Irrupción de la simulación clínica online en tiempos de COVID-19. Una experiencia ilustrativa de asignatura en el Grado de Psicología / The irruption of online clinical simulation in COVID-19 times. An explanatory experience of a course in the Psychology Degree

Introducción: El desafío de la educación superior durante la pandemia de COVID-19 fue transformar las prácticas clínicas a un entorno virtual de manera urgente. La simulación desempeñó un papel relevante, y se hace necesario analizar las consecuencias que acarrea un cambio súbito en su modalidad de impartición. Sujetos y métodos: Manteniendo los procedimientos lo más parecido a como eran en la modalidad original, se comparó la satisfacción de los estudiantes en prácticas en ambos entornos. Sus resultados académicos fueron contrastaron con los de los estudiantes de cursos previos. Resultados: Sin diferencias significativas en la satisfacción global, el material distribuido y la capacidad de concentración se percibieron como más satisfactorios en el modo presencial. Las calificaciones mejoraron significativamente en el modo virtual. Conclusión: En situaciones exigentes de cambio de modelo de enseñanza, se ha demostrado la idoneidad de la simulación virtual para el desarrollo de competencias clínicas en psicología.(AU)

Introduction: The challenge for higher education during COVID-19 was to urgently transform clinical practices into a virtual environment. Simulation played a relevant role and it is necessary to analyze the consequences of a sudden change in its mode of delivery. Subjects and methods: Keeping the procedures as close as possible to what they were in the face-to-face original mode, the degree of satisfaction of the students in clinical practices with simulation was compared in both environments. Their academic results were compared with those of students from previous courses. Results: With no significant differences in overall satisfaction, the material distributed and the ability to concentrate were perceived as more satisfactory for the face-to-face mode. Grades improved significantly in the virtual mode. Conclusion: In demanding situations of change of teaching model, the suitability of virtual simulation for the development of clinical competencies in Psychology has been demonstrated.(AU)

Impact of COVID-19 on Madrid hospital system / Impacto de COVID-19 en el sistema hospitalario de Madrid

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Comparison of machine learning algorithms for clinical event prediction (risk of coronary heart disease).

AIM: The aim of this study is to compare the utility of several supervised machine learning (ML) algorithms for predicting clinical events in terms of their internal validity and accuracy. The results, which were obtained using two statistical software platforms, were also compared. MATERIALS AND METHODS: The data used in this research come from the open database of the Framingham Heart Study, which originated in 1948 in Framingham, Massachusetts as a prospective study of risk factors for cardiovascular disease. Through data mining processes, three data models were elaborated and a comparative methodological study between the different ML algorithms - decision tree, random forest, support vector machines, neural networks, and logistic regression - was carried out. The global selection criterium for choosing the right set of hyperparameters and the type of data manipulation was the area under a curve (AUC). The software tools used to analyze the data were R-Studio® and RapidMiner®. RESULTS: The Framingham study open database contains 4240 observations. The algorithm that yielded the greatest AUC when analyzing the data in R-Studio was neural network applied to a model that excluded all observations in which there was at least one missing value (AUC = 0.71); when analyzing the data in RapidMiner and applying the same model, the best algorithm was support vector machines (AUC = 0.75). CONCLUSIONS: ML algorithms can reinforce the diagnostic and prognostic capacity of traditional regression techniques. Differences between the applicability of those algorithms and the results obtained with them were a function of the software platforms used in the data analysis.

Artrosis interfalángica sintomática y asintomática: un estudio ecográfico / Symptomatic and asymptomatic interphalageal osteoarthritis: an ultrasonographic study

