytic activity (CECT 5255 and CECT 5256). Over 85% of dried particles of L. saccharina were transformed into a suspension of free cell and bacterial and detrital particles after 24 hours of bacterial activity with this technique. These particles were less than 20 mum in diameter, constituting a suitable diet for bivalve mollusks. After 72 hours 99% of the total particulate volume consisted of particles less than 20 mum in diameter. Tests of hatchery diets for the seed of clam Ruditapes decussatus revealed increases of 54% and 68% for live weight and length, respectively, when SCD from L. saccharina was used as the sole dietary component compared with a live phytoplankton diet. However, SCD from L. saccharina is not a suitable food for the larvae of R. decussatus.

La especialidad de medicina familiar y comunitaria en 2004 con la aplicación de nuevo programa de formación / The specialisation of Family and Community Medicine in 2004 with the application of a new training program

No disponible

[Giving up the tobacco habit through the application of the Smoker's Aid Program in the Chantrea Health Centre]. / Abandono del hábito tabáquico mediante la aplicación del programa de ayuda al fumador en el centro de salud de Chantrea.

INTRODUCTION: This is a prospective descriptive study of intervention without aleatory assignation, carried out in the Chantrea Health Centre. Its aim is to determine the characteristics of the smokers who are taking part in two interventions by the Smokers' Aid Program (Programa de Ayuda al Fumador-PAF), and to evaluate the factors that influence the latter's success. MATERIAL AND METHODS: The characteristics of 100 smokers were analyzed. They were offered one of the two PAF interventions: Minimal Intervention 1 (MN1): they are given a support brochure in the first consultations, contacted by telephone after one month and called to consultation after 6 months to measure CO. Minimal Intervention 2 (MN2): the smoker makes 5 consultations of support in giving up smoking (+ or - nicotine patches) with the doctor, nurse or social worker indiscriminately. The factors that were influential in abandoning the habit with 65 subjects were evaluated. RESULTS: 60% of the subjects were male with an average age of 41 (DE 29). 29% showed a pathology related to tobacco, with no relation found between this and the success of the interventions. Those who chose MN2 (38%) had started tobacco consumption at an earlier age and were more dependent on nicotine. Of the 65 smokers who completed the program, 37% continued not to smoke after 6 months. Those who managed to give up smoking were of a greater average age, had spent more years smoking and belonged above all to the MN1 intervention. DISCUSSION: Notable successes are achieved if the actions are carried out by the First Aid Team. We find no significant differences between the characteristics of those who give up smoking and those who do not. Not even a serious pathology, related to tobacco, is predictive of success. The smoker's dependence on nicotine must be taken into account in the intervention.