Enfermedades graves y embarazo

Revisión clínica. Poblaciones especiales. Enfermedades graves y embarazo. Clinical review: Special populations--critical illness and pregnancy. Neligan PJ1, Laffey JG. Author information Crit Care. 2011 Aug 12;15(4):227. doi: 10.1186/cc10256. Abstract Critical illness is an uncommon but potentially devastating complication of pregnancy. The majority of pregnancy-related critical care admissions occur postpartum. Antenatally, the pregnant patient is more likely to be admitted with diseases non-specific to pregnancy, such as pneumonia. Pregnancy-specific diseases resulting in ICU admission include obstetric hemorrhage, pre-eclampsia/eclampsia, HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, amniotic fluid embolus syndrome, acute fatty liver of pregnancy, and peripartum cardiomyopathy. Alternatively, critical illness may result from pregnancy-induced worsening of pre-existing diseases (for example, valvular heart disease, myasthenia gravis, and kidney disease). Pregnancy can also predispose women to diseases seen in the non-pregnant population, such as acute respiratory distress syndrome (for example, pneumonia and aspiration), sepsis (for example, chorioamnionitis and pyelonephritis) or pulmonary embolism. The pregnant patient may also develop conditions co-incidental to pregnancy such as trauma or appendicitis. Hemorrhage, particularly postpartum, and hypertensive disorders of pregnancy remain the most frequent indications for ICU admission. This review focuses on pregnancy-specific causes of critical illness. Management of the critically ill mother poses special challenges. The physiologic changes in pregnancy and the presence of a second, dependent, patient may necessitate adjustments to therapeutic and supportive strategies. The fetus is generally robust despite maternal illness, and therapeutically what is good for the mother is generally good for the fetus. For pregnancy-induced critical illnesses, delivery of the fetus helps resolve the disease process. Prognosis following pregnancy-related critical illness is generally better than for age-matched non-pregnant critically ill patients. PDF Atención crítica materna: ¿qué podemos aprender de la experiencia del paciente? Un estudio cualitativo Maternal critical care: what can we learn from patient experience? A qualitative study Lisa Hinton, Louise Locock, Marian Knight BMJ Open. 2015; 5(4): e006676. Published online 2015 Apr 27. doi: 10.1136/bmjopen-2014-006676 Objective For every maternal death, nine women develop severe maternal morbidity. Many of those women will need care in an intensive care unit (ICU) or high dependency unit (HDU). Critical care in the context of pregnancy poses distinct issues for staff and patients, for example, with breastfeeding support and separation from the newborn. This study aimed to understand the experiences of women who experience a maternal near miss and require critical care after childbirth. Setting: Women and some partners from across the UK were interviewed as part of a study of experiences of near-miss maternal morbidity. Design: A qualitative study, using semistructured interviews. Participants; A maximum variation sample was recruited of 35 women and 11 partners of women who had experienced a severe maternal illness, which without urgent medical attention would have led to her death. 18 of the women were admitted to ICU or HDU. Results; The findings are presented in three themes: being in critical care; being a new mother in critical care; transfer and follow-up after critical care. The study highlights the shock of requiring critical care for new mothers and the gulf between their expectations of birth and what actually happened; the devastation of being separated from their baby, how valuable access to their newborn was, if possible, and the importance of breast feeding; the difficulties of transfer and the need for more support; the value of follow-up and outreach to this population of critical care patients. Conclusions: While uncommon, critical illness in pregnancy can be devastating for new mothers and presents a challenge for critical care and maternity staff. This study provides insights into these challenges and recommendations for overcoming them drawn from patient experiences. Keywords: QUALITATIVE RESEARCH PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Síndrome de burnout / Burnout syndorme

