Assessment of risk-adjusted mortality ratio (RAMR) in bloodstream infections using all-patient refined diagnosis-related groups (APR-DRGs).

OBJECTIVES: To calculate a risk-adjusted mortality ratio (RAMR) for bloodstream infections (BSIs) using all-patient refined diagnosis-related groups (APR-DRGs) and compare it with the crude mortality rate (CMR). METHODS: Retrospective observational study of prevalent BSI at our institution from January 2019 to December 2022. In-hospital mortality was adjusted with a binary logistic regression model adjusting for sex, age, admission type and mortality risk for the hospitalization episode according to the four severity levels of APR DRGs. The RAMR was calculated as the ratio of observed to expected in-hospital mortality, and the CMR was calculated as the proportion of deaths among all bacteraemia episodes. RESULTS: Of 2939 BSIs, 2541 were included: Escherichia coli (n = 1310), Klebsiella pneumoniae (n = 428), Pseudomonas aeruginosa (n = 209), Staphylococcus aureus (n = 498) and candidaemia (n = 96). A total of 436 (17.2%) patients died during hospitalization and 279 died within the first 14 days after the onset of BSI. Throughout the period, all BSI cases had a mortality rate above the expected adjusted mortality (RAMR value greater than 1), except for Escherichia coli (1.03; 95% CI 0.86-1.21). The highest overall RAMR values were observed for P. aeruginosa, Candida and S. aureus with 2.06 (95% CI 1.57-2.62), 1.99 (95% CI 1.3-2.81) and 1.8 (95% CI 1.47-2.16), respectively. The temporal evolution of CMR may differ from RAMR, especially in E. coli, where it was reversed. CONCLUSIONS: RAMR showed higher than expected mortality for all BSIs studied except E. coli and provides complementary to and more clinically comprehensive information than CMR, the currently recommended antibiotic stewardship programme mortality indicator.

Clinical safety and feasibility of a novel implantable neuroimmune modulation device for the treatment of rheumatoid arthritis: initial results from the randomized, double-blind, sham-controlled RESET-RA study.

BACKGROUND: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that causes persistent synovitis, bone damage, and progressive joint destruction. Neuroimmune modulation through electrical stimulation of the vagus nerve activates the inflammatory reflex and has been shown to inhibit the production and release of inflammatory cytokines and decrease clinical signs and symptoms in RA. The RESET-RA study was designed to determine the safety and efficacy of an active implantable device for treating RA. METHODS: The RESET-RA study is a randomized, double-blind, sham-controlled, multi-center, two-stage pivotal trial that enrolled patients with moderate-to-severe RA who were incomplete responders or intolerant to at least one biologic or targeted synthetic disease-modifying anti-rheumatic drug. A neuroimmune modulation device (SetPoint Medical, Valencia, CA) was implanted on the left cervical vagus nerve within the carotid sheath in all patients. Following post-surgical clearance, patients were randomly assigned (1:1) to active stimulation or non-active (control) stimulation for 1 min once per day. A predefined blinded interim analysis was performed in patients enrolled in the study's initial stage (Stage 1) that included demographics, enrollment rates, device implantation rates, and safety of the surgical procedure, device, and stimulation over 12 weeks of treatment. RESULTS: Sixty patients were implanted during Stage 1 of the study. All device implant procedures were completed without intraoperative complications, infections, or surgical revisions. No unanticipated adverse events were reported during the perioperative period and at the end of 12 weeks of follow-up. No study discontinuations were due to adverse events, and no serious adverse events were related to the device or stimulation. Two serious adverse events were related to the implantation procedure: vocal cord paresis and prolonged hoarseness. These were reported in two patients and are known complications of surgical implantation procedures with vagus nerve stimulation devices. The adverse event of vocal cord paresis resolved after vocal cord augmentation injections with filler and speech therapy. The prolonged hoarseness had improved with speech therapy, but mild hoarseness persists. CONCLUSIONS: The surgical procedures for implantation of the novel neuroimmune modulation device for the treatment of RA were safe, and the device and its use were well tolerated. TRIAL REGISTRATION: NCT04539964; August 31, 2020.

Pseudomonas aeruginosa Bloodstream Infections Presenting with Septic Shock in Neutropenic Cancer Patients: Impact of Empirical Antibiotic Therapy.

This large, multicenter, retrospective cohort study including onco-hematological neutropenic patients with Pseudomonas aeruginosa bloodstream infection (PABSI) found that among 1213 episodes, 411 (33%) presented with septic shock. The presence of solid tumors (33.3% vs. 20.2%, p < 0.001), a high-risk Multinational Association for Supportive Care in Cancer (MASCC) index score (92.6% vs. 57.4%; p < 0.001), pneumonia (38% vs. 19.2% p < 0.001), and infection due to multidrug-resistant P. aeruginosa (MDRPA) (33.8% vs. 21.1%, p < 0.001) were statistically significantly higher in patients with septic shock compared to those without. Patients with septic shock were more likely to receive inadequate empirical antibiotic therapy (IEAT) (21.7% vs. 16.2%, p = 0.020) and to present poorer outcomes, including a need for ICU admission (74% vs. 10.5%; p < 0.001), mechanical ventilation (49.1% vs. 5.6%; p < 0.001), and higher 7-day and 30-day case fatality rates (58.2% vs. 12%, p < 0.001, and 74% vs. 23.1%, p < 0.001, respectively). Risk factors for 30-day case fatality rate in patients with septic shock were orotracheal intubation, IEAT, infection due to MDRPA, and persistent PABSI. Therapy with granulocyte colony-stimulating factor and BSI from the urinary tract were associated with improved survival. Carbapenems were the most frequent IEAT in patients with septic shock, and the use of empirical combination therapy showed a tendency towards improved survival. Our findings emphasize the need for tailored management strategies in this high-risk population.

