Background: The early detection of moral distress requires a validated and reliable instrument. The aim of this study was to carry out an advanced analysis of the psychometric properties of the moral distress scale for health professionals (MMD-HP-SPA) by performing a validation of the construct and its internal and external reliability. Methods: We performed a multicentre cross-sectional study in health professionals belonging to the Andalusian public health system. Construct validity was performed by exploratory (n = 300) and confirmatory (n = 275) factor analysis (EFA/CFA) in different subgroups; we also analysed the internal consistency and temporal reliability of the scale. Results: 384 doctors and 191 nurses took part in the survey. The overall mean for moral distress was 128.5 (SD = 70.9), 95% CI [122.7–134.3], and it was higher in nurses at 140.5 (SD = 74.9) than in doctors at 122.5 (SD = 68.1), F = 8.37 p < 0.01. The EFA produced a model of five components which accounted for 54.8% of the variance of the model. The CFA achieved a goodness of fit of Chi2 = 972.4; AIC = 1144.3; RMSEA = 0.086; CFI = 0.844; TLI = 0.828; NFI = 0.785. Conclusions: The MMD-HP-SPA scale has solid construct validity, excellent internal consistency, optimal temporal reliability, and underlying dimensions which effectively explore the causes of moral distress in health professionals, thus guaranteeing its use in hospital and community settings.

Endoscopic ultrasound (EUS)-guided drainage is now the treatment of choice in cases of pancreatic pseudocysts and walled-off necrosis, especially in the absence of luminal bulging and in patients with portal hypertension. Malignant refractory ascites usually heralds a poor prognosis and substantially impairs the quality of life of patients because of the symptoms experienced and the need for repeated paracentesis. EUS-guided placement of lumen-apposing, fully covered, self-expandable metal stents (FCSEMS) has been reported for the drainage of malignant ascites. Herein, we present the results of EUS-guided placement of plastic pigtails stents for the drainage of refractory malignant ascites in three patients. The aim was to improve symptoms and minimize the possible drawbacks of large-caliber FCSEMS. In this preliminary experience, EUS-guided placement of plastic stents was feasible and avoided further paracentesis.

Objectives:The main objective of the study was to determine the characteristics of major opioids prescribing in Primary Care.Material and methods: A retrospective study was designed through the use of a historical cohort, assessing patients who have consumed major opiates in all Jaén city health centers during 2011, by systematic sampling, 215 patients, computing the sample size for a confidence level of 95 %, accuracy 5 %, 5 % losses (expanding the 5 % sample by reporting bias). Medical records were audited to collect the following data: Age, sex, medical history, social status, number of appointments and use of hospital resources, characteristics of opioids prescription (dose, duration, cost, adverse reaction) and use of other analgesics/adjuvants. Data were processed for a descriptive study and a subsequent comparison according to the prescribed opioid.Results: 215 patients were included (44 % of total population) those obtained 323 prescriptions for opiates in the study year (23 % of the sample with two prescriptions of opiates and 13 % with three). Most prescribed opioids were fentanyl (60 %) and buprenorphine (22 %) and the least prescribed is by 3 % morphine. Buprenorphine is the most used in monotherapy (70 %), preferably in older women and pensioners, especially for joint pain by the general practitioner. The fentanyl is mainly used in patches (95 % of prescriptions of fentanyl) and hydromorphone is used in younger patients (< 60 years), prescribed

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