New severity criteria for tricuspid regurgitation in a broad population of "real life" patients: Prevalence and prognostic impact.

Introduction Our objective was to determine, in "real life" patients, the prevalence of massive and torrential regurgitation among patients diagnosed with severe tricuspid regurgitation (TR), as well as its impact on long-term prognosis. Methods In a single-center retrospective study, all patients with an echocardiographic diagnosis of severe TR attended at a tertiary care hospital of an European country from January 2008 to December 2017 were recruited. Images were analysed off-line to measure the maximum vena contracta (VC) and TR was classified into three groups: severe (VC ≥ 7 mm), massive (VC 14-20 mm), and torrential (VC ≥ 21 mm). The impact of this classification on the combined event of heart failure (HF) admission and all-cause death in follow-up was investigated. Results A total of 614 patients (70 ± 13 years, 72 % women) were included. 81.4 % had severe TR, 15.8 % massive TR, and 2.8 % torrential TR. The 5-year HF-free survival  was 42 %, 43 %, and 12 % (p = 0.001), for the different subgroups of severe TR, respectively. After adjusting for baseline characteristics, TR severity was an independent predictor of survival free of the combined end-point: HR 0.91 [95 % CI 0.70-1.18] p = 0.46, for massive TR; and HR 2.5 [95 % CI 1.49-4.21] p = 0.001, for torrential TR considering severe TR as reference. Conclusions The prevalence of massive and torrential TR is not negligible among patients with severe TR in real life. The prognosis is significantly worse for patients with torrential TR measured by the maximum VC.

The Worsening of Heart Failure with Reduced Ejection Fraction: The Impact of the Number of Hospital Admissions in a Cohort of Patients.

BACKGROUND: Worsening heart failure (WFH) includes heart failure (HF) hospitalisation, representing a strong predictor of mortality in patients with heart failure with reduced ejection fraction (HFrEF). However, there is little evidence analysing the impact of the number of previous HF admissions. Our main objective was to analyse the clinical profile according to the number of previous admissions for HF and its prognostic impact in the medium and long term. METHODS: A retrospective study of a cohort of patients with HFrEF, classified according to previous admissions: cohort-1 (0-1 previous admission) and cohort-2 (≥2 previous admissions). Clinical, echocardiographic and therapeutic variables were analysed, and the medium- and long-term impacts in terms of hospital readmissions and cardiovascular mortality were assessed. A total of 406 patients were analysed. RESULTS: The mean age was 67.3 ± 12.6 years, with male predominance (73.9%). Some 88.9% (361 patients) were included in cohort-1, and 45 patients (11.1%) were included in cohort-2. Cohort-2 had a higher proportion of atrial fibrillation (49.9% vs. 73.3%; p = 0.003), chronic kidney disease (36.3% vs. 82.2%; p < 0.001), and anaemia (28.8% vs. 53.3%; p = 0.001). Despite having similar baseline ventricular structural parameters, cohort-1 showed better reverse remodelling. With a median follow-up of 60 months, cohort-1 had longer survival free of hospital readmissions for HF (37.5% vs. 92%; p < 0.001) and cardiovascular mortality (26.2% vs. 71.9%; p < 0.001), with differences from the first month. CONCLUSIONS: Patients with HFrEF and ≥2 previous admissions for HF have a higher proportion of comorbidities. These patients are associated with worse reverse remodelling and worse medium- and long-term prognoses from the early stages, wherein early identification is essential for close follow-up and optimal intensive treatment.

Physicochemical composition, phytochemical analysis and biological activity of ciricote (Cordia dodecandra A. D.C.) fruit from Yucatán.

The physicochemical properties, proximate composition, minerals, total polyphenols, carotenoids, phenolic compounds, antioxidant, and antibacterial activities of ciricote (Cordia dodecandra A. DC.) tropical fruit were investigated. Minerals were quantified by using micro-Energy Dispersive X-Ray Fluorescence. Lutein and ß-carotene were identified in ciricote fruit by using UPLC-PDA analysis. The highest values of the total polyphenols content and antioxidant activity were presented in ethanolic crude extracts obtaining by the ultrasonic-assisted method with freeze-dried fruit. The phenolic acids profile was identified and quantified by UPLC-PDA-ESI-MS. The main phenolic acids were caffeoyl hexoside, rufescenolide, quercetin 3-O-rutinoside, and rosmarinic acid. The ciricote extracts presented antibacterial activity against Staphylococus aureus (Gram+) and Salmonella typhymurium (Gram-). In conclusion, the ciricote (Cordia dodecandra A. DC.) tropical fruits could be very useful source of biological macromolecules, micro-elements, and phytochemical compounds for the food and pharmaceutical industry.

