Pharmacist care in hospital emergency departments: a consensus paper from the Spanish hospital pharmacy and emergency medicine associations. / Atención farmacéutica en los servicios de urgencias: documento de posicionamiento de la Sociedad Española de Farmacia Hospitalaria (SEFH) y la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES).

OBJECTIVES: To draft a list of actions and quality indicators for pharmacist care in hospital emergency departments, based on consensus among a panel of experts regarding which actions to prioritize in this setting. MATERIAL AND METHODS: A panel of experts from the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Emergency Medicine (SEMES) evaluated a preliminary list of potential actions and quality of care indicators. The experts used a questionnaire to assess the proposals on the basis of available evidence. In the first round, each expert individually assessed the importance of each proposed action based on 4 dimensions: evidence base, impact on clinical response and patient safety, ease of implementation, and priority. In the second round the experts attended a virtual meeting to reach consensus on a revised list of proposals; suggestions and comments that had been made anonymously in the first round were included. The group then prioritized each action as basic, intermediate, or advanced. RESULTS: The experts evaluated a total of 26 potential actions and associated quality indicators. No items were eliminated in the analysis of scores and comments from the first round. After the second round, 25 actions survived. Nine were considered basic, 10 intermediate, and 6 advanced. CONCLUSION: The expert panel's list of pharmacist actions and care quality indicators provides a basis for developing a pharmacist care program in Spanish emergency departments on 3 levels of priority. The list can serve as a guide to pharmacists, managers, physicians, and nurses involved in the effort to improve drug therapy in this hospital setting.

OBJETIVO: Desarrollar un conjunto de actividades e indicadores de atención farmacéutica en los servicios de urgencias hospitalarios mediante un consenso colectivo de un panel de expertos que permita priorizar las actividades a realizar por los farmacéuticos en estas unidades. METODO: Un comité formado por miembros de la Sociedad Española de Farmacia Hospitalaria (SEFH) y de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES) evaluó una propuesta inicial de actividades e indicadores potenciales, basados en la evidencia científica disponible, en formato de cuestionario. En una primera ronda, cada uno de los expertos del panel clasificó de forma individual la relevancia de cada una de las actividades propuestas en cuatro dimensiones: evidencia científica, impacto en la respuesta clínica y seguridad para el paciente, facilidad de implementación y grado de prioridad. La segunda ronda se realizó mediante una reunión grupal de forma virtual, a partir del cuestionario modificado de acuerdo con las sugerencias planteadas, así como los comentarios vertidos por los participantes del panel de forma anónima. En esta ronda, cada actividad fue clasificada por consenso como básica, intermedia o avanzada en función del grado de prioridad de implantación considerado por el grupo de expertos. RESULTADOS: Se propusieron un total de 26 potenciales actividades a los expertos, con indicadores asociados. Tras el análisis de las puntuaciones y los comentarios realizados en la primera ronda, no se eliminó ninguna de las actividades propuestas. Tras la segunda ronda, se mantuvieron 25 actividades, de las cuales se puntuaron 9 como actividades básicas, 10 actividades como intermedias y 6 actividades como avanzadas. CONCLUSIONES: El desarrollo del conjunto de actividades e indicadores de atención farmacéutica en urgencias, priorizados por grado de relevancia para la unidad, es la base para el desarrollo de esta cartera de servicios en los hospitales españoles, y sirve como guía tanto para farmacéuticos como para gestores, médicos y enfermeros de la unidad a fin de mejorar la farmacoterapia los pacientes atendidos en los servicios de urgencias.

Multidimensional analysis of immune cells from COVID-19 patients identified cell subsets associated with the severity at hospital admission.

BACKGROUND: SARS-CoV-2 emerged as a new coronavirus causing COVID-19, and it has been responsible for more than 760 million cases and 6.8 million deaths worldwide until March 2023. Although infected individuals could be asymptomatic, other patients presented heterogeneity and a wide range of symptoms. Therefore, identifying those infected individuals and being able to classify them according to their expected severity could help target health efforts more effectively. METHODOLOGY/PRINCIPAL FINDINGS: Therefore, we wanted to develop a machine learning model to predict those who will develop severe disease at the moment of hospital admission. We recruited 75 individuals and analysed innate and adaptive immune system subsets by flow cytometry. Also, we collected clinical and biochemical information. The objective of the study was to leverage machine learning techniques to identify clinical features associated with disease severity progression. Additionally, the study sought to elucidate the specific cellular subsets involved in the disease following the onset of symptoms. Among the several machine learning models tested, we found that the Elastic Net model was the better to predict the severity score according to a modified WHO classification. This model was able to predict the severity score of 72 out of 75 individuals. Besides, all the machine learning models revealed that CD38+ Treg and CD16+ CD56neg HLA-DR+ NK cells were highly correlated with the severity. CONCLUSIONS/SIGNIFICANCE: The Elastic Net model could stratify the uninfected individuals and the COVID-19 patients from asymptomatic to severe COVID-19 patients. On the other hand, these cellular subsets presented here could help to understand better the induction and progression of the symptoms in COVID-19 individuals.

