The objective was to evaluate whether pre operative administration of dexamethasone improved post operative nausea and vomiting (PONV), pain and respiratory function tests in women undergoing conservative surgery for breast cancer. This was a controlled clinical trial conducted between June 2013 and October 2014. Eighty patients were evaluated. Patients received a pre operative dose of 8 mg of dexamethasone (n = 40) or placebo (n = 40). The data on PONV and pain intensity was obtained and forced spirometry tests were performed, 1 hr before and at 1, 6, 12 and 24 hr after surgery. Any use of additional analgesic/antiemetic drugs was recorded. Patients were followed until 30 days after surgery for any surgical or medical complications. The pain intensity was lower in the treatment group for all periods; PONV was lower at 6, 12 and 24 hr; Additional analgesics/antiemetics were required less frequently (all p < .05).Both groups exhibited a restrictive ventilatory pattern immediately after surgery, which was reversed in the following hours. However, spirometric values were higher in the dexamethasone group. There were no pulmonary or metabolic complications after surgery. Our conclusions were that dexamethasone significantly reduced the incidences of PONV, pain and improved respiratory parameters, and reduced the need for additional post operative analgesic and antiemetic drugs. K E Y W O R D Sdexamethasone, mastectomy, nausea, postoperative pain, respiratory function tests, vomiting | INTRODUCTIONGlobally, breast cancer (BC) remains the most common malignancy in women. In developing countries, such as Mexico there has been an increase in mortality caused by BC (Rodríguez-Cuevas, GuisaHohenstein & Labastida-Almendaro, 2009;Siegel, Ma, Zou & Jemal, 2014). It is the most common cancer in this country, followed by cervical intraepithelial neoplasia; each year 25,000-30,000 new cases are diagnosed. Fortunately, more patients now have access to proper screening using mammography, so the proportion of patients with local tumours found at diagnosis is increasing. Total or partial mastectomy with or without axillary lymph node dissection is the most frequently used surgical treatment, along with adjuvant chemoor radiotherapy. Post operative nausea and vomiting (PONV) is a common complication after anaesthesia and surgery (Kovac, 2000;Watcha & White, 1992). Women undergoing mastectomy are at particularly high risk for developing PONV, and the reported incidence is 60%-80% in patients not receiving antiemetic medication (Hammas, Thorn & Wattwil, 2002;Oddby-Muhrbeck, Jakobsson, Andersson & Askergren, 1994;Sadhasivam et al., 1999). Emetic episodes predispose patients to numerous complications, such as gastric aspiration, wound dehiscence, psychological distress, and delayed recovery and discharge times (Watcha & White, 1992). These reasons justify the use of prophylactic antiemetics in women scheduled for breast surgery. In addition, respiratory function is often compromised after a major surgical procedure, particularly those p...

Burnout syndrome is a psychological condition that commonly affects health professionals, medical students, and others in professions with long shifts. It is defined by a high amount of emotional exhaustion, depersonalization, and low personal job satisfaction. We aimed to determine the prevalence of burnout syndrome in medical interns and establish the relationships between this condition and the time and type of hospital at which students worked during their medical internship. This was a survey study in which we used the Maslach Burnout Inventory, applied to fifth-year medical students on an internship at private and public hospitals in Mexico. The participants were 96 women (54.5%) and 80 men (45.5%), with ages ranging from 21 to 34 years old. We found burnout syndrome in 20% of these medical students 22% of the women and 18.6% of the men in the sample. Second-semester interns suffered burnout at a rate of 29%, in contrast to 15% of first-semester students. Emotional exhaustion and depersonalization scores were higher in second-semester interns who worked in public hospitals. However, the prevalence did not differ between public and private hospitals. Our study reports a higher prevalence of burnout syndrome during the second semester of internship. Students who practiced their internship in a public hospital showed higher scores in emotional exhaustion and depersonalization than those who practiced in a private hospital.

Background: Patients admitted to the intensive care unit (ICU) experience sleep disruption caused by a variety of conditions, such as staff activities, alarms on monitors, and overall noise. In this study, we explored the relationship between noise and other factors associated with poor sleep quality in patients. Methods: This was a prospective cohort study. We used the Richards-Campbell Sleep Questionnaire to explore sleep quality in a sample of patients admitted to the ICU of a private hospital. We measured the noise levels within each ICU three times a day. After each night during their ICU stay, patients were asked to complete a survey about sleep disturbances. These disturbances were classified as biological (such as anxiety or pain) and environmental factors (such as lighting and ICU noise). Results: We interviewed 71 patients; 62% were men (mean age 54.46 years) and the mean length of stay was 8 days. Biological factors affected 36% and environmental factors affected 20% of the patients. The most common biological factor was anxiety symptoms, which affected 28% of the patients, and the most common environmental factor was noise, which affected 32.4%. The overall mean recorded noise level was 62.45 dB. Based on the patients' responses, the environmental factors had a larger effect on patients' sleep quality than biological factors. Patients who stayed more than 5 days reported less sleep disturbance. Patients younger than 55 years were more affected by environmental and biological factors than were those older than 55 years.

The quadrantectomy procedure had better acceptance, but the overall health status did not differ between the groups. The overall health status was lower among the women older than 50 years who had received a mastectomy without reconstruction.

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .