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La certificación de la defunción es un acto médico en el que el profesional debe poner el mismo esfuerzo y dedicación que en el resto de los informes elaborados en vida del paciente. Para su correcta cumplimentación el facultativo debe seguir las instrucciones básicas, poniendo especial cuidado en rellenar adecuadamente la secuencia de causas de muerte. En casos de pandemia, la cumplimentación del certificado de defunción corresponde a la medicina asistencial y para poder hacerlo los organismos oficiales deben publicar instrucciones basadas en recomendaciones internacionales. Debe establecerse, cuanto antes, la posibilidad de comunicación telemática de las defunciones. Mientras eso no sea posible, tienen que establecerse procedimientos que permitan en situación de pandemia, comunicar de forma inmediata la mortalidad a las autoridades sanitarias.

Background: The main objective was to determine whether the administration of chemotherapy (CT) during the month before intensive care unit (ICU) admission of medical patients with cancer influences the survival rate. The design was a single-institution observational cohort study in an ICU of a tertiary university hospital. Methods: Our cohort included 248 oncology patients admitted to the ICU from 2005 to 2014 due to nonsurgical problems. Seventy-six (30.6%) patients had received CT in the month before admission (CT group) and 172 did not receive CT (control group). The main outcome measures were ICU, hospital, 30-day, 90-day, and 1-year mortalities. We performed survival analysis using the Kaplan-Meier estimator, comparing both groups using the log-rank test, and multivariate analysis using Cox regression adjusted for gender, age, maximum Sequential Organ Failure Assessment (SOFA), and delta maximum SOFA to calculate the hazard ratios (HRs) and their respective 95% confidence intervals. This association was also evaluated by a graphic representation of survival. Results: The CT group presented an ICU mortality rate of 27.6% versus 25.5% in the control group. The multivariate analysis adjusted for age, sex, and delta maximum SOFA showed significant differences between the groups (HR: 2.12; P = .009). The hospital mortality rate was 55.3% in the CT group compared to 45.4% in the control group (adjusted HR: 1.81; P = .003). At 30 days, the mortality rate was 56.6% in the CT group compared to 46.5% in the control group (adjusted HR: 1.69; P = .008). Mortality at 90 days was 65.8% in the CT group versus 59.9% in the control group (adjusted HR: 1.47; P = .03). One-year mortality was also higher in the CT group (79% vs 72.7%, adjusted HR: 1.44; P = .02). Conclusion: The administration of CT in the month before ICU admission in patients with cancer was associated with higher mortality in the ICU, in the hospital, and 30 and 90 days after admission when adjusted for the increase in organ failure measured by delta maximum SOFA. We provide useful new information for decision-making about ICU management of patients with cancer.

Objective: To evaluate some methodological and ethical quality variables of clinical trials (CTs) published in 10 family medicine journals. Methods: Quality descriptive study of 10 family medicine journals including CTs in humans published since 2010 to 2013. We obtained 141 CT and 2447 were excluded. Results: CTs parallels controlled in 92.9% (95% confidence interval [95% CI]: 92.0-93.9). Masked randomization in 72.3% (95% CI: 71.7-73.1), decentralized in 51.8% (95% CI: 51.4-52.4) and using as control an active treatment in 82.2% (95% CI: 81.5-83.1). Wrote informed consent in 48.9% (95% CI; 48.5-49.5) and it was not withdrawn in 56.0% of cases (95% CI: 55.5-56.7). Approval by clinical research ethics committee (CREC) in 134, and there was no conflict of interest in 117 CTs. Average K was 0.96 (95% CI: 0.93-0.99). Conclusions: We observe an increase in some quality variables like masked randomization (19.6%) and approval by CREC (75%) post CONSORT, in CTs published in 10 family medicine journals (2010-2013).

The paper contributes to the understanding of empathy by American psychosomatic medicine in the 1940s-1950s, the most important period in the development of this School. I will discuss what empathy is, how it works, and who is capable of performing it analysing stories of poliomyelitis patients and their parents. I will focus the study on the management of the emotional impact of the diagnosis of poliomyelitis, then considered a tragic diagnosis, in both patients and their parents. I also will refer to how the professionals, especially nurses, perceived the experience of illness in hospitalized patients, because of the interesting and disturbing impacts of these perceptions, from an empathic point of view. As we will know, narratives play a central role in the representation of empathy in the special link established between physicians and other health professionals and poliomyelitis patients, because of the relational quality of empathy. Thus, we will observe positive and negative aspects of the empathy in the clinical practices.