ABO blood group is involved in the quality of the specific immune response anti-SARS-CoV-2.

Since December 2019, the coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has spread throughout the world. To eradicate it, it is crucial to acquire a strong and long-lasting anti-SARS-CoV-2 immunity, by either natural infection or vaccination. We collected blood samples 12-305 days after positive polymerase chain reactions (PCRs) from 35 recovered individuals infected by SARS-CoV-2. Peripheral blood mononuclear cells were stimulated with SARS-CoV-2-derived peptide pools, such as the spike (S), nucleocapsid (N) and membrane (M) proteins, and we quantified anti-S immunoglobulins in plasma. After 10 months post-infection, we observed a sustained SARS-CoV-2-specific CD4+ T-cell response directed against M-protein, but responses against S- or N-proteins were lost over time. Besides, we demonstrated that O-group individuals presented significantly lower frequencies of specific CD4+ T-cell responses against Pep-M than non O-group individuals. The non O-group subjects also needed longer to clear the virus, and they lost cellular immune responses over time, compared to the O-group individuals, who showed a persistent specific immune response against SARS-CoV-2. Therefore, the S-specific immune response was lost over time, and individual factors might determine the sustainability of the body's defenses, which must be considered in the future design of vaccines to achieve continuous anti-SARS-CoV-2 immunity.

Manejo de la urticaria en urgencias: recomendaciones de un grupo multidisciplinar de expertos / Managing urticaria in the emergency department: recommendations of a multidisciplinary expert panel

La urticaria y el angioedema ocasionan consultas frecuentes en los servicios de urgencias. Por ello, es importante que sean diagnosticados y tratados correctamente en este nivel asistencial y ofrecer un tratamiento y unas pautas de derivación adecuados para evitar visitas adicionales. Un grupo de expertos en dermatología y en medicina de urgencias y emergencias ha revisado las principales guías y publicaciones, y ha desarrollado y consensuado una herramienta práctica para el abordaje de la urticaria, el angioedema y la anafilaxia en urgencias. Presentamos una guía de manejo, un algoritmo basado en el diagnóstico diferencial, un algoritmo terapéutico y unas recomendaciones de derivación de los pacientes. La implementación de esta guía, avalada por la Sociedad Española de Dermatología (AEDV) y la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), permitirá optimizar el manejo de los pacientes con urticaria y angioedema en urgencias, y mejorará la interrelación con otros servicios. (AU)

Urticaria and angioedema account for many visits to emergency departments. It is important to diagnose and treat them properly at this level of care and to suggest treatments and guidance that can make additional visits unnecessary. A panel of experts in dermatology and emergency medicine reviewed the main guidelines and publications on urticaria and angioedema. The panel then developed and reached consensus on practical approaches and tools for managing urticaria, angioedema, and anaphylaxis in the emergency department. The resulting statement is a guide to management, with algorithms for differential diagnosis and treatment and recommendations for patient referral. Implementing these guidelines, which are supported by the Spanish Academy of Dermatology and Venereology (AEDV) and the Spanish Society of Emergency Medicine (SEMES) will facilitate optimal management of emergency department patients with urticaria and angioedema as well as improve interdepartmental relations. (AU)

Managing urticaria in the emergency department: recommendations of a multidisciplinary expert panel. / Manejo de la urticaria en urgencias: recomendaciones de un grupo multidisciplinar de expertos.

Urticaria and angioedema account for many visits to emergency departments. It is important to diagnose and treat them properly at this level of care and to suggest treatments and guidance that can make additional visits unnecessary. A panel of experts in dermatology and emergency medicine reviewed the main guidelines and publications on urticaria and angioedema. The panel then developed and reached consensus on practical approaches and tools for managing urticaria, angioedema, and anaphylaxis in the emergency department. The resulting statement is a guide to management, with algorithms for differential diagnosis and treatment and recommendations for patient referral. Implementing these guidelines, which are supported by the Spanish Academy of Dermatology and Venereology (AEDV) and the Spanish Society of Emergency Medicine (SEMES) will facilitate optimal management of emergency department patients with urticaria and angioedema as well as improve interdepartmental relations.

