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Doege‐Potter syndrome is a rare hypoglycemic paraneoplastic disorder. This case describes that severe and symptomatic hypoglycemia can occasionally be due to a rare malignant neoplasm, and the differential diagnosis of malignancy should not be overlooked in this setting.

Introduction Smoking is a stroke risk factor but the most efficient way to promote cessation is unknown. The smoking behavior in patients during the first 2 years post-stroke is studied comparing brief advice and intensive behavioral counseling interventions, taking into consideration biological, psychological, and social factors. Methods Randomized clinical trial of 196 stroke patients, stratified by the presence or not of an insular cortex lesion, with two levels of smoking cessation intervention. Results The study retention rate was 85.2%. Abstinence point prevalence at three months after stroke was 50% in the brief advice group and 51.7% in the intensive behavioral counseling group (p = .82) and at 24 months, 48.3% in the brief group and 47.5% in the intensive group (p = .92). Most relapses occurred in the first weeks. After 3 months the curves separated with fewer events in the intensive group and at 24 months the Hazard Ratio was 0.91 (95% CI = 0.61 to 1.37; p = .67). Twenty-four months after stroke, patients with an insular lesion were more likely to be abstinent (OR 3.60, 95% CI = 1.27 to 10.14), as were those who lived with a partner (OR 2.31, 95% CI = 1.17 to 4.55) and those who were less dependent (OR 0.84, 95% CI = 0.73 to 0.97). Conclusions A high percentage of patients gave up smoking in both intervention groups with no significant differences between the two. The effect of the insular lesion on smoking cessation, which is early and continued after two years, is particularly notable. Implications This two-year clinical trial compares for the first time the efficacy of two different intensities of smoking cessation intervention in stroke patients, taking into consideration the effect of the insula. Good results are obtained both in the short and medium-term in people with stroke, especially when this is accompanied by an insular cortex lesion, but there is no evidence that better results are obtained with longer, more time-intensive, and possibly more costly follow-ups obtain better results than are obtained with briefer interventions.

The mental health of nurses working in long-term healthcare centers is affected by the care they provide to older people with major chronic diseases and comorbidity and this in turn affects the quality of that care. The aim of the study was to investigate dispositional optimism, burnout and self-reported health among nurses working in long-term healthcare centers. A descriptive, cross-sectional survey design was used. Survey questionnaires were distributed in 11 long-term health care centers (n = 156) in Catalonia (Spain). The instruments used were LOT-R (dispositional optimism), MBI (burnout) and EuroQol EQ-5D (self-reported health). Bivariate analyses and multivariate linear regression models were used. Self-reported health correlated directly with dispositional optimism and inversely with emotional exhaustion and cynicism. Better perceived health was independently associated with greater dispositional optimism and social support, lower levels of emotional exhaustion level and the absence of burnout. Dispositional optimism in nurses is associated with a greater perception of health and low levels of emotional exhaustion.

Introduction Tobacco use is a public health problem causing high morbidity and mortality, including stroke. This study evaluates predictive factors of smoking cessation in the long term after stroke. Methods We followed a cohort of 110 consecutive smokers with stroke for up to 6 years. Sociodemographic variables, stroke severity, insular involvement, stage of change in smoking habit before stroke and disruption of addiction variable (smoking cessation, absence of relapses, having stopped smoking without difficulties and not having had urge) were evaluated. Results Twenty patients died during follow-up and two patients were lost leaving a final cohort of 88 patients. The prevalence of smoking cessation in the remaining population was 65.9% post-stroke, 54.9% at 3-6 months, 40.9% at 1 year and 37.5% at 6 years. Prevalence was significantly higher in patients with insular involvement during the first year of follow-up, but not at 6 years. Disruption immediately after stroke (OR = 10.1; 95% CI = 2.5 to 40.1) and intention to change before having the stroke (OR = 4.8; 95% CI = 1.0 to 23.0) were predictors of abstinence at 6 years after adjusting for age, sex and stroke severity at baseline. When tobacco abstinence at the 1 year follow-up was included in the model, this factor was the best predictor of tobacco abstinence at 1 year (OR = 10.5; 95% CI = 2.2 to 49.4). Conclusions Intention of change, having the disruption criteria, and abstinence 1 year after stroke were predictors of abstinence at 6 years. An insular lesion in the acute phase of stroke does not determine the tobacco use status at 6 years. Implications This study is the first prospective investigation with a cohort of stroke patients to examine the long-term influence of biological and psychological factors on smoking cessation. Tobacco abstinence 1 year after stroke was the strongest predictor of abstinence at 6 years of follow-up. The effect of the insular cortex lesion on tobacco cessation, which had been relevant during the first year, no longer had an influence over the longer period studied here.

