Impact of discontinuing non-pharmacological interventions on cognitive impairment in dementia patients by COVID-19 lockdown. A pilot observational, longitudinal, retrospective study carried out in an adult day center in Spain during the COVID-19 pandemic.

Background: The lockdown imposed during the COVID-19 pandemic led to social isolation and prevented patients with dementia from receiving a suite of non-pharmacological interventions (NPIs) that prevent cognitive decline. This discontinuation of NPIs could substantially affect the mental health status of people with dementia in social care settings, such as adult day care centers (ADCs). Propose: The study aimed to evaluate the effects of the COVID-19 lockdown on mental health and cognitive impairment in patients with dementia who could not attend their usual ADCs and did not receive our NPIs, based on World Health Organization (WHO) Guidelines. Methods: Observational, longitudinal, retrospective study carried out in an adult day center in Spain and reported it in accordance with the Strengthening Reporting of Observational Studies in Epidemiology (STROBE) statement. Cognitive status was assessed using the Mini-Mental State Examination (MMSE) in 80 patients attending the ADC of the "Leonese Association of Dementia Patients" (León, Spain), who had been evaluated with this instrument before the COVID-19 lockdown. Results: We observed a 0.4-point decrease in MMSE score/month (IQR = 1.4) during lockdown versus a 0.1-point decrease/month (IQR = 0.3) before this period (p = 0.038). Notably, this translated to >10-point decreases in MMSE score/year in 33.8% of participants during lockdown versus 5.5% earlier (p < 0.001). No statistically significant associations (p < 0.05) were found between the individual characteristics of the caregivers and the occurrence of the event. Conclusion: The reported declines in MMSE scores reveal a significant acceleration of cognitive decline during the period of inactivity. This could suggest that our NPIs, focused on slowing cognitive decline, are beneficial and, therefore, necessary in patients with dementia.

Impact of COVID-19 Confinement on Quality of Life of Patients with Age-Related Macular Degeneration: A Two-Wave Panel Study.

Age-related macular degeneration (AMD) is the leading cause of blindness in developed countries. Intravitreal injections of antiangiogenic agents (anti-VEGF) can stop vision loss in the neovascular form of the disease (nAMD). The aim of this study was to assess the general health-related quality of life (HRQoL) in a cohort of patients with nAMD treated with intravitreal anti-VEGF injections and to detesrmine to what extent their HRQoL was affected by COVID-19. This was an observational, analytical, and longitudinal study performed with a two-wave panel survey. Clinical outcomes, HRQoL, and tangible support were evaluated. In the final survey, changes in living conditions and medical visits due to the COVID-19 pandemic were also examined. Of the 102 patients initially interviewed in the before-COVID survey, 24 were lost after 30 months of follow-up. In the initial assessment, the mean health index was 0.73 ± 0.2. The EQ VAS score worsened at the final survey (p = 0.048). Patients needing treatment in both eyes (p = 0.007) and with lower levels of bilateral visual acuity (p = 0.018) reported an increase in social support at the final survey. In conclusion, patients perceived a worsening in HRQoL after confinement. However, patients enjoyed good social support that improved in the after-COVID survey.

Quality of Life in Women over 65 Years of Age Diagnosed with Osteoporosis.