La urticaria y el angioedema ocasionan consultas frecuentes en los servicios de urgencias. Por ello, es importante que sean diagnosticados y tratados correctamente en este nivel asistencial y ofrecer un tratamiento y unas pautas de derivación adecuados para evitar visitas adicionales. Un grupo de expertos en dermatología y en medicina de urgencias y emergencias ha revisado las principales guías y publicaciones, y ha desarrollado y consensuado una herramienta práctica para el abordaje de la urticaria, el angioedema y la anafilaxia en urgencias. Presentamos una guía de manejo, un algoritmo basado en el diagnóstico diferencial, un algoritmo terapéutico y unas recomendaciones de derivación de los pacientes. La implementación de esta guía, avalada por la Sociedad Española de Dermatología (AEDV) y la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES), permitirá optimizar el manejo de los pacientes con urticaria y angioedema en urgencias, y mejorará la interrelación con otros servicios.

Comprehensive Flow Cytometry Profiling of the Immune System in COVID-19 Convalescent Individuals.

SARS-CoV-2 has infected more than 200 million people worldwide, with more than 4 million associated deaths. Although more than 80% of infected people develop asymptomatic or mild COVID-19, SARS-CoV-2 can induce a profound dysregulation of the immune system. Therefore, it is important to investigate whether clinically recovered individuals present immune sequelae. The potential presence of a long-term dysregulation of the immune system could constitute a risk factor for re-infection and the development of other pathologies. Here, we performed a deep analysis of the immune system in 35 COVID-19 recovered individuals previously infected with SARS-CoV-2 compared to 16 healthy donors, by flow cytometry. Samples from COVID-19 individuals were analysed from 12 days to 305 days post-infection. We observed that, 10 months post-infection, recovered COVID-19 patients presented alterations in the values of some T-cell, B-cell, and innate cell subsets compared to healthy controls. Moreover, we found in recovered COVID-19 individuals increased levels of circulating follicular helper type 1 (cTfh1), plasmablast/plasma cells, and follicular dendritic cells (foDC), which could indicate that the Tfh-B-foDC axis might be functional to produce specific immunoglobulins 10 months post-infection. The presence of this axis and the immune system alterations could constitute prognosis markers and could play an important role in potential re-infection or the presence of long-term symptoms in some individuals.

Traducción y adaptación transcultural l español, catalán y gallego de la escala Hopkins Symptom Checklist-25 para la detección de depresión en Atención Primaria / Translation and cross-cultural adaptation into Spanish, Catalan and Galician of the Hopkins Symptom Checklist-25 to identify depression in Primary Care

OBJETIVO: Describir el proceso de traducción y adaptación transcultural de la escala Hopkins Symptom Checklist-25 (HSCL-25) al español, catalán y gallego. DISEÑO: Traducción, adaptación transcultural y análisis de la comprensibilidad mediante entrevistas cognitivas. EMPLAZAMIENTO: Unidades de Investigación de Atención Primaria de Barcelona y Vigo. PARTICIPANTES: Médicos de familia y pacientes de Atención Primaria. MEDICIONES PRINCIPALES: Siguiendo las guías de la International Society for Pharmacoeconomics and Outcomes Research (ISPOR), se realizaron: 1) traducción directa; 2) estudio piloto basado en metodología Delphi con médicos de familia; 3) retrotraducción; 4) análisis de equivalencias; 5) análisis de comprensibilidad de las versiones obtenidas en español, catalán y gallego mediante entrevista cognitiva en una muestra de pacientes, y 6) armonización transcultural. RESULTADOS: En el estudio Delphi participaron 73 médicos de familia. El consenso se estableció en la primera ronda para la traducción española y catalana, y en la segunda ronda para la gallega. Las retrotraducciones fueron similares en los 3 idiomas. Todas las versiones fueron equivalentes entre ellas y respecto a la versión original inglesa. En la entrevista cognitiva participaron 10 pacientes por cada idioma, sin que se modificara la redacción de los ítems. CONCLUSIONES: Las traducciones de la escala HSCL-25 en español, catalán y gallego son equivalentes semántica y conceptualmente a la versión original. Las traducciones son comprensibles y bien aceptadas por los pacientes