The purpose of this study was to analyse the relationship between perceived quality of life and levels of burnout among healthcare personnel. A sample of 1095 participants (nurses, physicians, nursing assistants and orderlies) from five hospitals in the province of Girona (Spain) were studied (78% women, mean age=36.6 years, SD=8.8) using the 36-item short-form health questionnaire (SF-36) and the Maslach Burnout Inventory. The results showed that health-related quality of life reported by this sample of healthcare personnel was lower than the reference population values, especially in those SF-36 dimensions that comprise the mental component. In comparing the dimensions of the SF-36 by profession, we found that physicians had better perceived health in the dimensions of the physical component than nurses and other professionals (P 0.05). Moreover, perceived health was worse among those that reported a high level on any of the components of burnout. These results should be taken account when designing a burnout prevention programme in the workplace.

Resumen Objetivos Estudiar la satisfaccion general de los pacientes hospitalizados y su satisfaccion con los cuidados de enfermeria durante su estancia hospitalaria. Metodo El diseno del presente estudio es observacional, descriptivo y prospectivo, desarrollado en el Hospital Universitario Dr. Josep Trueta de Girona en la unidad de neurologia medicoquirurgica. La satisfaccion de los pacientes se ha valorado con las escalas de satisfaccion SGEM, CEP y LOPPS 12. Resultados Se han estudiado 150 pacientes con patologia neurologica medica y quirurgica, que han expresado altos niveles de satisfaccion. Entre los aspectos peor valorados destacan la informacion, el espacio fisico y la hosteleria. No se ha hallado asociacion entre ninguna variable sociodemografica y la satisfaccion de los pacientes. Los mas dependientes valoraron mas la calidad de los cuidados recibidos, los pacientes con estudios universitarios apreciaron mas los consejos y los que presentaron alguna complicacion valoraron mas la asistencia tecnica. Tampoco se observan diferencias significativas entre las puntuaciones de satisfaccion realizadas en la hospitalizacion con las realizadas ya en el domicilio. Conclusiones Se destaca la necesidad de mejorar la comunicacion y la informacion con los pacientes hospitalizados.

Fundamento y objetivo La ansiedad y la depresion son frecuentes en enfermos hospitalizados.Su relacion con la gravedad de la enfermedad es objeto de discusion. La sensacion de gravedaddel enfermo y sus perspectivas de mejoria pueden estar influidas por la ansiedad y la depresion. Pacientes Y Metodo Pacientes ingresados en un servicio de medicina interna. Se recogieron variablessociodemograficas, las puntuaciones en el State-Trait Anxiety Inventory, Hospital Anxietyand Depression Scale (HAD), Beck Depression Inventory (BDI), APACHE II, asi como autoevaluacionde gravedad y reversibilidad de la enfermedad. Los pacientes fueron clasificadoscomo ansiosos o deprimidos si puntuaban 10 o mas en el HAD. Resultados Se estudiaron 260 ingresos, con una edad media de 64,1 anos, un 66,2% eran varones.La ansiedad estaba presente en el 39,8% de las mujeres y 21,5% de los varones (p =0,003) y la depresion en el 31,8% de las mujeres y 16,3% de los varones (p = 0,006). Los pacientescon ansiedad y depresion no estaban mas graves segun el indice APACHE. Los pacientescon ansiedad tenian peor conocimiento del diagnostico medico, y los deprimidos, masedad, menor escolarizacion y mas deterioro fisico. Los pacientes con sensacion de mayor gravedadpresentaban valores mas altos de ansiedad y depresion en todos los cuestionarios, pero nomayor gravedad por APACHE, siendo la ansiedad por HAD el mejor predictor. Los pacientes conautoevaluacion de menor reversibilidad de su enfermedad tenian mas ansiedad y depresion, yse hallaban mas graves, siendo el APACHE y la depresion mediante BDI los mejores predictores. Conclusiones La prevalencia de ansiedad y depresion en enfermos hospitalizados es alta, especialmenteen mujeres, sin guardar relacion con la gravedad de la enfermedad, y se asocia a unapercepcion subjetiva del enfermo de mayor gravedad y menor mejoria.