(1) Background: Today's society is moving towards active aging, underlining the importance of understanding and improving quality of life (QoL). This QoL in women over the age of 65 years diagnosed with osteoporosis was compared with the QoL of the general population, and risk factors for osteoporosis related to QoL were identified. (2) Methods: This is an observational, descriptive, cross-sectional study with a personal interview. The study population was 704 women over 65 years of age diagnosed with osteoporosis as of 1 November 2018, based on medical records from four health centers of the eastern Valladolid urban health area. This was a random sample of 247 women stratified by health center. Information on osteoporosis risk factors, comorbidities, daily lifestyle habits, and QoL assessed with the EQ-5D was collected. QoL was modeled using sociodemographic variables, lifestyle, and clinical variables. (3) Results: Women with osteoporosis had a positive perception of their health (EQ-5D% VAS 64.9 ± 18.31). High EQ-5D QoL scores were obtained on the dimensions of mobility: 51.6% [95% CI (44.2%, 58.9%)]; self-care: 75.3% [95% CI (68.5%, 81.2%)]; activities of daily living: 71.4% [95% CI (64.4%, 77.6%)]; pain/discomfort: 25.8% [95% CI (19.8%, 32.6%)]; and anxiety/depression: 53.8% [95% CI (46.4%, 61.0%)]. (4) Conclusions: The QoL of the study group was no worse than the QoL of the general population, except for pain/discomfort and anxiety/depression. Age, highest educational level reached, inflammatory diseases, physical activity, and insomnia were independent predictors of QoL in women with osteoporosis.

Novel Prehospital Phenotypes and Outcomes in Adult-Patients with Acute Disease.

An early identification of prehospital phenotypes may allow health care workers to speed up and improve patients' treatment. To determine emergency phenotypes by exclusively using prehospital clinical data, a multicenter, prospective, and observational ambulance-based study was conducted with a cohort of 3,853 adult patients treated consecutively and transferred with high priority from the scene to the hospital emergency department. Cluster analysis determined three clusters with highly different outcome scores and pathological characteristics. The first cluster presented a 30-day mortality after the index event of 45.9%. The second cluster presented a mortality of 26.3%, while mortality of the third cluster was 5.1%. This study supports the detection of three phenotypes with different risk stages and with different clinical, therapeutic, and prognostic considerations. This evidence could allow adapting treatment to each phenotype thereby helping in the decision-making process.

Modifiable Determinants of Satisfaction with Intravitreal Treatment in Patients with Neovascular Age-Related Macular Degeneration.

BACKGROUND: The success of intravitreal treatment for neovascular age-related macular degeneration (nAMD) depends on maximal adherence to treatment, which in turn requires patient satisfaction. OBJECTIVE: The aim of this study was to assess the factors associated with nAMD patient satisfaction to implement actions to improve treatment experiences and increase adherence. DESIGN: This was a prospective, observational, analytical, cross-sectional study. SUBJECTS: Our study included 100 consecutive nAMD patients under intravitreal treatment for at least 1 year. METHODS: Patients completed the Macular Disease Treatment Satisfaction Questionnaire (MacTSQ) and the EuroQol Visual Analog Scale (EQ VAS). A logistic regression was estimated to model the low values of the satisfaction score (MacTSQ < 50). RESULTS: The mean age of patients was 82.1 ± 7.8 years and 62% were female. Males (p = 0.002) and patients who improved their visual acuity (p = 0.004) were more satisfied, while patients who received a higher number of injections (p = 0.036) and treatment in both eyes (p = 0.001) were less satisfied. Higher health-related quality of life was related to higher satisfaction. The sensitivity and specificity of the predictive model were 75.8% and 76.1%, respectively. Factors independently associated with low satisfaction were female sex (odds ratio [OR] 6.84), going to the clinic alone (OR 8.51), longer duration of treatment (OR 0.62), receiving treatment in both eyes (OR 3.54), and suffering a decline in visual acuity (OR 3.30). The questionnaire revealed patients' needs for more information and injection points closer to their homes. CONCLUSIONS: Well-defined areas for improvement were identified, i.e. to improve the information offered to each patient, to incorporate new long-acting drugs, and to establish locations for injection services in peripheral areas.

Constrained parsimonious model-based clustering.

A new methodology for constrained parsimonious model-based clustering is introduced, where some tuning parameter allows to control the strength of these constraints. The methodology includes the 14 parsimonious models that are often applied in model-based clustering when assuming normal components as limit cases. This is done in a natural way by filling the gap among models and providing a smooth transition among them. The methodology provides mathematically well-defined problems and is also useful to prevent us from obtaining spurious solutions. Novel information criteria are proposed to help the user in choosing parameters. The interest of the proposed methodology is illustrated through simulation studies and a real-data application on COVID data.

