Brain-derived neurotrophic factor in the nucleus tractus solitarii modulates glucose homeostasis after carotid chemoreceptor stimulation in rats.

Neuronal systems, which regulate energy intake, energy expenditure and endogenous glucose production, sense and respond to input from hormonal related signals that convey information from body energy availability. Carotid chemoreceptors (CChr) function as sensors for circulating glucose levels and contribute to glycemic counterregulatory responses. Brain-derived neurotrophic factor (BDNF) that plays an important role in the endocrine system to regulate glucose metabolism could play a role in hyperglycemic glucose reflex with brain glucose retention (BGR) evoked by anoxic CChr stimulation. Infusing BDNF into the nucleus tractus solitarii (NTS) before CChr stimulation, showed that this neurotrophin increased arterial glucose and BGR. In contrast, BDNF receptor (TrkB) antagonist (K252a) infusions in NTS resulted in a decrease in both glucose variables.

Provider and patient insights into the cancer care journey.

OBJECTIVES: To assess provider and patient preferences for an oncologist selection tool, value-based care, involvement in cancer care, and end-of-life planning. STUDY DESIGN: We conducted a cross-sectional survey of primary care providers (PCPs) and insured patients with cancer. METHODS: We asked PCPs about their method of oncologist referral; utilization of an oncologist selection tool that directs patients to high-quality, high-value oncologists; involvement in cancer care and value-based care; and when an advance directive should be established. We asked patients to reflect upon their personal experience when selecting their oncologist, utilization of an oncologist selection tool, and establishing an advance directive. RESULTS: PCPs tend to refer patients to oncologists who are part of their health system (67.9%). Most PCPs (79.2%) were not currently utilizing an oncologist selection tool; most (77.3%) expressed a willingness to use such a tool. Most PCPs (69.8%) believe the best time to talk about an advance directive is at the time of cancer diagnosis. Patients ranked a PCP referral (52.7%) as "very important" when selecting an oncologist. One-third of patients used a web-based oncologist selection tool; 65.2% responded that an oncologist selection tool would be "somewhat" or "very" important. Most (54.5%) patients had an advance directive. CONCLUSIONS: These results present a compelling rationale for developing a data-driven oncologist selection tool, optimizing patient and provider involvement in care, and expanding the portion of patients who have an advance directive at the start of their cancer care to optimize their cancer journey.

[Perception of the staff in training on patient's safety during the COVID-19 pandemic]. / Percepción del personal en formación sobre seguridad del paciente durante pandemia de COVID-19.

Background: The recent pandemic has presented several challenges in relation to patient safety with the increase of cognitive, depressive and anxiety symptoms in health workers due to the fear of being infected from COVID-19. Objective: To determine the relationship between anxiety, depression and fear of COVID-19, with the perception of the patient safety environment in medical residents. Material and methods: Observational, cross-sectional, prospective and analytical study. 258 subjects were surveyed. Medical residents who agreed to participate, whose age or sex was of no importance, were included. It was assessed the perception of the patient safety environment through the self-administered Agency for Healthcare Research and Quality (AHRQ) questionnaire; the depression and anxiety symptoms by using Beck's self-applied inventories for each entity, and the fear of COVID-19 by using a scale developed with the same name. The Pearson correlation coefficient was calculated. Results: A negative linear relationship was found within most of the dimensions explored by the AHRQ questionnaire and the Beck Anxiety Inventory. This relationship was observed too with the Beck Depression Inventory, except in 3 of those dimensions. No statistically significant relationship was found in the Fear of COVID-19 scale. Conclusions: There is a relationship between the degree of anxiety and depression symptoms in residents with the results in the AHRQ questionnaire; however, this result is not reproducible with the Fear of COVID-19 test or other sociodemographic measurement parameters.