AIM: To describe the translation and cross-cultural adaptation process of the Hopkins Symptom Checklist-25 (HSCL-25) scale into Spanish, Catalan and Galician. DESIGN: Translation, cross-cultural adaption and comprehensibility analysis through cognitive debriefing. LOCATION: Research Units of Primary Care in Barcelona and Vigo. PARTICIPANTS: Family doctors and Primary Care patients. MAIN MEASUREMENTS: Following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR): 1) Direct translation. 2) Pilot study based on Delphi methodology with family doctors. 3) Back-translation. 4) Equivalence analysis. 5) Comprehension analysis of versions obtained in Spanish, Catalan and Galician through cognitive debriefing in a sample of patients. 6) Transcultural harmonization. RESULTS: 73 family doctors participated in the Delphi study. The consensus was established in the first round for the Spanish and Catalan translations, and in the second round for the Galician. The back-translations were similar in all 3 languages. All versions were equivalent between them and compared to the original English version. In the cognitive interview, 10 patients participated for each language, without modifying the writing of the items. CONCLUSIONS: The translations of the HSCL-25 scale in Spanish, Catalan and Galician are semantically and conceptually equivalent to the original version. Translations are understandable and well accepted by patients

[Translation and cross-cultural adaptation into Spanish, Catalan and Galician of the Hopkins Symptom Checklist-25 to identify depression in Primary Care]. / Traducción y adaptación transcultural al español, catalán y gallego de la escala Hopkins Symptom Checklist-25 para la detección de depresión en Atención Primaria.

AIM: To describe the translation and cross-cultural adaptation process of the Hopkins Symptom Checklist-25 (HSCL-25) scale into Spanish, Catalan and Galician. DESIGN: Translation, cross-cultural adaption and comprehensibility analysis through cognitive debriefing. LOCATION: Research Units of Primary Care in Barcelona and Vigo. PARTICIPANTS: Family doctors and Primary Care patients. MAIN MEASUREMENTS: Following the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR): 1) Direct translation. 2) Pilot study based on Delphi methodology with family doctors. 3) Back-translation. 4) Equivalence analysis. 5) Comprehension analysis of versions obtained in Spanish, Catalan and Galician through cognitive debriefing in a sample of patients. 6) Transcultural harmonization. RESULTS: 73 family doctors participated in the Delphi study. The consensus was established in the first round for the Spanish and Catalan translations, and in the second round for the Galician. The back-translations were similar in all 3languages. All versions were equivalent between them and compared to the original English version. In the cognitive interview, 10 patients participated for each language, without modifying the writing of the items. CONCLUSIONS: The translations of the HSCL-25 scale in Spanish, Catalan and Galician are semantically and conceptually equivalent to the original version. Translations are understandable and well accepted by patients.

La encuesta retrospectiva en contraposición con la opinión puntual: ¿cuál es la mejor forma de obtener feedback de nuestros residentes al valorar la actividad en urgencias? / The retrospective survey as opposed to the immediate opinion: What is the best way to receive feedback from our residents about their activity in emergency wards?

INTRODUCCIÓN: La recopilación de información a partir del usuario sobre un servicio o producto es esencial para la mejora del mismo. En medicina de urgencias, la pedagogía y supervisión no están sujetas a normativas homogéneas habituales en especialidades reconocidas y por lo tanto, con frecuencia, requieren modificaciones. Nos planteamos, cuál es el mejor método de recopilar la opinión de nuestros residentes: la encuesta retrospectiva anual, utilizada en la actualidad, o la recolección de información inmediatamente después de una guardia, atendiendo a una extrapolación de las técnicas de generación de índices de satisfacción del consumidor. MÉTODO: Encuestamos a 75 residentes de 4 hospitales distintos preguntando por su grado de acuerdo con 5 enunciados sobre sus guardias, tanto de forma retrospectiva anual como con respecto a la última guardia. Añadimos una pregunta control sobre la comida proveída por la correspondiente cafetería del hospital. RESULTADOS: En todas las dimensiones encuestadas, los residentes fueron mucho más críticos cuando hicieron valoraciones retrospectivas que cuando opinaron sobre su guardia más reciente. Al repetir la encuesta en 35 residentes, preguntando por otra guardia de forma puntual, los porcentajes de acuerdo se mantuvieron similares. CONCLUSIÓN: Nuestros resultados indican que, con el propósito de recoger información sobre supervisión y actividad asistencial en urgencias, la técnica de encuestas retrospectivas tiende a infravalorar la opinión real de los residentes. Estas observaciones coinciden con las recomendaciones universales sobre índices de satisfacción del consumidor y estrategias de corrección de los sesgos de memoria