Delayed Neurological Improvement After Full Endovascular Reperfusion in Acute Anterior Circulation Ischemic Stroke.

Background and Purpose: We aimed to determine the prevalence and predictors of delayed neurological improvement (DNI) after complete endovascular reperfusion in anterior circulation acute ischemic stroke (AIS). Methods: Retrospective analysis of an online multicenter prospective reperfusion registry of patients with consecutive anterior circulation AIS treated with endovascular thrombectomy (EVT) from January 2018 to June 2019 in tertiary stroke centers of the NORDICTUS (NORD-Spain Network for Research and Innovation in ICTUS) network. We included patients with AIS with a proximal occlusion in whom a modified Thrombolysis in Cerebral Infarction 3 reperfusion pattern was obtained. DNI was defined if, despite absence of early neurological improvement during the first 24 hours, patients achieved functional independence on day 90. Clinical and radiological variables obtained before EVT were analyzed as potential predictors of DNI. Results: Of 1565 patients with consecutive AIS treated with EVT, 1381 had proximal anterior circulation occlusions, 803 (58%) of whom achieved a modified Thrombolysis in Cerebral Infarction 3. Of these, 628 patients fulfilled all selection criteria and were included in the study. Mean age was 73.8 years, 323 (51.4%) were female, and median baseline National Institutes of Health Stroke Scale was 16. Absence of early neurological improvement was observed in 142 (22.6%) patients; 32 of these (22.5%) achieved good long-term outcome and constitute the DNI group. Predictors of DNI in multivariable-adjusted logistic regression were male sex (odds ratio, 6.4 [95% CI, 2.1­22.3] P=0.002), lower pre-EVT National Institutes of Health Stroke Scale score (odds ratio, 1.4 [95% CI, 1.2­1.5], P<0.001), and intravenous thrombolysis (odds ratio, 9.1 [95% CI, 2.7­30.90], P<0.001). Conclusions: One-quarter of patients with anterior circulation AIS who do not clinically improve within the first 24 hours after complete cerebral endovascular recanalization will achieve long-term functional independence, regardless of the poor early clinical course. Male sex, lower initial clinical severity, and use of intravenous thrombolysis before EVT predicted this clinical pattern.

optimalFlow: optimal transport approach to flow cytometry gating and population matching.

BACKGROUND: Data obtained from flow cytometry present pronounced variability due to biological and technical reasons. Biological variability is a well-known phenomenon produced by measurements on different individuals, with different characteristics such as illness, age, sex, etc. The use of different settings for measurement, the variation of the conditions during experiments and the different types of flow cytometers are some of the technical causes of variability. This mixture of sources of variability makes the use of supervised machine learning for identification of cell populations difficult. The present work is conceived as a combination of strategies to facilitate the task of supervised gating. RESULTS: We propose optimalFlowTemplates, based on a similarity distance and Wasserstein barycenters, which clusters cytometries and produces prototype cytometries for the different groups. We show that supervised learning, restricted to the new groups, performs better than the same techniques applied to the whole collection. We also present optimalFlowClassification, which uses a database of gated cytometries and optimalFlowTemplates to assign cell types to a new cytometry. We show that this procedure can outperform state of the art techniques in the proposed datasets. Our code is freely available as optimalFlow, a Bioconductor R package at https://bioconductor.org/packages/optimalFlow . CONCLUSIONS: optimalFlowTemplates + optimalFlowClassification addresses the problem of using supervised learning while accounting for biological and technical variability. Our methodology provides a robust automated gating workflow that handles the intrinsic variability of flow cytometry data well. Our main innovation is the methodology itself and the optimal transport techniques that we apply to flow cytometry analysis.