This essay examines how psychosomatic medicine, as it emerged between 1920 and 1960, introduced new ideas about the emotional body and the emotional self. Focusing on cancer, a shift can be mapped over the course of the twentieth century. While cancer was regarded at the beginning of the century as the organic disease par excellence, traceable to malignant cells and thus not caused or influenced by emotions, in later decades it would come to be thoroughly investigated within the field of psychosomatic medicine. This essay illuminates why and how this shift occurred in Germany and how it was affected by the earlier turn toward a psychosomatic understanding of cancer in the United States.

Los pacientes con enfermedades oncológicas en cuidados paliativos pertenecen a un grupo caracterizado como altamente vulnerable y su inclusión en estudios clínicos presenta diversos problemas éticos. Estudio de corte transversal, analítico; el 82 % de las personas consideró ético realizar investigación con pacientes en cuidados paliativos, con el fin de ayudar a otros en el futuro (40 %), con la esperanza de mejorar (32 %) o por confianza en su médico-investigador (10 %). La amplia aceptación para participar en estos estudios de investigación demostraría que los beneficios potenciales excederían a lo meramente terapéutico; el altruismo, la esperanza de mejorar o la percepción de seguir ¿luchando¿ son aspectos que se deben tener en cuenta al momento de evaluar el respeto por la autonomía de las personas involucradas.

We show that tarantism was well known among the homeopaths in 19th century. Particularly, we analyse the book Medical study of the tarantula venom following the Hahnemann method (Madrid, 1864) published by José Núñez, one of the most important Spanish representatives of homeopathy during 19th century. We observe that the homeopathic perspective of tarantism accentuates vitalistic and empirical aspects, and is based on the extemporal analysis of earlier medical writings. We establish the sources on the tarantism in this period. Núñez maintained that music had a direct influence on organic structures such as the brain, as had been stated in previous centuries, but now he based the theory on his experience of the pathogenesis. The longest section of Núñez¿ treatise is dedicated to experiments with tarantula venom. The book is a milestone in the history of tarantism and music therapy with a new perspective which completes the lengthy course of this phenomenon to the present.

Objective: To analyse in the context of Orthopaedic Surgery some ethical issues related to the physician-patient relationship (respect for the patient¿s beliefs, the ethics of reasonable bargaining, issues with geriatric patients and malpractice and medical error). Attention is also given to problems related to technological development, «enhancement», the use of sham interventions, and finally, the potential conflicts of interest between orthopaedic surgeon and the prosthesis industry. Design: Analysis of the main general medical ethics guidelines, and also of some specific guidelines published by speciality organisations, such as the American Academy of Orthopaedic Surgeons. Conclusions: The ethics of Orthopaedic Surgery is consistent with that of medicine in general. Professional ethics means better professional practice, improves the physician-patient relationship, and creates a more humane and trustworthy environment. Orthopaedic surgeons, both at the individual level and as members of professional organizations are responsible for the humanitarian and scientific quality of the health-care they dispense Objetivo:Analizar los aspectos éticos de la especialidad de Cirugía ortopédica y traumatología, derivados de la relación del médico con el paciente: el respeto a las convicciones del enfermo, la ética de la concesión razonable, la traumatología geriátrica y lo relacionado con la mala praxis y el error médico. Otras cuestiones se refieren al desarrollo tecnológico, al «mejoramiento» o «enhancement», la práctica de las intervenciones simuladas y, finalmente, los posibles conflictos de interés entre el cirujano ortopédico y la industria ortopédica. Diseño: Análisis de los principales documentos ético-médicos de la profesión y los específicos de la especialidad, como los elaborados por la Academia Americana de Cirujanos Ortopédicos. Conclusiones: La ética del cirujano ortopédico y traumatólogo no difiere de la del médico, en general. La ética profesional mejora la práctica profesional; potencia la relación entre médicos y pacientes y crea un clima de humanidad y confianza. Los cirujanos ortopédicos, en el plano individual, y las organizaciones profesionales son responsables de la humanidad y de la ciencia con que se dispensan los cuidados de la especialidad