Communicating with the patient in clinical practice refers to the way in which the doctor and the patient interact both verbally and nonverbally, in order to achieve a shared understanding of problems and solutions. Traditional learning and assessment systems are overwhelmed when it comes to addressing the complex and multi-dimensional problems of professional practice. Problem Based Learning (PBL) has been put forward as an alternative to the mere reproduction of knowledge and pre-established patterns, enabling students to develop their own learning strategies to overcome problems in their future professional practice. The challenge is to determine how to assess the acquisition of clinical communication skills. The authors have recommended a summative assessment of clinical communication skills based on the combination of different methods. It highlights the importance of feedback-based formative assessment. This raises the need to develop and validate assessment scales in clinical communication at an undergraduate level. Based on this work, the authors put forward a "fanned out" assessment in terms of clinical communication skills in Medicine degrees, with the use of different instruments in a "spiraled" manner, where the greater the contact with clinical practice in the various degree and integral courses, the greater difficulty experienced, with the participation of all the stakeholders involved (self, hetero and peer assessment) without precluding the involvement of patients (real or simulated) in the design of assessment instruments

Burnout syndrome is related to cultural and individual factors. The aim of this study was to compare the frequency of burnout and the scores for its three components with the perceptions and the demographic and professional characteristics of the workers.Burnout syndrome was studied in 11,530 Hispanic Americans and Spanish healthcare professionals (51% male, mean age 41.7 years). The Maslach Burnout Inventory and a previously drawn up questionnaire were administered online from the Intramed website from December 2006 to September 2007. Associations were tested using multiple logistic regression.The frequency of burnout in professionals resident in Spain was 14.9%, in Argentina 14.4%, and in Uruguay 7.9% whereas professionals in Mexico, Ecuador, Peru, Columbia, Uruguay, Guatemala and El Salvador presented frequencies of burnout of between 2.5% and 5.9%. By professions, doctors had a prevalence of burnout of 12.1%, nurses 7.2%, and dentists, psychologists and nutritionists of6%. Amongst doctors, burnout predominated amongst doctors working in emergency departments (17%) and internal medicine departments (15.5%) whereas anaesthetists and dermatologists had the lowest prevalence (5% and 5.3%, respectively). Older age (OR=0.96), having children (OR=0.93), the perception of feeling valued (OR=0.53), optimism (OR=0.80), job satisfaction (OR=0.80), and satisfaction with salary (OR=0.91) are variables which protect against burnout.The expression of burnout varies among nations and professions. Age (older age), having children, the perception of feeling valued, optimism, job satisfaction and satisfaction with salary are protective variables of burnout.

Anxiety and depression are common among medical inpatients. While their relation to the severity of illness is often discussed, the feeling of such severity by the patient and his/her prospects of improvement can be influenced by anxiety and depression.Patients admitted in an internal medicine ward. Sociodemographic characteristics, State-Trait Anxiety Inventory, Hospital Anxiety and Depression Scale (HAD), Beck Depression Inventory (BDI), APACHE II, illness severity and reversibility self-evaluation were recorded. The HAD cut-off for anxiety or depression was 10.We included 260 admissions: 66.2% men, mean age 64.1 years. Anxiety was detected in 39.8% of women and 21.5% of men (p = 0.003); 31.8% of women and 16.3% of men had depression (p = 0.006). Anxious and depressive subjects did not score high in APACHE. Anxious patients had a worse knowledge of the medical diagnosis. Depressive patients were older, had a lower educational level and a greater physical impairment. Patients with a higher perception of severity displayed higher scores both on anxiety and depression scales. Patients with lower illness reversibility self-evaluation had more anxiety and depression, and more illness severity as well.The prevalence of anxiety and depression in hospitalized medical patients is high, occurs mainly in women, and no relation to illness severity is observed. Anxiety and depression are associated with both illness perception of greater severity and less improvement.