Objetivo. Pocos estudios han examinado si existen diferencias morfológicas detectables con ecografía entre las articulaciones sintomáticas y las que no lo son en pacientes con artrosis. Este estudio describe y compara los hallazgos clínicos, radiológicos y ecográficos de los pacientes con artrosis interfalángica proximal (IFP) y/o distal (IFD) que tienen articulaciones con y sin dolor. Métodos. Prospectivamente, se incluyó a pacientes con artrosis IFP y/o IFD según los criterios ACR. El reumatólogo clínico eligió hasta un máximo de 3 articulaciones dolorosas y 3 articulaciones no dolorosas de localización simétrica en cada paciente para formar 2 cohortes de artrosis: grupo con dolor (GD) y grupo sin dolor (GSD). La radiografía simple postero-anterior de las manos fue leída por un reumatólogo según las recomendaciones del atlas OARSI, ciego a toda información clínica y ecográfica. El estudio ecográfico fue realizado por un reumatólogo en las articulaciones previamente seleccionadas por el clínico ciego a los datos clínicos y radiológicos. Se registraron como ausente o presente: osteofitos, pinzamiento articular, sinovitis, señal Doppler intraarticular, erosiones y visualización del cartílago. Se realizó un estudio de fiabilidad intralector para la radiología y para la ecografía. Resultados. Se estudió un total de 50 articulaciones en cada cohorte de 20 mujeres diestras de 61,85 años de edad (46-73) con artrosis IFP y IFD diagnosticada hace 6,8 años (1-17 años). El 70% de las articulaciones del GD y GSD se localizaron en la mano derecha e izquierda, respectivamente. El GD tenía significativamente más osteofitos, sinovitis y ausencia de cartílago que el GSD. La fiabilidad interlector radiológico y ecográfico fue excelente. Conclusión. La ecografía detecta más daño estructural y sinovitis en las IFP y/o IFD artrósicas que presentan dolor (AU)

Objective: To date few studies have examined whether ultrasonography can depict morphologic differences in painful and painless osteoarthritis (OA). This study describes and compares the clinical, radiographic and ultrasonographic findings of patients with both painful and painless proximal interphalgeal (PIP) and/or distal interphalgeal (DIP) OA. Methods: Patients with PIP and/or DIP OA (ACR criteria) were prospectively recruited. The clinical rheumatologist chose up to 3 painful joints and up to 3 painless symmetric joints in each patient to define 2 cohorts of OA: symptomatic (SG) and asymptomatic (ASG). A conventional postero-anterior hand x ray was performed and read by one rheumatologist following the OARSI atlas, blinded to clinical and sonographic data. Ultrasound (US) was performed by an experienced rheumatologist, blinded to both clinical and radiographic data in joints previously selected by the clinical rheumatologist. US-pathology was assessed as present or absent as defined in previous reports: osteophytes, joint space narrowing, synovitis, intra-articular power doppler signal, intra-articular bony erosion, and visualization of cartilage. Radiographic and ultrasonographic intrareader reliability test was performed. Results: A total of 50 joints in the SG and ASG were included from 20 right handed women aged 61.85 (46-73) years with PIP and DIP OA diagnosed 6.8 (1-17) years ago. 70% SG joints and ASG were right and left sided respectively. The SG showed significantly more osteophytes, synovitis and non-visualization of joint cartilage. Intrareader radiographic and ultrasonographic agreement was excellent. Conclusion: This study demonstrates that painful PIP and/or DIP OA have more ultrasonographic structural changes and synovitis (AU)

Glucose series complexity in hypertensive patients.

Nonlinear methods have been applied to the analysis of biological signals. Complexity analysis of glucose time series may be a useful tool for the study of the initial phases of glucoregulatory dysfunction. This observational, cross-sectional study was performed in patients with essential hypertension. Glucose complexity was measured with detrended fluctuation analysis (DFA), and glucose variability was measured by the mean amplitudes of glycemic excursion (MAGE). We included 91 patients with a mean age of 59 ± 10 years. We found significant correlations for the number of metabolic syndrome (MS)-defining criteria with DFA (r = 0.233, P = .026) and MAGE (r = 0.396, P < .0001). DFA differed significantly between patients who complied with MS and those who did not (1.44 vs. 1.39, P = .018). The MAGE (f = 5.3, P = .006), diastolic blood pressures (f = 4.1, P = .018), and homeostasis model assessment indices (f = 4.2, P = .018) differed between the DFA tertiles. Multivariate analysis revealed that the only independent determinants of the DFA values were MAGE (ß coefficient = 0.002, 95% confidence interval: 0.001-0.004, P = .001) and abdominal circumference (ß coefficient = 0.002, 95% confidence interval: 0.000015-0.004, P = .048). In our population, DFA was associated with MS and a number of MS criteria. Complexity analysis seemed to be capable of detecting differences in variables that are arguably related to the risk of the development of type 2 diabetes.

Symptomatic and asymptomatic interphalageal osteoarthritis: An ultrasonographic study.

OBJECTIVE: To date few studies have examined whether ultrasonography can depict morphologic differences in painful and painless osteoarthritis (OA). This study describes and compares the clinical, radiographic and ultrasonographic findings of patients with both painful and painless proximal interphalgeal (PIP) and/or distal interphalgeal (DIP) OA. METHODS: Patients with PIP and/or DIP OA (ACR criteria) were prospectively recruited. The clinical rheumatologist chose up to 3 painful joints and up to 3 painless symmetric joints in each patient to define 2 cohorts of OA: symptomatic (SG) and asymptomatic (ASG). A conventional postero-anterior hand x ray was performed and read by one rheumatologist following the OARSI atlas, blinded to clinical and sonographic data. Ultrasound (US) was performed by an experienced rheumatologist, blinded to both clinical and radiographic data in joints previously selected by the clinical rheumatologist. US-pathology was assessed as present or absent as defined in previous reports: osteophytes, joint space narrowing, synovitis, intra-articular power doppler signal, intra-articular bony erosion, and visualization of cartilage. Radiographic and ultrasonographic intrareader reliability test was performed. RESULTS: A total of 50 joints in the SG and ASG were included from 20 right handed women aged 61.85 (46-73) years with PIP and DIP OA diagnosed 6.8 (1-17) years ago. 70% SG joints and ASG were right and left sided respectively. The SG showed significantly more osteophytes, synovitis and non-visualization of joint cartilage. Intrareader radiographic and ultrasonographic agreement was excellent. CONCLUSION: This study demonstrates that painful PIP and/or DIP OA have more ultrasonographic structural changes and synovitis.

Cystatin C as a predictor of mortality and cardiovascular events in a population with chronic kidney disease.

Background. We examine whether cystatin C, a surrogate marker of renal function, could identify patients with chronic kidney disease (CKD) with an increased risk of renal disease progression, death, or cardiovascular events. Methods. Data were obtained for 180 patients, with a diagnosis of chronic renal failure based on serum creatinine estimated glomerular filtration rate (eGFRcreat) <90 mL/min/1.73 m(2). This population was grouped in tertiles according to cystatin C and creatinine values at baseline. Cardiovascular events and overall mortality were estimated for each tertile. Predictors of overall mortality and for the development of renal disease progression were analyzed. Results. The median age was 75 years (interquartile range 69-82) and the median eGFRcreat 38 mL/min m(2) (interquartile range 33-49). Overall mortality was lower on the first and on the second tertiles of cystatin C than on the third one (HR = 0.060; 95% CI: 0.008-0.447 and HR = 0.094; 95% CI: 0.022-0.406, resp.). Deaths related to the creatinine tertiles followed the same pattern, but differences were not as large. Cardiovascular mortality was lower on the second than on the third cystatin C tertile (HR = 0.198; 95% CI: 0.040-0.987), but it did not show differences on the first and the second creatinine tertiles compared with the third one (HR = 0.126; 95% CI: 0.013-1.265 and HR = 0.403; 95% CI: 0.093-1.740). The only independent predictors of mortality during followup were baseline cystatin C (OR = 0.100; 95% CI: 0.021-0.463) and baseline uric acid (OR = 1.377; 95% CI: 1.070-1.773). Conclusion. Cystatin C may be an alternative to creatinine for detecting a high risk of death and cardiovascular events in a population with CKD.

Infección por el VIH en el adulto: cambios epidemiológicos durante 25 años (1983–2008) en un área de la Comunidad de Madrid / HIV infection in the adult: Epidemiological changes over 25 years (1983–2008) in an area of the Community of Madrid

Objetivo Describir las características epidemiológicas y evolutivas durante 25 años de una cohorte de pacientes infectados por el VIH en Madrid. Métodos Estudio de cohortes longitudinal prospectivo de todos los pacientes diagnosticados de infección por VIH vistos en el Hospital de Móstoles (1983–2008).Resultados De los 2.156 pacientes atendidos, el 73% fueron hombres. En el 68% la vía de contagio fue el consumo de drogas. Se describe un máximo de nuevos diagnósticos en 1991 (188 pacientes) y un descenso posterior paulatino. Durante estos últimos años han aumentado los contagios por vía sexual (mayor ascenso de la vía heterosexual). El porcentaje de inmigrantes también ha aumentado (superior al 60% en los últimos 3 años); África subsahariana es la región de origen predominante en nuestra área. El 5% de los pacientes se diagnostica en la fase de infección aguda y el diagnóstico de sida en un plazo inferior a un año desde el diagnóstico de infección por VIH oscila entre el 20–30% en todos estos años. La tasa estimada de nuevos diagnósticos de infección por VIH en 2006 fue de 195 por millón de habitantes (269 por millón de habitantes en hombres y 121 por millón en mujeres).Conclusiones En estos 25 años se han producido grandes cambios epidemiológicos de la infección por VIH en nuestra área. Realizar de forma sistemática serologías sin esperar datos de alarma sería una práctica de impacto en el diagnóstico precoz y en la mejora del pronóstico de los pacientes (AU)