Effectiveness of a Physical Therapeutic Exercise Programme for Caregivers of Dependent Patients: A Pragmatic Randomised Controlled Trial from Spanish Primary Care.

Female family caregivers (FFCs) constitute one of the basic supports of socio-health care for dependence in developed countries. The care provided by FFCs may impact their physical and mental health, negatively affecting their quality of life. In order to alleviate the consequences of providing care on FFCs, the Spanish Public Health System has developed the family caregiver care programme (FCCP) to be applied in primary care (PC) centres. The effectiveness of this programme is limited. To date, the addition of a physical therapeutic exercise (PTE) programme to FCCP has not been evaluated. A randomised multicentre clinical trial was carried out in two PC centres of the Spanish Public Health System. In total, 68 FFCs were recruited. The experimental group (EG) performed the usual FCCP (4 sessions, 6 h) added to a PTE programme (36 sessions in 12 weeks) whereas the control group performed the usual FCCP performed in PC. The experimental treatment improved quality of life (d = 1.17 in physical component summary), subjective burden (d = 2.38), anxiety (d = 1.52), depression (d = 1.37) and health-related physical condition (d = 2.44 in endurance). Differences between the groups (p < 0.05) were clinically relevant in favour of the EG. The experimental treatment generates high levels of satisfaction.

Characterization of Hearing Loss in Adult Patients With Nondialysis Chronic Kidney Disease.

OBJECTIVE: To confirm the association between chronic kidney disease and sensorineural hearing loss in non-dialysis non-diabetic patients and to establish the audiological profile of these patients indicating the possible location of the auditory damage. STUDY DESIGN: Cross-sectional study. SETTING: Tertiary referral center. PATIENTS: Patients between 18 and 60 years old with chronic kidney disease, without diabetes mellitus and without personal history of otology disease, were compared with a healthy control group pared by sex and age to establish differences between their audiological profile. INTERVENTIONS: Pure tone audiometry (PTA), transient evoked otoacoustic emissions (TEOAEs), distortion products otoacoustic emissions (DPOAEs), and auditory brainstem responses (ABR) were performed in both groups. MAIN OUTCOME MEASURES: Mean and standard deviation of PTA auditory thresholds, TEOAEs reproducibility, DPOAEs level/noise, and ABR absolute latency and interwave latency were measured, and compared using linear mixed models. RESULTS: Fifty one cases were included and compared with 51 healthy volunteers. The audiometric profile found in patients with chronic kidney disease was a sensorineural hearing loss in 4 to 8 kHz frequencies in the PTA, a decrease in the TEOAEs reproducibility and a decrease in the DPOAEs level. An enlargement in the V wave absolute latency and III to V and I to V interwave latency in the ABR were also found but within normal range. CONCLUSIONS: There is an association between chronic kidney disease in non-dialysis non diabetic adults patients and sensorineural hearing loss, affecting high frequencies and having the cochlea as the main site of auditory damage.

Pain Neuroscience Education and Physical Therapeutic Exercise for Patients with Chronic Spinal Pain in Spanish Physiotherapy Primary Care: A Pragmatic Randomized Controlled Trial.

Chronic musculoskeletal pain affects more than 20% of the population, leading to high health care overload and huge spending. The prevalence is increasing and negatively affects both physical and mental health, being one of the leading causes of disability. The most common location is the spine. Most treatments used in the Public Health Services are passive (pharmacological and invasive) and do not comply with current clinical guidelines, which recommend treating pain in primary care (PC) with education and exercise as the first-line treatments. A randomized multicentre clinical trial has been carried out in 12 PC centres. The experimental group (EG) conducted a program of pain neuroscience education (6 sessions, 10 h) and group physical exercise with playful, dual-tasking, and socialization-promoting components (18 sessions in 6 weeks, 18 h), and the control group performed the usual physiotherapy care performed in PC. The experimental treatment improved quality of life (d = 1.8 in physical component summary), catastrophism (d = 1.7), kinesiophobia (d = 1.8), central sensitization (d = 1.4), disability (d = 1.4), pain intensity (d = 3.3), and pressure pain thresholds (d = 2). Differences between the groups (p < 0.001) were clinically relevant in favour of the EG. Improvements post-intervention (week 11) were maintained at six months. The experimental treatment generates high levels of satisfaction.