A How-to Guide to Building a Robust SARS-CoV-2 Testing Program at a University-Based Health System.

When South Florida became a hot spot for COVID-19 disease in March 2020, we faced an urgent need to develop test capability to detect SARS-CoV-2 infection. We assembled a transdisciplinary team of knowledgeable and dedicated physicians, scientists, technologists, and administrators who rapidly built a multiplatform, polymerase chain reaction- and serology-based detection program, established drive-through facilities, and drafted and implemented guidelines that enabled efficient testing of our patients and employees. This process was extremely complex, due to the limited availability of needed reagents, but outreach to our research scientists and multiple diagnostic laboratory companies, and government officials enabled us to implement both Food and Drug Administration authorized and laboratory-developed testing-based testing protocols. We analyzed our workforce needs and created teams of appropriately skilled and certified workers to safely process patient samples and conduct SARS-CoV-2 testing and contact tracing. We initiated smart test ordering, interfaced all testing platforms with our electronic medical record, and went from zero testing capacity to testing hundreds of health care workers and patients daily, within 3 weeks. We believe our experience can inform the efforts of others when faced with a crisis situation.

Associations between Feelings of Loneliness and Attitudes towards Physical Education in Contemporary Adolescents According to Sex, and Physical Activity Engagement.

BACKGROUND: Currently, adolescents grow up consuming a large amount of multimedia content and lead a sedentary lifestyle. As a result, emerging trends show greater feelings of loneliness. The present research seeks to describe adolescents' attitudes towards Physical Education (PE), indices of loneliness and physical activity (PA) engagement. Further, it analyses associations between attitudes towards PE as a function of PA engagement and considers sex, loneliness and school year repetition as factors. METHOD: A sample of 2388 adolescents (43.3% males and 56.6% females) was recruited. Participants were aged 11-17 years (M = 13.8 years; SD = 1.2) and came from Spain. The following instruments were used: The Attitudes towards Physical Education questionnaire (AQPE) in order to analyze attitudes towards PE, and the University of California at Los Angeles (UCLA) loneliness scale to estimate loneliness. RESULTS: With regard to sex and attitudes towards PE, significant differences were detected in relation to the difficulty of PE, with higher values being achieved in males (M = 2.4) than females (M = 2.3). A medium correlation emerged between the dimension of loneliness and the usefulness of PE (r = 0.323 **). CONCLUSIONS: It is confirmed that adolescents who experience greater levels of emotional or relational loneliness have less positive attitudes towards PE.

Successful use of problem-solving methodology to reduce pharmacy chemotherapy processing time.

OBJECTIVES: The primary objectives of this study were to (1) reduce pharmacy turnaround time (TAT) without compromising safety and quality and (2) reduce compounding order overload during peak hours (8:00 AM-5:00 PM). The secondary objective was to decrease patient wait time pertinent to pharmacy services. SETTING: The setting was a hospital-based pharmacy. PRACTICE DESCRIPTION: Pharmacy dispensing more than 1800 doses daily, 30% of which goes to outpatient cancer treatment. Patients usually receive multiple compounded medications; thus, compounding numbers are several folds higher than patient number. High compounded chemotherapy order volume overloaded pharmacy staff during peak hours and was a major contributor to patient wait time. PRACTICE INNOVATION: Using Define Measure Analyze Improve Control Six Sigma and intelligent risk-taking strategies, a dedicated team identified root causes of problems and designed long-lasting solutions that would not compromise quality. EVALUATION: The most effective initiative was the advanced preparation of chemotherapy for select patients (Concierge), which addressed pharmacy TAT, patient wait time, and chemotherapy order overload, all without affecting safety or quality of dispensed medications. RESULTS: Pharmacy TAT decreased by 77% for Concierge patients and 31% for standard patients. Comparable decreases were observed for patient wait time: 67% for Concierge and 27% for standard patients. Safety and quality were maintained for all dispensations during and after implementation of Concierge. A concurrent 8% increase in patient number was observed despite no changes in physical capacity. CONCLUSION: The implementation of Concierge initiatives: markedly reduced pharmacy TAT without compromising safety checks performed by pharmacists; decreased chemotherapy order overload during peak hours; improved distribution of assignments for pharmacy staffand statistically significant decreased wait time for all patients, especially those selected for Concierge. Effective selection of Concierge patients minimized additional costs associated with wasted premixed chemotherapy. Improving workflow for a subset of patients affected a greater patient population, allowing additional patients to be treated daily.