Objective To describe the epidemiological characteristics and evolution of a cohort of HIV-infected patients in Madrid (Spain) over a period of 25 years. Methods Longitudinal, prospective, cohort study of all patients diagnosed with HIV infection seen at the Hospital de Móstoles (1983–2008).Results Of the 2156 patients attended, 73% were men. In 68%, the route of infection was illicit drug use. There was a peak of new diagnoses in 1991 (188 patients) and a subsequent gradual decline. Sexual transmission increased over the time period studied, with a higher rise in heterosexual transmission. The percentage of immigrants with the infection also increased (more than 60% in the last 3 years). Sub-Saharan Africa remains the predominant region of origin of our immigrant patients. Over the period studied, 5% of patients were diagnosed during the acute infection, and 20% to 30% were diagnosed with AIDS within 1 year after detection of HIV infection. The estimated rate of new diagnoses of HIV infection in 2006 was 195 per million population (pmp), 269 pmp in men and 121 pmp in women. Conclusions Many changes have occurred in the epidemiology of HIV infection in our area in the last 25 years. Routine serologic testing without waiting for warning signs would have an impact on early diagnosis and improving the prognosis of these patients(AU)

[HIV infection in the adult: epidemiological changes over 25 years (1983-2008) in an area of the Community of Madrid]. / Infección por el VIH en el adulto: cambios epidemiológicos durante 25 años (1983-2008) en un área de la Comunidad de Madrid.

OBJECTIVE: To describe the epidemiological characteristics and evolution of a cohort of HIV-infected patients in Madrid (Spain) over a period of 25 years. METHODS: Longitudinal, prospective, cohort study of all patients diagnosed with HIV infection seen at the Hospital de Móstoles (1983-2008). RESULTS: Of the 2156 patients attended, 73% were men. In 68%, the route of infection was illicit drug use. There was a peak of new diagnoses in 1991 (188 patients) and a subsequent gradual decline. Sexual transmission increased over the time period studied, with a higher rise in heterosexual transmission. The percentage of immigrants with the infection also increased (more than 60% in the last 3 years). Sub-Saharan Africa remains the predominant region of origin of our immigrant patients. Over the period studied, 5% of patients were diagnosed during the acute infection, and 20% to 30% were diagnosed with AIDS within 1 year after detection of HIV infection. The estimated rate of new diagnoses of HIV infection in 2006 was 195 per million population (pmp), 269 pmp in men and 121 pmp in women. CONCLUSIONS: Many changes have occurred in the epidemiology of HIV infection in our area in the last 25 years. Routine serologic testing without waiting for warning signs would have an impact on early diagnosis and improving the prognosis of these patients.

Effect of simultaneous use of highly active antiretroviral therapy on survival of HIV patients with tuberculosis.

INTRODUCTION: The optimal timing for initiation of highly active antiretroviral therapy (HAART) in patients with AIDS and tuberculosis (TB) is an unresolved question. To assess the effect of HAART on the survival of patients with TB, we designed this study. METHODS: We selected all HIV patients included in the COMESEM cohort with TB diagnosis after 1996. Clinical and epidemiological data were registered. We compared patients who started HAART at the diagnosis of TB [simultaneous therapy (ST)] or not. Survival was assessed by Cox analysis. RESULTS: Among the 6934 HIV patients included in the cohort, 1217 patients had TB, 322 of them (26.5%) after 1996. At the time of TB diagnosis, 45% of them started HAART (ST). There were no differences between groups regarding basal characteristics, except for a lower viral load in ST patients. ST therapy was associated with improved survival (hazard ratio 0.38; 95% confidence interval 0.20 to 0.72, P = 0.003). By univariate analysis, survival was also associated with no endovenous drug use and a later year of TB diagnosis. After adjusting for other prognostic variables, by Cox multivariate analysis, ST remained robustly associated with improved survival (hazard ratio 0.37; 95% confidence interval 0.17 to 0.66, P = 0.001). CONCLUSIONS: Simultaneous HAART and TB treatment in HIV patients with TB is associated with improved survival.