Trapeziometacarpal total joint arthroplasty for osteoarthritis: 199 patients with a minimum of 10 years follow-up.

We report outcomes of 228 consecutive patients with total joint arthroplasty using the Arpe® prosthesis, among which 216 trapeziometacarpal joints in 199 patients had a minimum of 10 years follow-up. The cumulative survival rate of the 216 implants at 10 years using the Kaplan-Meyer method was 93%. Two hundred joints were functional and painless. We found good integration and positioning of the components in 184 (93%) of the joints. Sixteen prostheses failed. We conclude that this implant has acceptable long-term survival rate and restores good hand function. We also report our methods to improve implant survival and to decrease the risk of component malpositioning, and failure rate. Level of evidence: II.

The Prognostic Value of Prehospital Blood Lactate Levels to Predict Early Mortality in Acute Cardiovascular Disease.

INTRODUCTION: The knowledge of the prognostic value of prehospital lactate (PLA) is limited. Our objective was to evaluate the predictive capacity of PLA to predict early mortality (within 48 h) from the index event in acute cardiovascular disease (ACVD). METHODS: Prospective, longitudinal, multicenter, observational study in patients, attended by advanced life support units, transferred to the emergency department of their reference hospital and diagnosed with ACVD. We collected demographic, physiological, clinical, analytical variables, main cardiological diagnosis, and data on hospital admission and early mortality. The main outcome variable was mortality from any cause within 2 days. RESULTS: Between March 1, 2018 and January 31, 2019, a total of 492 patients were included in our study. Early mortality after the index event within the first 48 h affected 27 patients (5.5%). The most frequent cause of care demand was chest pain with 223 cases (45.3%). The predictive power of PLA to discriminate mortality at 2 days obtained an area under the curve of 0.911 (95% confidence interval [CI]: 0.83-0.98, P < 0.001). A value equal or superior to 4.3 mmol/L globally attained a sensitivity of 92.6% (95% CI, 76.6-97.9) with a specificity of 82.8% (95% CI, 79.1-86.0), with a positive predictive value of 23.8 (16.7-32.8) and a negative predictive value of 99.5 (98.1-99.9). CONCLUSION: PLA represents a prognostic biomarker with excellent predictive capacity for ACVD. Prehospital Emergency Services (PhEMS) should incorporate this test routinely in their usual procedures.

Evaluación económica de la vacunación frente al neumococo en mayores de 65 años de Castilla y León / Economic evaluation of pneumococcal vaccination in adults aged over 65 years in Castilla y León (SPAIN)

Introducción: La carga de enfermedad por neumonía en adultos mayores supone un impacto de gran magnitud en los sistemas de salud. El objetivo de este trabajo es realizar una evaluación económica de la estrategia de vacunación frente a Streptococcus pneumoniae mediante la vacuna neumocócica conjugada 13-valente frente a la no vacunación. Material y métodos: Se ha desarrollado un modelo económico simulado en forma de árbol de decisión para evaluar el coste/efectividad de la estrategia de vacunación en la cohorte de población mayor de 65 años del Área de Salud de Valladolid-Este versus no vacunación mediante un análisis probabilístico de Monte Carlo. Resultados: Streptococcus pneumoniae origina anualmente en el Área de Salud Valladolid-Este un total de 557,24 casos de enfermedad neumocócica, de los cuales 506,60 episodios son cuadros neumónicos. A partir del tercer año, la vacunación a la población mayor de 65 años es una medida eficiente, con un coste por años de vida ajustados por calidad (AVAC) de 20.496,20 Euros. El número de AVAC ganados en una década es de 86,07 y se evitaría el gasto de 216.252,89 Euros con esta estrategia vacunal. Conclusiones: La evaluación de los diferentes costes incrementales (AVAC y euros) en los años de seguimiento pone de manifiesto que el programa de vacunación frente al neumococo a personas mayores de 65 años en Castilla y León es una medida coste eficiente