Introducción: la reciente pandemia ha presentado varios retos sobre la seguridad del paciente con el aumento de síntomas cognitivos, de depresión y ansiedad en los trabajadores de la salud por el miedo de contagiarse de COVID-19. Objetivo: determinar la relación entre síntomas de ansiedad, depresión y miedo al COVID-19 con la percepción del clima de seguridad del paciente en médicos residentes de un hospital de tercer nivel de atención. Material y métodos: estudio observacional, transversal, prospectivo y analítico. Se encuestaron 258 sujetos. Se incluyeron médicos residentes que aceptaran participar, independientemente de su edad y sexo. Se evaluó la percepción del clima de seguridad del paciente con el cuestionario autoaplicado de la Agency for Healthcare Research and Quality (AHRQ), la presencia de síntomas de depresión y ansiedad mediante los inventarios autoaplicados de Beck para cada entidad, y el miedo a COVID-19 mediante una escala previamente validada con el mismo nombre. Se calculó el coeficiente de correlación de Pearson. Resultados: se encontró una relación lineal negativa con la mayoría de las dimensiones exploradas por el cuestionario AHRQ y el Inventario de ansiedad de Beck (BAI) y con el Inventario de depresión de Beck (BDI), excepto en tres de las dimensiones. No se encontró relación estadísticamente significativa en la encuesta de miedo a COVID-19. Conclusiones: hay una relación entre el grado de síntomas de ansiedad y depresión en residentes con los resultados en el cuestionario AHRQ; sin embargo, este resultado no es reproducible con el test de Miedo a COVID-19 u otros parámetros sociodemográficos de medición.

Utilizing Lean Six Sigma Methodology to Improve the Authored Works Command Approval Process at Naval Medical Center San Diego.

INTRODUCTION: Inefficiencies in the command approval process for publications and/or presentations negatively impact DoD Graduate Medical Education (GME) residency programs' ability to meet ACGME scholarly activity requirements. A preliminary review of the authored works approval process at Naval Medical Center San Diego (NMCSD) disclosed significant inefficiency, variation in process, and a low level of customer satisfaction. In order to facilitate and encourage scholarly activity at NMCSD, and meet ACGME requirements, the Executive Steering Council (ESC) chartered an interprofessional team to lead a Lean Six Sigma (LSS) Rapid Improvement Event (RIE) project. MATERIALS AND METHODS: Two major outcome metrics were identified: (1) the number of authored works submissions containing all required signatures and (2) customer satisfaction with the authored works process. Primary metric baseline data were gathered utilizing a Clinical Investigations database tracking publications and presentations. Secondary metric baseline data were collected via a customer satisfaction survey to GME faculty and residents. The project team analyzed pre-survey data and utilized LSS tools and methodology including a "gemba" (environment) walk, cause and effect diagram, critical to quality tree, voice of the customer, "muda" (waste) chart, and a pre- and post-event value stream map. The team selected an electronic submission system as the intervention most likely to positively impact the RIE project outcome measures. RESULTS: The number of authored works compliant with all required signatures improved from 52% to 100%. Customer satisfaction rated as "completely or mostly satisfied" improved from 24% to 97%. For both outcomes, signature compliance and customer satisfaction, statistical significance was achieved with a p < 0.0001. CONCLUSION: This RIE project utilized LSS methodology and tools to improve signature compliance and increase customer satisfaction with the authored works approval process, leading to 100% signature compliance, a comprehensive longitudinal repository of all authored work requests, and a 97% "completely or mostly satisfied" customer rating of the process.

Repercusión académica de la COVID-19 en universitarios peruanos / Academic impact of COVID-19 on Peruvian university students

Introducción: La pandemia del coronavirus ha generado que muchos estudiantes teman perder el ciclo. Objetivo: Validar una escala que mida la percepción de posibles repercusiones académicas en estudiantes universitarios en el Perú. Metodología: Se realizó un proceso de validación de un test que mide la percepción acerca de las posibles repercusiones académicas en estudiantes universitarios. La validación se realizó mediante búsqueda de literatura científica, construcción del primer bosquejo, validación del test por expertos (59 expertos: epidemiólogos, investigadores, médicos), análisis factorial exploratorio y estadístico. Resultados: Respecto a la relevancia se observa que el ítem 7 es más esencial o importante que los demás (V = 1,00; IC 95 por ciento: 0,73-0,96). El ítem 8 (M = 3,80; /= 1,152) presenta la mayor media y, la más baja, el ítem 6 (M = 3,03; DE = 1,342). La pertinencia del AFE se justifica con el índice KMO (0,85) y la prueba de Bartlett (12577,0; gl = 28; p = / 0,001) siendo aceptables y significativos. Se obtuvo un coeficiente α de Cronbach de 0,899 con un intervalo de confianza del 95 por ciento de 0,882-0,898; indicando que la consistencia del instrumento es buena. Conclusiones: Se validó una escala de factor único que mide la percepción que tienen los estudiantes universitarios acerca de las posibles repercusiones de la pandemia del coronavirus en sus estudios. Es necesario evaluar cada realidad y el instrumento puede servir como una escala base para ello(AU)

Introduction: As a result of the coronavirus pandemic, many students are worried that they may lose their academic term. Objective: Validate a scale to measure the perception of possible academic impacts among Peruvian university students. Method: A validation process was conducted of a test measuring the perception of university students about possible academic impacts. The validation was based on a scientific bibliography search, development of a preliminary overview, validation of the test by 59 experts: epidemiologists, researchers and physicians, exploratory factor analysis, and statistical analysis. Results: In terms of relevance, item 7 was found to be more essential or important than the others (V = 1.00; CI 95 percent: 0.73-0.96). Item 8 (M = 3.80; /= 1.152) exhibits the highest mean, and item 6 the lowest (M = 3.03; SD = 1.342). AFE relevance is justified by the KMO index (0.85) and Bartlett's test (12577.0; gl = 28; p = / 0.001), both of which were found to be acceptable and significant. A Cronbach's α coefficient of 0.899 was obtained, with a confidence interval of 95 percent, SD 0.882-0.898, indicating a good consistency level. Conclusions: A single factor scale was validated which measures the perception of university students about the possible impacts of the coronavirus pandemic on their studies. It is necessary to evaluate each reality, and the tool may serve as a base scale for that purpose(AU)

Factores asociados al paciente empoderado en el tema de coronavirus en el Perú

RESUMEN Introducción: Para combatir al Coronavirus se requiere saber cómo afrontarlo, saber sus características más importantes y reconocer que lo más sustancial es generar medidas higiénicas básicas. Objetivo: Determinar los factores asociados al paciente empoderado en el tema de coronavirus. Métodos: Estudio transversal-analítico, con encuesta autoaplicada de carácter multicéntrico realizado en Perú entre marzo y mayo de 2020. El "paciente empoderado" se definió mediante encuesta de diez preguntas (alpha de Cronbach: 0,83); cuatro: conocimiento básico, de la gravedad y del contagio; dos: en quienes genera más daño y cuatro: medidas de protección. Se hizo la sumatoria del total de los puntajes y se cruzó versus cuatro variables socio-educativas. Resultados: De los 4167 encuestados; la mayoría sabía las medidas para evitar el contagio: el lavado de manos y estornudar adecuadamente (ambas con 65 % de personas muy de acuerdo). En el análisis multivariado, los del nivel técnico tenían un menor empoderamiento con respecto a la enfermedad (coeficiente: 0,39; IC95%: 0,15-0,98; p=0,046); además, en comparación con los encuestados que no tenían riesgo de complicaciones, los que eran del personal de salud sin riesgo (coeficiente: 1,77; IC95%: 1,01-3,09; p= 0,045) y los del personal de salud que tenían algún riesgo (coeficiente: 4,73; IC95%: 1,46-15,31; p= 0,010), fueron los más empoderados con respecto a la enfermedad; todas estas comparaciones se ajustaron por el sexo, la edad y el lugar de encuestado. Conclusiones: El personal de salud, debido a su actividad laboral, son lo más empoderados con respecto a COVID-19 y tienen mejor conocimiento en los temas de transmisión y prevención.

ABSTRACT Introduction: The fight against coronavirus infection requires knowledge about how to cope with this disease, as well as awareness of its main characteristics and the leading role played by basic hygiene actions. Objective: Determine the factors associated to patient empowerment in the context of coronavirus infection. Methods: A multicenter analytical cross-sectional study based on a self-applied survey was conducted in Peru from March to May 2020. The "empowered patient" was defined by a 10-question survey (Cronbach's alpha: 0.83); four: basic knowledge about severity and contagion; two: who are the most harshly affected, and four: protection measures. Total scores were added together and compared with four socioeducational variables. Results: Most of the 4 167 respondents were aware of the measures required to prevent contagion: hand and respiratory hygiene (both with 65% respondents very much in agreement). Multivariate analysis revealed that people with a technical educational level were less empowered about the disease (coefficient: 0.39; CI95%: 0.15-0.98; p=0.046). Comparison between respondents under no risk for complications, the health personnel (coefficient: 1.77; CI 95%: 1.01-3.09; p=0.045) and the health personnel under some sort of risk (coefficient: 4.73; CI 95%: 1.46-15.31; p=0.010) showed that the latter were the most empowered about the disease. These comparisons were adjusted for respondent sex, age and location. Conclusions: The health personnel were found to be the most highly empowered about COVID-19, due to the job they do, and showed to have the broadest knowledge about transmission and prevention topics.

Factores asociados al fatalismo ante la COVID-19 en 20 ciudades del Perú en marzo 2020 / Factors associated with fatalism in the face of COVID-19 in 20 Peruvian cities in March 2020

RESUMEN Introducción: la pandemia del COVID-19 ha generado reacciones diversas, pero estas aún no han sido medidas en la población latinoamericana. Objetivo: determinar los factores asociados a la percepción de fatalismo ante la infección del COVID-19 en pobladores de 20 departamentos del Perú. Material y Métodos: estudio transversal analítico, de tipo multicéntrico que con una muestra de 2466 personas en 20 departamentos del Perú midió el fatalismo ante la pandemia del COVID - 19 a través de una encuesta validada (Alpha Crombach: 0,78) que consistía en 7 ítems. El análisis estadístico fue realizado en función de cada ciudad y se consideró significativos p < 0,05. Resultados: de los 2466 encuestados, el 36 % se deprimirían, el 26 % piensa que podrían fallecer, el 17 % dice que esto es evidencia del fin del mundo y el 9 % podrían tomar una decisión fatal. Las mujeres tuvieron mayor frecuencia de 3 de las conductas fatalistas (contagiarse p=0,020; contagiar a otros p=0,004 y deprimirse p=0,020). A mayor edad hubo 5 percepciones (contagiar a otros p=0,007; complicarse p<0,001; deprimirse p<0,001, pensar que morirían p<0,001 o suicidarse p=0,014). Los que tenían un riesgo para complicación por COVID-19 tuvieron 4 percepciones (contagiar a otros p=0,024; complicarse p=0,002; pensar que morirían p<0,001 y que esto es señal del fin del mundo p=0,039). El ser agnóstico tuvo menor frecuencia de 5 percepciones, el ser ateo en 2. Conclusión: Se halló muchas ideas fatalistas entre la población ante la pandemia de coronavirus.

ABSTRACT Introduction: The COVID-19 pandemic has generated diverse reactions, but these have not yet been measured in the Latin American population. Objective: To determine the factors associated with the perception of fatalism in the face of COVID-19 infection in inhabitants of 20 cities in Peru. Material and Methods: A cross-sectional, multicenter study with a sample size of 2 466 people from 20 cities of Peru that measured fatalism during the COVID-19 pandemic was conducted through a validated survey (Cronbach´s alpha: 0,78) consisting of 7 items. Statistical analysis was conducted in terms of each city, and p < 0,05 was considered significant. Results: Of the 2 466 respondents, 36 % were depressed, 26 % thought that they might die, 17 % say that this was evidence of the end of the world, and 9 % could make a fatal decision. Women were more likely to engage in three of the fatalistic behaviors (becoming infected, p = 0,020; infecting others, p = 0,004, and becoming depressed, p = 0,020). At an older age there were 5 perceptions (infecting others, p = 0,007; becoming complicated, p < 0,001; becoming depressed, p < 0,001, thinking they would die, p < 0,001; or committing suicide, p = 0,014). Those at risk of complications of COVID-19 had 4 perceptions (infecting others, p = 0,024; becoming complicated, p = 0,002; thinking they would die, p < 0,001; and thinking that this is a sign of the end of the world, p = 0,039). Respondents who were agnostic exhibited a lower frequency in 5 perceptions, while atheist respondents showed a lower frequency in 2 perceptions. Conclusion: Many fatalistic ideas are found among the population in the face of the coronavirus pandemic.

Adaptación cultural y validación al español en población pediátrica de la Escala Funcional de Movilidad: estudio piloto / Cultural adaptation and validation of the Functional Mobility Assessment Scale to Spanish: a pilot study in the paediatric population

Introducción. La movilidad es un derecho de los pacientes con discapacidad y fundamental para la inclusión. La evaluación funcional cuantitativa de los dispositivos de movilidad es primordial. La Escala Funcional de Movilidad (FMA, por sus siglas en inglés) ha reportado una alta fiabilidad. Objetivo. Realizar la adaptación cultural y validación de la escala FMA en español para población pediátrica con un equivalente análogo visual. Material y métodos. Estudio piloto, longitudinal y prospectivo, aplicando una traducción española propuesta del FMA previa adaptación cultural con los criterios de Beaton en una muestra de 32 pacientes, para evaluar la fiabilidad (alfa de Cronbach, correlación intraclase, índice de Kappa) y la validez (análisis factorial, correlación de Spearman y Pearson) en comparación con un estándar de oro, el WeeFIM. Resultados. La FMA propuesta reportó muy buena fiabilidad en relación con cada uno de los ítems evaluados, así como una excelente concordancia en diferentes jueces. El análisis factorial fue de un 66,29% en las preguntas 5 y 9, con los valores más altos. La correlación de Pearson y Spearman fue evidente entre la FMA y el WeeFIM. Conclusiones. Con este estudio piloto, se encontraron áreas de mejora en la traducción de las preguntas 2 y 5, proponiéndose seguir aplicando la escala a una población más representativa e incluso en un estudio multicéntrico, para establecer una escala que pueda aplicarse a todo nuestro sistema (AU)

Introduction. Disabled people have the right to mobility, which is essential to their social inclusion. Quantitative assessment of functional mobility devices is a priority. The functional mobility assessment (FMA) scale has been demonstrated to have high reliability. Objective. Cultural adaptation and validation of the FMA scale in Spanish and for the paediatric population. An equivalent visual analogue scale was also used. Material and methods. A pilot, longitudinal, prospective study, applying a Spanish translation of the FMA with prior culture adaptation using Beaton criteria in a sample of 32 patients to evaluate the reliability (Cronbach's alpha, intraclass correlation, Kappa index) and validity (factor analysis, Pearson and Spearman correlation) of the scale compared with those of a gold standard (WeeFIM). Results. The FMA showed very good reliability in relation to each of the items evaluated, as well as excellent concordance in different observers. Factor analysis showed that two components had a cumulative percentage of 66.29%. The highest values were found for questions 5 and 9. Pearson and Spearman correlation showed a significant correlation between the FMA and WeeFIM. Conclusions. In this pilot study, areas for improvement were found in the translation of questions 2 and 5. We propose continued application of the scale in a more representative population and even a multicenter study to establish a scale that can be applied to our entire system (AU)