10 Abstract Cushing's syndrome (CS) is a rare endocrine 11 disease, due to cortisol hypersecretion. CS patients have 12 comorbidities, often still present after biochemical cure. 13 Specific nursing healthcare programs to address this dis-14 ease and achieve improved health related quality of life 15 (HRQoL) are lacking. Thus, an educational nursing inter-16 vention, through the development and promotion of 17 specific educational tools, appears to be justified. The 18 objective of this study is to assess the effectiveness of an 19 educational nursing program in CS patients on HRQoL, 20 clinical parameters, level of pain and physical activity, 21 patterns of rest, and use of health resources. A prospective, 22 randomized study was conducted in two reference hospitals 23 for CS. Sixty-one patients (mean age 47 ± 12.7 years, 24 83.6 % females) were enrolled and divided into 2 groups: 25 an ''intervention'' group where educational sessions were 26 performed over 9 months and a ''control'' group, without 27 these sessions. Specific questionnaires were used at the 28 beginning and end of the study. After educational sessions, 29 the intervention group had a better score in the Cush-30 ingQoL questionnaire (p \ 0.01), reduced level of pain 31 (p \ 0.05), improved physical activity (p \ 0.01) and 32 healthy lifestyle (p \ 0.001) compared to the control 33 group. A correlation between the CushingQoL score and 34 reduced pain (r = 0.46, p \ 0.05), improved physical 35 activity (r = 0.89, p \ 0.01), and sleep (r = 0.53, 36 p = 0.01) was observed. This educational nursing program 37 improved physical activity, healthy lifestyle, better sleep 38 patterns, and reduced pain in CS patients, influencing 39 HRQoL and reducing consumption of health resources. 40 Moreover, the brief nature of the program suggests it as a 41 good candidate to be used in CS patients. Patients with cushing's syndrome (CS) suffer from multi-47 ple comorbidities, mainly cardiovascular (hypertension, 48 atherosclerosis, changes in heart functionality), and meta-49 bolic (dyslipidemia, central obesity, diabetes), as well as 50 thrombotic disorders, bone disorders, cognitive and neu-51 ropsychological impairment, and impaired sexual function 52 due to glucocorticoid (GC) excess [1][2][3][4][5][6].53 The assumption that resolution of hypercortisolism 54 normalized comorbidities is currently questioned, since R E V I S E D P R O O F55 there is evidence that cured CS patients still have increased 56 morbidity and mortality despite endocrine control [7][8][9]. 57 Most patients with CS develop metabolic syndrome, which 58 may persist after remission of hypercortisolism, con-59 tributing to increased cardiovascular risk and deserve to be 60 treated according to common standard practice [7]. 61 Awareness of this persistent increase in cardiovascular risk 62 in CS patients after endocrine cure leads to strict control of 63 improvable factors, including blood pressure, dyslipemia, 64 hyperglycemia, smoking, obesity, and prothrombotic state 65 [10]. 66 There is am...

Background Few surgical studies have provided adjusted comparative postoperative outcome data among contemporary patients with and without COVID-19 infection and patients treated before the pandemic. The aim of this study was to determine the impact of performing emergency surgery in patients with concomitant COVID-19 infection. Methods Patients who underwent emergency general and gastrointestinal surgery from March to June 2020, and from March to June 2019 in 25 Spanish hospitals were included in a retrospective study (COVID-CIR). The main outcome was 30-day mortality. Secondary outcomes included postoperative complications and failure to rescue (mortality among patients who developed complications). Propensity score-matched comparisons were performed between patients who were positive and those who were negative for COVID-19; and between COVID-19-negative cohorts before and during the pandemic. Results Some 5307 patients were included in the study (183 COVID-19-positive and 2132 COVID-19-negative during pandemic; 2992 treated before pandemic). During the pandemic, patients with COVID-19 infection had greater 30-day mortality than those without (12.6 versus 4.6 per cent), but this difference was not statistically significant after propensity score matching (odds ratio (OR) 1.58, 95 per cent c.i. 0.88 to 2.74). Those positive for COVID-19 had more complications (41.5 versus 23.9 per cent; OR 1.61, 1.11 to 2.33) and a higher likelihood of failure to rescue (30.3 versus 19.3 per cent; OR 1.10, 0.57 to 2.12). Patients who were negative for COVID-19 during the pandemic had similar rates of 30-day mortality (4.6 versus 3.2 per cent; OR 1.35, 0.98 to 1.86) and complications (23.9 versus 25.2 per cent; OR 0.89, 0.77 to 1.02), but a greater likelihood of failure to rescue (19.3 versus 12.9 per cent; OR 1.56, 95 per cent 1.10 to 2.19) than prepandemic controls. Conclusion Patients with COVID-19 infection undergoing emergency general and gastrointestinal surgery had worse postoperative outcomes than contemporary patients without COVID-19. COVID-19-negative patients operated on during the COVID-19 pandemic had a likelihood of greater failure-to-rescue than prepandemic controls.

Resumen: La dignidad del paciente puede verse afectada, en el transcurso de la hospitalización, por conductas observables de los profesionales. A pesar de su importancia, existen pocos instrumentos para evaluarla. A través de un estudio transversal, descriptivo, analítico y cuantitativo, se evalúa la percepción de dignidad del paciente a partir del "Cuestionario de percepción de dignidad de paciente hospitalizado (CuPDPH)", en español y validado. La muestra estuvo formada por 148 hombres y 138 mujeres con una media de edad de 62.82 (DE 4.05). La mediana en las puntuaciones de los ítems (escala1-5) fue de 4,59, y la media 4,51 (DE 0.34). La media de la suma de las puntuaciones en el CuPDPH ha sido de 84.51 (DE 9.3), (mín. 19-máx. 95). Los ítems de la dimensión etiquetada como "identidad" han obtenido una puntuación media de 4.85 (DE 0.04), la dimensión "consideración" 3.97 (DE 0.66). No se hallaron diferencias significativas en las puntuaciones y las variables sociodemográficas. Los resultados permiten identificar puntos fuertes y áreas de mejora en el cuidado y respeto a la dignidad de las personas hospitalizadas. Profundizar en el tema resulta una oportunidad en el camino hacia la excelencia profesional, defendiendo las competencias técnica y ética.

Objetivos: Explorar, a partir de una experiencia didáctica basada en la práctica reflexiva, la narrativa sobre una experiencia personal vivida en torno a la muerte, de estudiantes de 2º curso de Grado en enfermería. Comprender el proceso en torno a la muerte y su transcendencia en la práctica de los cuidados enfermeros. Métodos: Estudio cualitativo con un enfoque fenomenológico hermenéutico. Los participantes de este estudio fueron estudiantes de "Comunicación terapéutica" de 2º curso de Grado en enfermería, reclutados en el aula, en la 2ª sesión de la asignatura. Su participación fue voluntaria ya que el estudiante pudo elegir entre 4 temas distintos. Los datos fueron colectados a través de escritura reflexiva. Se analizaron los textos mediante análisis de contenido cualitativo semántico. Resultados: Se identificaron unidades de significado que revelaron la estructura del fenómeno de estudio. Posteriormente, se agruparon en 8 categorías de las que emergieron 6 temas: Impacto de la noticia; Despedida; Evocación; Afrontamiento; Creencias y valores; Crecimiento personal. Conclusiones: Tomar consciencia de la propia vivencia en torno a la muerte permite precisar aspectos significativos que pueden enriquecer los cuidados profesionales. Reconocer las conductas observadas durante el proceso de duelo contribuye al acompañamiento sensible de las personas en procesos en torno a la muerte. El relato pedagógico, como estrategia didáctica, es útil en la formación enfermera ya que posibilita la comprensión de significados y del impacto ante situaciones complejas. La reflexión sobre las experiencias vividas y el contraste con la literatura permite guiar el proceso del cuidado comprensivo. : Palabras clave: Aprendizaje experiencial; Muerte; Estudiantes de enfermería; Práctica reflexiva.