INTRODUCTION: Our aim is to determine which way to gather feedback form our residents Is better: an annual retrospective survey which is used nowadays, or to collect information immediately after an emergency ward, given the knowledge gained from the technics of development of customer satisfaction. METHOD: A survey was carried out on 75 residents from four different hospitals asking about their level of agreement with five statements related to their emergency wards, both retrospectively during the previous year and their last on-call session. A control question was also including asking their opinion about the meals provided by the hospital dining service. RESULTS: In all the dimensions of the questionnaire, residents were much more critical when they made yearly retrospective assessments than when they asked about their last emergency on-call session. When the survey was repeated among 35 residents asking about another last emergency on-call session, the results remained similar. CONCLUSION: Our results show that a retrospective survey tends to underestimate the real opinion of residents about their experience during emergency sessions. This observation is coincident with the universal recommendations on user satisfaction index and strategies to avoid memory bias

Un millar de muertes: violencia de género / A thousand deaths from gender-based violence

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Encuesta nacional sobre valoración de la actividad de los médicos internos residentes en los servicios de urgencias españoles / National survey on the evaluation of the activity of internal physicians resident in Spanish emergency departments

INTRODUCCIÓN: La actividad asistencial de los médicos internos residentes es común a la práctica totalidad de los programas formativos de especialidades médicas y quirúrgicas, sin embargo, no se dispone de datos nacionales respecto de la situación de esta actividad desde la perspectiva del propio residente. El presente estudio ha pretendido recoger la opinión de los médicos internos residentes sobre el desempeño asistencial y el carácter docente que los vincula a sus correspondientes servicios de urgencias en los siguientes ámbitos: valor formativo global, apreciación de la carga de trabajo, características de la rotación matutina, supervisión o tutorización, etc. MÉTODO: El estudio se hizo por medio de una encuesta que fue distribuida a nivel nacional por medio de la red de representantes del grupo SEMES-MIR de la Sociedad Española de Medicina de Urgencias y Emergencias. RESULTADOS: Se recogieron 1.083 encuestas de 38 centros hospitalarios, correspondientes a una tasa de respuesta del 28%. El aporte docente más significativo fue el de conocimientos generales sobre la atención médica en urgencias y la interpretación de pruebas complementarias, mientras que los menos señalados fueron los aspectos relacionados con farmacoeconomía, sostenibilidad y costo-beneficio de los procesos médicos y no médicos relacionados con la medicina de urgencias. En cuanto a la carga asistencial durante una jornada de atención continuada, los residentes de primer año promediaron 12,3 pacientes (DE 2,2), los de segundo y tercer año 18,1 (DE 2,2) y los residentes mayores 14,5 (DE 2,4). El 44% de los encuestados identificó su modelo de supervisión como «directo» mientras que el 37,2 como «semipiramidal». Un 14,2% de los encuestados reconoció haber sido incentivado a realizar actividades científicas relacionadas con la medicina de urgencias. CONCLUSIONES: Los resultados de esta encuesta deben servir de base para la futura planificación de nuevos modelos de relación docente y asistencial de los residentes y los servicios de urgencias, así como para estratificar las prioridades de atención la relación servicio de urgencias-médicos residentes

INTRODUCTION: The care activity of internal resident doctors is common to practically all medical and surgical training programs; however, there are no national data available regarding the situation of this activity from the perspective of the resident. The present study has sought to collect the opinion of the resident internal physicians on the health care performance and the teaching character that links them to their corresponding emergency departments, in the following areas: overall training value, appreciation of the workload, characteristics of the morning rotation, supervision or tutoring, etc. METHOD: The study was performed using a questionnaire that was distributed at the national level through the network of representatives of the SEMES-MIR group of the Spanish Society of Emergency and Emergency Medicine. RESULTS: A total of 1083 questionnaires were collected from 38 hospitals, corresponding to a response rate of 28%. The most significant educational contribution was the general knowledge about emergency medical care and the interpretation of complementary tests, while the less significant were aspects related to pharmacoeconomics, sustainability and cost-benefit of medical and non-medical processes related to medicine Emergency. As for the burden of care during a day of continuous care, the first year residents saw a mean of 12.3 patients) (SD 2.2), the second and third year 18.1 (SD 2.2), and the older residents 14.5 (SD 2.4). Less than half (44%) of the respondents identified their supervision model as «direct», while 37.2% identified it as «semi-pyramidal». A minority (14.2%) of respondents acknowledged having been encouraged to undertake scientific activities related to emergency medicine. CONCLUSIONS: The results of this questionnaire should serve as a basis for the future planning of new models of teaching and care for residents and emergency services, as well as to stratify the priorities of attention to the relationship between emergency services and resident physicians