An exploratory study in breast cancer of factors involved in the use and communication with health professionals of Internet information.

OBJECTIVE: To study the impact of the spontaneous use of Internet on breast cancer patients and on their relationship with health professionals. METHODS: A mixed methodology was used. Two questionnaires were designed through three focus groups, and then administered to 186 patients and 59 professionals in order to assess: (1) patients' use of Internet for health-related information and (2) the impact of this information on patients' psychological outcomes and on their relationship with professionals. RESULTS: Patients spent more time looking for illness-related information after diagnosis, using interactive communities more than static information websites. Patients and professionals disagreed about the use of Internet in terms of the knowledge it provides, and its psychological impact. The main barrier reported by patients regarding the sharing of online information with their professionals was the belief that it would damage their relationship. CONCLUSIONS: Both professionals and patients have a protectionist conception of the therapeutic relationship. This attitude tends to dismiss the positive impact that the use of Internet and the new communication tools may have in cancer patients. New resources should provide an "Internet Prescription" and modes of interaction to facilitate a more open digital communication.

Effects of the Application of a Program of Adapted Utilitarian Judo (JUA) on the Fear of Falling Syndrome (FOF) for the Health Sustainability of the Elderly Population.

This research analyzes the fall history of a group of elderly people and studies the effects of an intervention program based on Adapted Utilitarian Judo (JUA) to teach fall control in subjects with fear of falling syndrome (FOF). We adopted a quasi-experimental research design with pre-post measurement of the experimental group, in a healthy, pre-fragile sample of 12 women aged 71.5 ± 8 years, chosen using non-probabilistic-incidental accessibility sampling. The WHO questionnaire was used for the functional assessment of the fall. To evaluate FOF, we applied the 16-item version of the Falls Efficacy Scale-International (FES-I), (pretest and posttest). This intervention program was based on Adapted Utilitarian Judo and conducted over 8 weeks, with two 60-minute sessions each week. After analyzing the scores obtained by the subjects in the pre and post FES-I, we found that the intervention with the JUA program had been significant for the experimental group with p ≤ 0.004, and there was an 11.9% decrease in the fear of falling (FES-I pos = 18.17). The results show that after the application of the JUA program there were significant improvements in subjects' perception of FOF, with this being greater in those who had the highest levels of fear of falling before the intervention.

Evaluación de un programa motivacional de establecimiento de objetivos para la optimización del rendimiento en deportistas de alto nivel: una aproximación cualitativa / Evaluation of a motivational program to goal setting to optimize performance in high level athletes: a qualitative approach / Avaliação de um programa motivacional de estabelecimento de objectivos para a optimização do rendimento em desportistas de alto nível: uma abordagem qualitativa

El propósito de este estudio se orienta a descubrir las bondades de un programa de entrenamiento por establecimiento de objetivos (EO) desde la óptica de los propios implicados. Para ello, se diseña y se aplica un programa motivacional de EO en dos equipos de fútbol de alto nivel, con metas a corto, medio y largo plazo, individual y colectivo, abordando tipologías de objetivos autoimpuestos en los planos físico, técnico-táctico y psicológico. La metodología empleada se sustenta en el método de investigación evaluativa. El enfoque metodológico predominante es de naturaleza interpretativa, y se concreta en un diseño articulado desde los preceptos de la Grounded Theory (o Teoría Fundamentada en los datos). El análisis de los datos cualitativos se llevó a cabo mediante el software Atlas.ti. Los datos registrados se utilizaron como base para la elaboración de networks (o mapas conceptuales) y para el cálculo del coeficiente C, posteriormente se exportan a una matriz de datos cuantitativa para trabajar técnicas estadísticas descriptiva y correlacional (medidas de dispersión y coeficientes de contingencia). Los resultados obtenidos ofrecen una caracterización de objetivos establecidos por deportistas de alto nivel, según categoría y demarcación de los jugadores. Se llega a la conclusión de que la mayor parte de los objetivos que se plantean los jugadores son fundamentalmente de corte psicológico, más que físicos o técnico-tácticos, al igual que los objetivos perseguidos por centrocampistas y porteros