Introduction: The burden of disease due to pneumonia in older adults has a major impact on health systems. The aim of this study is to carry out an economic evaluation of the vaccination strategy against Streptococcus pneumoniae using the 13-valent pneumococcal conjugate vaccine. Material and methods: A simulated economic model has been developed in the form of a decision tree to evaluate the cost of the vaccination strategy in the population over 65 years of the Valladolid-East Health Area, versus non-vaccination, using a Monte Carlo probabilistic analysis. Results: Streptococcus pneumoniae annually generates 557.24 cases of pneumococcal disease in the Valladolid-East Health Area, and 506.60 episodes have pneumonia symptoms. Vaccination of the cohort over 65 years of age is an efficient measure from the third year, with a cost per quality-adjusted life years (QALY) of 20,496.20 Euros. The number of QALYs gained in a decade is 86.07 and an amount of 216.252.89 Euros with this vaccination strategy would be saved. Conclusions: The evaluation of the different incremental costs (QALY,euros) in the years of follow-up, the pneumococcus vaccination program in people over 65 in Castilla y León is cost-effective

Pain neuroscience education and physical exercise for patients with chronic spinal pain in primary healthcare: a randomised trial protocol.

BACKGROUND: Chronic musculoskeletal pain affects more than 20% of the population, and the prevalence is increasing, causing suffering, loss of quality of life, disability, and an enormous expenditure on healthcare resources. The most common location for chronic pain is the spine. Many of the treatments used are mainly passive (pharmacological and invasive) and poor outcomes. The treatments currently applied in the public health system do not comply with the recommendations of the main clinical practice guidelines, which suggest the use of educational measures and physical exercise as the first-line treatment. A protocol based on active coping strategies is described, which will be evaluated through a clinical trial and which could facilitate the transfer of the recommendations of the clinical practice guidelines to a primary care setting. METHODS: Randomised and multicentre clinical trials, which will be carried out in 10 Primary Care centres. The trial will compare the effect of a Pain Neuroscience Education program (six sessions, 10 h) and group physical exercise (18 sessions program carried out in six weeks, 18 h), with usual care physiotherapy treatment. Group physical exercise incorporates dual tasks, gaming, and reinforcement of contents of the educational program. The aim is to assess the effect of the intervention on quality of life, as well as on pain, disability, catastrophism, kinesiophobia, central sensitisation, and drug use. The outcome variables will be measured at the beginning of the intervention, after the intervention (week 11), at six months, and a year. DISCUSSION: Therapeutic interventions based on active coping strategies are essential for the treatment of chronic pain and the sustainability of the Public Health System. Demonstrating whether group interventions have an effect size is essential for optimising resources in such a prevalent problem. TRIAL REGISTRATION: NCT03654235 "Retrospectively registered" 31 August 2018.

Accuracy of National Early Warning Score 2 (NEWS2) in Prehospital Triage on In-Hospital Early Mortality: A Multi-Center Observational Prospective Cohort Study.

INTRODUCTION: In cases of mass-casualty incidents (MCIs), triage represents a fundamental tool for the management of and assistance to the wounded, which helps discriminate not only the priority of attention, but also the priority of referral to the most suitable center. HYPOTHESIS/PROBLEM: The objective of this study was to evaluate the capacity of different prehospital triage systems based on physiological parameters (Shock Index [SI], Glasgow-Age-Pressure Score [GAP], Revised Trauma Score [RTS], and National Early Warning Score 2 [NEWS2]) to predict early mortality (within 48 hours) from the index event for use in MCIs. METHODS: This was a longitudinal prospective observational multi-center study on patients who were attended by Advanced Life Support (ALS) units and transferred to the emergency department (ED) of their reference hospital. Collected were: demographic, physiological, and clinical variables; main diagnosis; and data on early mortality. The main outcome variable was mortality from any cause within 48 hours. RESULTS: From April 1, 2018 through February 28, 2019, a total of 1,288 patients were included in this study. Of these, 262 (20.3%) participants required assistance for trauma and injuries by external agents. Early mortality within the first 48 hours due to any cause affected 69 patients (5.4%). The system with the best predictive capacity was the NEWS2 with an area under the curve (AUC) of 0.891 (95% CI, 0.84-0.94); a sensitivity of 79.7% (95% CI, 68.8-87.5); and a specificity of 84.5% (95% CI, 82.4-86.4) for a cut-off point of nine points, with a positive likelihood ratio of 5.14 (95% CI, 4.31-6.14) and a negative predictive value of 98.7% (95% CI, 97.8-99.2). CONCLUSION: Prehospital scores of the NEWS2 are easy to obtain and represent a reliable test, which make it an ideal system to help in the initial assessment of high-risk patients, and to determine their level of triage effectively and efficiently. The Prehospital Emergency Medical System (PhEMS) should evaluate the inclusion of the NEWS2 as a triage system, which is especially useful for the second triage (evacuation priority).

Statin intake can decrease acute pancreatitis severit.

BACKGROUND/OBJECTIVES: Acute Pancreatitis (AP) is one of the leading gastrointestinal conditions requiring hospitalization. It has been suggested that statins could exert a protective role in the natural history of AP; however, their influence is not entirely clear. Our objective was to investigate the relationship between statin intake and AP. METHODS: Retrospective analysis of a prospective registry of patients diagnosed with AP. Statin intake on admission as well as clinical, analytical, demographic and radiological data were recorded. OUTCOME PARAMETERS: Severity of AP, SIRS development, organ failure, local complications, intensive care admission, collection drainage, hospital length of admission, and death. Univariate and multivariate analyses as well as a propensity score logistic regression were conducted. RESULTS: From March 2014-October 2018 we studied 356 patients. 101 patients (28%) were taking statins. 55 (15%) suffered from moderate/severe pancreatitis. Multivariate analysis showed a 50% less risk of suffering from moderate/severe AP (OR 0.50 95% CI 0.22-1.0, p 0.50) and 33% less risk of developing local complications (OR 0.33 95%CI 0.15-0.80, p 0.014) among statin consumers, with a tendency towards less SIRS. Propensity score analysis confirmed that patients on statins suffering from AP had a lower risk to have a moderate/severe episode (OR 0.409 95%CI 0.192-0.872, p 0.031), to develop local complications (OR 0.47 95%CI 0.20-1.06, p 0.11) and SIRS (OR 0.516 95% CI 0.28-0.93, p 0.041). CONCLUSIONS: Patients taking statins who suffer from an episode of AP are more likely to follow a mild course and have a lower risk of developing local complications and SIRS.

[Economic evaluation of pneumococcal vaccination in adults aged over 65 years in Castilla y León (SPAIN)]. / Evaluación económica de la vacunación frente al neumococo en mayores de 65 años de Castilla y León.

INTRODUCTION: The burden of disease due to pneumonia in older adults has a major impact on health systems. The aim of this study is to carry out an economic evaluation of the vaccination strategy against Streptococcus pneumoniae using the 13-valent pneumococcal conjugate vaccine. MATERIAL AND METHODS: A simulated economic model has been developed in the form of a decision tree to evaluate the cost of the vaccination strategy in the population over 65 years of the Valladolid-East Health Area, versus non-vaccination, using a Monte Carlo probabilistic analysis. RESULTS: Streptococcus pneumoniae annually generates 557.24 cases of pneumococcal disease in the Valladolid-East Health Area, and 506.60 episodes have pneumonia symptoms. Vaccination of the cohort over 65 years of age is an efficient measure from the third year, with a cost per quality-adjusted life years (QALY) of 20,496.20 €. The number of QALYs gained in a decade is 86.07 and an amount of 216.252.89 € with this vaccination strategy would be saved. CONCLUSIONS: The evaluation of the different incremental costs (QALY,euros) in the years of follow-up, the pneumococcus vaccination program in people over 65 in Castilla y León is cost-effective.

A Multicenter Observational Prospective Cohort Study of Association of the Prehospital National Early Warning Score 2 and Hospital Triage with Early Mortality.

AIM OF THE STUDY: To evaluate the ability of the prehospital National Early Warning Score 2 scale (NEWS2) to predict early mortality (within 48 hours) after the index event based on the triage priority assigned for any cause in the emergency department. METHODS: This is a multicenter longitudinal observational cohort study on patients attending Advanced Life Support units and transferred to the emergency department of their reference hospital. We collected demographic, physiological, and clinical variables, main diagnosis, and hospital triage level as well as mortality. The main outcome variable was mortality from any cause within two days of the index event. RESULTS: Between April 1 and November 30, 2018, a total of 1054 patients were included in our study. Early mortality within the first 48 hours after the index event affected 55 patients (5.2%), of which 23 cases (41.8%) had causes of cardiovascular origin. In the stratification by triage levels, the AUC of the NEWS2 obtained for short-term mortality varied between 0.77 (95% CI: 0.65-0.89) for level I and 0.94 (95% CI: 0.79-1) for level III. CONCLUSIONS: The Prehospital Emergency Medical Services should evaluate the implementation of the NEWS2 as a routine evaluation, which, together with the structured hospital triage system, effectively serves to predict early mortality and detect high-risk patients.

Development of a new algorithm based on FDT Matrix perimetry and SD-OCT to improve early glaucoma detection in primary care.

PURPOSE: The purpose of this study was to develop an objective algorithm to discriminate the earliest stages of glaucoma using frequency doubling technology (FDT) Matrix perimetry and spectral domain-optical coherence tomography (OCT) technology to improve primary care detection. MATERIALS AND METHODS: Three hundred six eyes (mean age 58.67±15.12) from 161 patients were included and classified in the following three groups: 101 nonglaucoma (GI-NG), 100 glaucoma suspect (GII-SG), and 105 open-angle glaucoma (GIII-OAG). All participants underwent a visual field exploration using the Humphrey Matrix visual field instrument and retinal nerve fiber layer evaluation using the Topcon 3D OCT-2000. Pattern deviation plot was divided into 19 areas and five aggrupation or quadrants and ranked with a value between 0 and 4 according to its likelihood of normality, and differences among three groups were analyzed. Principal component analysis (PCA) was also used to extract the most notable features of FDT and OCT, and a logistic regression analysis was applied to obtain the classification rules. RESULTS: Only area numbers 7 and 12 and the central zone of FDT Matrix showed statistical differences (P<0.05) between GI-NG and GII-SG. The classification rules were estimated by the four PCA obtained from FDT Matrix and 3D OCT-2000 in a separate and combined use. Area under the receiver operating characteristic curve was 78.88% with FDT-PCA, 82.09% with OCT-PCA, and 94.27% with combined use of FDT and OCT-PCA to discriminate GI-NG and GII-SG. CONCLUSION: The predictive rules based on FDT-PCA or OCT-PCA provide a high sensitivity and specificity to detect the earliest stages of glaucoma and even better in combined use. These predictive rules may help the future development of software for FDT Matrix perimetry and 3D OCT-2000, which will greatly improve their diagnostic ability, making them useful in daily practice in a primary care setting.