Noviembre 21, 2017. No. 2909

Síndrome de burnout en medicina de urgencias Burnout syndrome in emergency medicine Dubravka Ivanic1, Visnja Nesek Adam1,2,3,  Ivana Srzic1, Anika Stepic1 and Hrvoje Pintaric4,5 Hong Kong Journal of Emergency Medicine 2017:24(6) Abstract Background: Occupational burnout syndrome generally develops in individuals of helping professions and is considered to result from long-standing stress. Burnout syndrome is characterized by loss of interest, fatigue, or frustration, the negative consequences of which affect the individual's performance, thus being a major factor that influences the quality of work. Objectives: The aim of the study was to assess the existence of burnout syndrome in medical staff working at hospital emergency department. Methods: The study included 120 subjects working at emergency departments. The following two questionnaires were used: Copenhagen Burnout Inventory and Copenhagen Psychosocial Questionnaire. Likert scale was employed on scoring the answers offered in the questionnaires. Statistical analysis was performed using the exploratory factor analysis, analysis of variance, Bonferroni test, and Pearson correlation coefficient. The level of statistical significance was set at p < 0.05. Results: Study results revealed that the subjects suffer mostly from the symptoms of fatigue due to occupational burnout and exhaustion at the end of the day. The prevalence of burnout syndrome was highest among subjects with 11-15 years work in emergency department, while lower risk was recorded in those nurses and physicians who reported a higher level of social support, sense of community, and feedback information. Conclusion: Results of the study confirmed the existence of burnout syndrome in medical staff working at hospital emergency department, with the highest prevalence recorded in those working at this department for more than 11 years. The main burnout symptoms reported by study subjects were fatigue, exhaustion at the end of the day, and feeling that they were giving more than they were receiving in return. Burnout syndrome was found to be less common among those nurses and physicians who reported a higher level of social support, sense of community, and feedback information. Keywords Burnout syndrome, medical staff, emergency department PDF Síndrome de burn out durante la residencia Burnout Syndrome During Residency. Turgut N1, Karacalar S1, Polat C1, Kıran Ö1, Gültop F1, Kalyon ST1, Sinoğlu B1, Zincirci M1, Kaya E2. Author information Turk J Anaesthesiol Reanim. 2016 Oct;44(5):258-264. Epub 2016 Oct 1. Abstract OBJECTIVE: The aim of this study is identified the degree of Burnout Syndrome (BOS) and find out its correlation with years of recidency and sociodemograpfic chareacteristics, training, sleeping habits, such as smoking and alcohol consumption. METHODS: After approval from the Hospital Ethics Committee and obtaining informed consent, First, second, third, fourth and fifth year of recidency staff (n=127) working in our hospital were involved in this study. The standardized Maslach Burnout Inventory (MBI) was used in this study. RESULTS: Fifty six male (44.1%) and seventy one female (55.9%) residents were enroled in this study (Coranbach Alfa(α)=0.873). 57% of the first year residents smokes cigaret and 54% of them use alcohol. 2% of them gets one day off after hospital night shift, 61% of them suffers from disturbed sleep. 60% of them had been stated that they willingly selected their profession. 61% of them prefers talking to friends and 32% of them prefers shopping to overcome stress. There were statistical difference acording to years of recidency in MBI, Emotional Burnout (EB) and desensitisation scale (DS) points. EB scale points of the second year of residency group was statisticaly higher than fourth year of residency group. DS points of second year of residency group was also statisticaly higher than the third and fourth year of residency group. There was no statistical difference between any groups in Personal Success. CONCLUSION: BOS is a frequent problem during residency in anaesthesia. Appropriate definition and awareness are the first important steps to prevent this syndrome. Further administrative approaches should be evaluated with regard to their effects. KEYWORDS: Burnout syndrome; Maslach Burnout Inventory; resident PDF Anestesistas y síndrome de burnout: ¿qué estrategias pueden prevenir esta peligrosa combinación? Anesthetists and burnout syndrome: what strategies can prevent this dangerous combination? Caruselli M1, Michel F2,3. Minerva Anestesiol. 2017 Feb;83(2):136-137. doi: 10.23736/S0375-9393.16.11771-7. Epub 2016 Nov 8. PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Dolor crónico postamputación / Chronic post-amputation pain

Noviembre 17, 2017. No. 2905 Estimad@ Dr@ Víctor Valdés:

Dolor crónico post-aputación. Manejo perioperataorio. Revisión Chronic post-amputation pain: peri-operative management - Review. Srivastava D1. Author information Br J Pain. 2017 Nov;11(4):192-202. doi: 10.1177/2049463717736492. Epub 2017 Oct 9. Abstract STUDY DESIGN: Narrative review. METHOD: Eight bibliographic databases were searched for studies published in the (last five years up until Feb 2017). For the two database searches (Cochrane and DARE), the time frame was unlimited. The review involved keyword searches of the term 'Amputation' AND 'chronic pain'. Studies selected were interrogated for any association between peri-operative factors and the occurrence of chronic post amputation pain (CPAP). RESULTS: Heterogeneity of study populations and outcome measures prevented a systematic review and hence a narrative synthesis of results was undertaken. The presence of variation in two gene alleles (GCH1 and KCNS1) may be relevant for development of CPAP. There was little evidence to draw conclusions on the association between age, gender and CPAP. Pre-operative anxiety and depression influenced pain intensity post operatively and long-term post amputation pain (CPAP). The presence of pre-amputation pain is correlated to the development of acute and chronic post amputation pain while evidence for the association of post-operative pain with CPAP is modest. Regional anaesthesia and peri-neural catheters improve acute postoperative pain relief but evidence on their efficacy to prevent CPAP is limited. A suggested whole system pathway based on current evidence to optimize peri-operative amputation pain is described. CONCLUSION: The current evidence suggests that optimized peri-operative analgesia reduces the incidence of acute peri-operative pain but no firm conclusion can be drawn on reducing risk for CPAP. KEYWORDS: Amputation; chronic pain; persistent post-surgical pain; phantom limb pain; stump pain PDF XIV Congreso Virtual Mexicano de Anestesiología 2017 Octubre 1-Diciembre 31, 2017 Información / Information Video informativo LI Congreso Mexicano de Anestesiología Mérida Yucatán, Noviembre 21-25, 2017 Información / Information International Anesthesia Research Society Annuals Meetings USA Informes / Information

Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org

Medwave edición Noviembre-Diciembre 2017

Medwave edición noviembre-diciembre 2017 Vea este email en su navegador

Estimado(a) Victor Manuel Valdes:

-----  Contenidos recientemente publicados:  ----- EDITORIAL ¿Qué son los preprints? Dra. Vivienne C. Bachelet, MSc Medwave 2017 Nov-Dic;17(9):e7091 EPISTEMONIKOS Corrección temprana versus tardía en hernia diafragmática congénita Alexandra Yunes, Matías Luco, Juan Carlos Pattillo (Chile) Medwave 2017 Nov-Dic;17(8):e7081 REVISIÓN CLÍNICA Preservación de la fertilidad en la paciente oncológica Anibal Scarella Chamy, César Díaz-García, Sonia Herraiz, Jhenifer Kliemchen Rodrigues (Internacional) Medwave 2017 Nov-Dic;17(9):e7090 Enfermedad coronaria aguda, pronóstico y prevalencia de los factores de riesgo en adultos jóvenes Alvaro Gudiño Gomezjurado, Bianca Pujol Freitas, Flavia Contreira Longatto, Juliana Negrisoli, Gustavo Aguiar Sousa (Brasil) Medwave 2017 Nov-Dic;17(9):e7088 Medwave está actualmente indizada en: MEDLINE/PubMed, Scopus (MEDLINE-sourced), LILACS, DOAJ, Emerging Sources Citation Index (WoS) de Clarivate Analytics. Envío de manuscritos originales http://ojs.medwave.cl/index.php/medwave/login ------------------------------------------------ Instrucciones a los autores http://www.medwave.cl/link.cgi/instrucciones.act ----------------------------------------------------------------- Si quiere participar como par revisor de Medwave http://www.medwave.cl/link.cgi/revisor.act ------------------------------------------------------------------ Contacto con la revista: Rodrigo Núñez publishing@medwave.cl

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