The purpose of this study was to discover the benefits of a training program by goal setting from the perspective of those involved. To this end, a motivational goal setting program is designed and implemented in two high-level football teams, with short, medium and long term goals, individual and collective, addressing typologies of selfimposed objectives in the physical, technical-tactical and psychological. The methodology used was based on the method of evaluative research. The predominant methodological approach is of an interpretive nature, and is concretized in a design articulated from the Grounded Theory. The analysis of the qualitative data was carried out using Atlas.ti software. The data recorded were used as a basis for the elaboration of networks (or conceptual maps) and for the calculation of the coefficient C, subsequently exported to a quantitative data matrix to work descriptive and correlational statistical techniques (dispersion measures and contingency coefficients). The results obtained offer a characterization of objectives established by high level athletes, according to category and demarcation of the players. It is concluded that most of the objectives that the players pose are fundamentally psychological, rather than physical or technical-tactical, as are the goals pursued by midfielders and goalkeepers

O objetivo deste estudo foi descobrir os benefícios de um programa de treino tendo por base o estabelecimento de objetivos da perspectiva dos envolvidos. Para isso, um programa motivacional de estabelecimento de objetivos foi desenvolvido e aplicada a duas equipas de futebol de alto nível, com objetivos a curto, médio e longo prazo, bem como individuais e coletivos abordando tipologias de objetivos auto-impostas ao nível físico, técnico-tático e psicológico. A metodologia utilizada baseiou-se no método de pesquisa avaliadora. A abordagem metodológica foi predominante de natureza interpretativa e é concretizada numprojeto articulado a partir dos pressupostos da Grounded Theory (ou teoria fundamentada nos dados). A análise dos dados qualitativos foi realizada utilizando o software Atlas.ti. Os dados registados foram utilizados com base para o desenvolvimento de redes (ou mapas conceituais) e para o cálculo do coeficiente C, depois foram exportados para uma matriz de dados quantitativos, sendo analisados com recurso a uma análise descritiva e de correlação estatísticas descritivas e correlacionais (medidas de dispersão e coeficientes de contingência). Os resultados obtidos oferecem uma caracterização dos objetivos estabelecidos pelos atletas de alto nível, de acordo com a categoria e limitação dos jogadores. Conclui-se que a maioria dos objetivos que os jogadores criam são maioritariamente psicológicos, comparativamente aos físicos ou técnico-táticos, bem como os objetivos perseguidos pelos médios-centro e guarda-redes

Delivering Patient Value by Using Process Improvement Tools to Decrease Patient Wait Time in an Outpatient Oncology Infusion Unit.

PURPOSE: This study aimed to streamline workflow from arrival to premedication by decreasing patient wait time to increase value in a high-volume academic outpatient oncology infusion unit. The streamlining process involved identifying and prioritizing patients for treatment by driving out waste in patient flow. METHODS: The plan-do-check-act (PDCA) method and Lean Methodology were used in completing a project to streamline a defined subset of patient experiences within an outpatient oncology infusion unit in an academic comprehensive cancer center. Wait time for patients whose labs were completed before treatment day and within normal limits and whose orders were signed the day before treatment was collected manually for a period of 5 months and tracked via value stream and control charts. RESULTS: Postimplementation, patients experienced a decrease of 17 minutes in mean patient arrival to premedication start time (preimplementation 77 minutes, postimplementation 60 minutes). Additionally, a value stream analysis demonstrated that in the new process, patient touch points were decreased by two, and value-added time was increased by 17%. CONCLUSION: By using the systematic PDCA tool, the team was able to identify opportunities to reduce waste in the system and streamline patient care. The results demonstrated a significant improvement in reducing patient wait time from arrival to premedication start time and increasing percentage of total value added during a patient's treatment cycle.