Asociación entre las perspectivas salariales y la elección de especialidades quirúrgicas en estudiantes de medicina de una universidad pública de Perú / Association between the salary perspectives and the choice of surgical specialties in medical students of a public university in Peru

Introducción: En Perú, los médicos especialistas del área quirúrgica perciben un mayor salario; además, es necesario un incremento de estos profesionales para cubrir la demanda existente. Esto podría influir en los estudiantes de medicina a elegir una especialidad quirúrgica en el futuro. El objetivo del estudio fue determinar la asociación entre las perspectivas salariales y la elección de especialidades quirúrgicas. Sujetos y métodos: Estudio transversal analítico, realizado en estudiantes de medicina de una universidad peruana. La percepción de salario en el futuro y la intención de seguir una especialidad del área quirúrgica se midieron a través de preguntas abiertas, las cuales posteriormente se categorizaron. Además, se incluyeron la edad, familiares médicos, ranking universitario y agrupación por ciclos académicos como variables de confusión. Se utilizaron modelos de regresión de Poisson para estimar esta posible asociación y para realizar el ajuste respectivo. Resultados: Se recogieron datos de 341 estudiantes de medicina. El 50,7% manifestó su deseo de ganar un salario mayor a 4.000 soles peruanos (1.427 dólares) mensuales y el 37,2% mencionó que deseaba seguir una especialidad del área quirúrgica en el futuro. Después de ajustar por las variables de confusión, aquellos que deseaban ganar un mayor salario tenían un 58% más de probabilidades de seguir una especialidad del área quirúrgica, en comparación con aquellos estudiantes que querían seguir otras especialidades (odds ratio: 1,58; IC 95%: 1,19-2,10). Conclusiones: Los estudiantes de medicina que desean ganar un mayor salario tienen más probabilidad de escoger una especialidad quirúrgica en el futuro

Introduction: In Peru, specialist surgeons receive higher salaries than physicians from other specialties; on the other hand, more surgery specialists are needed to meet the current existing demand. This configuration could influence medical students to choose a surgical specialty in the future. The present study sought to determine the association between salary expectations and choosing surgical specialties. Subjects and methods: Cross-sectional analytical study from medical students in a Peruvian university. Future salary expectations and the intention of taking up a surgical specialty were measured using open questions, which were then categorized. Variables such as age, having relatives who were physicians, university ranking, and grouping by academic year were included in the analysis as confounding variables. Poisson regression models were employed to estimate possible associations and to perform fitting. Results: Data from 341 medical students were collected. The desire of having a salary higher than 4000 PER (1427 USD) per month was expressed by 50.7% of students, while 37.2% stated their intention to take up a surgical specialty in the future. After fitting for confounding variables, students who expected higher salaries were 58% more likely to set about studying a surgical specialty in the future in comparison with those who had the intention of studying other specialties (OR: 1.58; 95% CI: 1.19-2.10). Conclusions: Medical students who desire higher salaries have a higher probability of choosing a surgical specialty than students with lower salary expectations

Investigación en pregrado: interés según sexo y ciclo académico / Undergraduate research: Interest by sex and academic cycle

ANTECEDENTES: El Perú es considerado el país de América del Sur con la más baja proyección de producción científica en 2015. Una estrategia para revertir esta situación es mantener el interés en la investigación a través de la participación en sociedades científicas de los estudiantes de medicina. OBJETIVO: Determinar el interés por la investigación científica en los estudiantes de medicina y su variación por sexo y ciclos académicos. MÉTODO: Estudio transversal, realizado en 341 estudiantes de medicina de la Universidad Nacional San Luis Gonzaga de Ica, Perú. Todos los participantes recibieron un cuestionario diseñado para recoger información sobre el interés en la redacción, la participación, la publicación científica y el interés de hacer una carrera de investigación en el futuro. RESULTADOS: Los estudiantes mostraron un alto interés por la investigación científica (> 80%), sin embargo, cuando se les preguntó si querían hacer una carrera de investigación en el futuro solo el 53,9% respondió afirmativamente. Este interés disminuye según progresan los ciclos académicos (p = 0,0532), y es mayor en las mujeres (p = 0,1623). Cuando se agruparon los ciclos académicos en ciencias preclínicas y clínicas, el interés por participar en eventos científicos de las clínicas fue menor (p = 0,0199). Las mujeres mostraron un mayor interés por la redacción de artículos científicos (p = 0,0031). CONCLUSIONES: Los estudiantes de medicina mostraron un alto interés por la investigación científica, sin embargo, este disminuye al aumentar los ciclos académicos

BACKGROUND: Peru is considered the South American country with the lowest projection of scientific production in 2015, a strategy to reverse this situation is to keep the interest in research through participation in scientific societies of medical students. OBJECTIVE: To Determine the scientific research interest in medical students and their variation by sex and academic cycles. Method: Cross-sectional study, conducted in 341 medical students from the Universidad Nacional San Luis Gonzaga de Ica, Peru. All participants received a questionnaire designed to collect information on the interest in drafting, participation, scientific publishing, and the interest to make a career in research in the future. RESULTS: Students showed a high interest in scientific research (> 80%), however, when we asked if they wanted to make a career in research in the future, only 53.9% responded affirmatively. This interest decreases according increasing the academic cycles (p = 0.0532), and is higher in women (p = 0.1623). When grouped in preclinical and clinical sciences academic cycles the interest in participating in sciences events among clinical was lower (p = 0.0199). Women showed a high interest in writing scientific papers (p = 0.0031). CONCLUSIONS: Medical students showed a high interest in scientific research, however, this decreases with the increasing of academic cycles