Correlational study of psychological variables self-confidence and anxiety / Estudo da correlação das variáveis psicológicas autoconfiança e ansiedade / Estudio correlacional de las variables psicológicas autoconfianza y ansiedad

The purpose of this study is to analyze the concurrent validity of the psychological variables self-confidence and anxiety among the psychological measurement instruments: Psychological Characteristics Questionnaire related to Sports Performance (CPRD); Competitive State Anxiety Inventory-2 (CSAI-2); and Sports Psychological Inventory LOEHR. For this purpose, a correlational study was conducted between the selected variables and pertinent aspects of the measurement instruments. The study has revealed that the psychological variables self-confidence and anxiety are relevant in all three instruments, although not in all of the selected items.

O objetivo deste estudo é analisar a validade concorrente das variáveis psicológicas de autoconfiança e ansiedade entre os instrumentos de medição psicológica: Questionário de Características Psicológicas relacionadas ao Desempenho Esportivo (CPRD), Inventário de Ansiedade Estado Competitivo-2 (CSAI-2) e Inventário Psicológico Esportivo LOEHR. Para isso foi realizado um estudo de correlação entre os itens selecionados e coincidentes em tais instrumentos. A análise revelou que as variáveis psicológicas autoconfiança e ansiedade guardam relação nos três instrumentos, mas não em todos os itens selecionados.

El objetivo del presente estudio es analizar la validez concurrente de las variables psicológicas autoconfianza y ansiedad entre los instrumentos de medición psicológica: Cuestionario de Características Psicológicas relacionadas con el Rendimiento Deportivo (CPRD), Competitive State Anxiety Inventory-2 (CSAI-2) e Inventario Psicológico Deportivo LOEHR. Para ello, se ha llevado a cabo un estudio correlacional entre los ítems seleccionados y coincidentes en dichos instrumentos. El estudio ha revelado que las variables psicológicas autoconfianza y ansiedad guardan relación en los tres instrumentos, aunque no en todos los ítems seleccionados.

[Acute arterial occlusion associated disseminated hydatidosis]. / Oclusión arterial aguda asociada a hidatidosis diseminada.

Hydatidosis or echinococcosis are terms used to denote the zoonotic infestation caused by adult and larval stages (metacestode) of the cestode from the genus Echinococcus (family tenidae). The term hydatidosis should be applied to the infestation caused by the metacestode while echinococcosis for the larval and adult stages. In Peru there is a high prevalence of this infection, liver and lung being the most affected organs. There are factors from the host and from the infectious agent that contribute to this infection, with the immune component of the host as an important infection and dissemination point. A case of acute arterial occlusion associated with disseminated hydatidosis in a 54 years old patient, born and from Huancavelica, with sudden onset of an acute arterial obstruction is reported. The patient did not improve after surgery and died within 48 hours of presentation.

Oclusión arterial aguda asociada a hidatidosis diseminada / Acute arterial occlusion associated disseminated hydatidosis

Hidatidosis o equinococosis son términos usados para denominar a la infestación zoonótica causada por los estadios adulto y larvario (metacéstode) del céstode del género Equinococcus (familia tenidae). El término hidatidosis debe ser aplicado a la infestación por el metacéstode mientras que el de equinococosis a los estadios larvario y adulto. En el Perú existe una alta prevalencia de esta infección siendo el hígado y pulmón los órganos más afectados. Existen factores tanto del agente infeccioso como del hospedero que contribuyen a esta infección, donde el componente inmunológico del hospedero es un punto importante tanto en la infección como en la diseminación. En el presente artículo se reporta un caso de oclusión arterial aguda asociada a hidatidosis diseminada en un paciente de 54 años de edad, natural y procedente de Huancavelica, de inicio súbito con un cuadro de obstrucción arterial aguda; que no mejoró luego de la cirugía con fallecimiento a las 48 horas de la presentación.

Hydatidosis or echinococcosis are terms used to denote the zoonotic infestation caused by adult and larval stages (metacestode) of the cestode from the genus Echinococcus (family tenidae). The term hydatidosis should be applied to the infestation caused by the metacestode while echinococcosis for the larval and adult stages. In Peru there is a high prevalence of this infection, liver and lung being the most affected organs. There are factors from the host and from the infectious agent that contribute to this infection, with the immune component of the host as an important infection and dissemination point. A case of acute arterial occlusion associated with disseminated hydatidosis in a 54 years old patient, born and from Huancavelica, with sudden onset of an acute arterial obstruction is reported. The patient did not improve after surgery and died within 48 hours of presentation.