Cystatin C is associated with the metabolic syndrome and other cardiovascular risk factors in a hypertensive population.

Serum cystatin C has been associated with cardiovascular disease. We investigated whether cystatin C concentration is associated with the metabolic syndrome and with other cardiovascular risk factors in a hypertensive population. In this cross-sectional study, we prospectively included 611 essential hypertensive patients during a 12-month period. Cystatin C concentration was measured by nephelometry. The metabolic syndrome was present in 46% of the patients. Cystatin C was significantly higher in patients with the metabolic syndrome (0.94 +/- 0.27 mg/L) than in those without (0.87 +/- 0.23 mg/L) (P < .0001). Pearson partial correlation analysis showed a significant correlation between cystatin C and body mass index (r = 0.240; P = .001); waist circumference (r = 0.173; P = .012); microalbuminuria (r = 0.273; P < .0001); triglycerides (r = 0.138; P = .047); C-reactive protein (r = 0.190; P = .006); uric acid (r = 0.284; P < .0001); age (r = 0.409; P < .0001); and glomerular filtration rate (GFR) (r = -0.638; P < .0001). Multivariate analysis showed that GFR (B = -0.0061; 95% confidence interval [CI], -0.0073 to -0.0049; P < .0001), age (B = 0.0023; 95% CI, 0.0005-0.0041; P = .009), microalbuminuria (B = 0.0005; 95% CI, 0.0002-0.0007; P < .0001), uric acid (B = 0.0252; 95% CI, 0.0085-0.0418; P = .003), body mass index (B = 0.0051, 95% CI, 0.0012-0.0089; P = .011), and C-reactive protein (B = 0.0048; 95% CI, 0.0015-0.0082; P = .005) were independent determinants of cystatin C concentration. Measuring cystatin C concentration in hypertensive patients may be useful for evaluating their cardiovascular risk profile.

[Validation of a questionnaire to estimate satisfaction with antiretroviral treatment: CESTA questionnaire]. / Validación del cuestionario de satisfacción con el tratamiento antirretroviral: cuestionario CESTA.

BACKGROUND: Assessment of patient satisfaction with antiretroviral therapy is generating increasing interest in clinical practice, since the outcome is directly related with compliance with therapy and its effectiveness. Currently, there is no validated patient satisfaction questionnaire to evaluate this factor as related to control of the disease. PATIENTS AND METHODS: An "ad hoc" questionnaire--Cuestionario Español de Satisfacción con el Tratamiento Antiretroviral (CESTA), Spanish Antiretroviral Treatment Satisfaction Questionnaire--was developed to evaluate satisfaction in patients switching to a simplified regimen. In a second phase, the questionnaire was validated in an observational study including 321 patients divided into two cohorts (patients switching to a simplified regimen and patients maintaining the same regimen). RESULTS: A total of 99% and 93% patients, respectively, completed the questionnaire at baseline and at the end-of-study visit. Cronbach's alpha coefficient for internal consistency and test-retest reliability were 0.82 and 0.69, respectively. Patients switching to a simplified regimen showed a statistically significant higher overall satisfaction score at the third-month visit than at baseline. CONCLUSIONS: The CESTA questionnaire is a valid instrument for use in clinical practice and provides valuable information on patient satisfaction with antiretroviral therapy.

Validación del cuestionario de satisfacción con el tratamiento antirretroviral: cuestionario CESTA / Validation of a questionnaire to estimate satisfaction with antiretroviral treatment: CESTA questionnaire

Antecedentes. La evaluación de la satisfacción con el tratamiento es una medida que centrada en el paciente está adquiriendo mayor importancia en la práctica clínica ya que podría incidir en el cumplimiento de los regímenes terapéuticos y por tanto en la efectividad del mismo. En la actualidad no existe ningún cuestionario validado de satisfacción con el tratamiento antirretroviral que permita valorar la importancia del control de la enfermedad. Pacientes y métodos. Se elaboró un cuestionario ad hoc (Cuestionario Español de Satisfacción con el Tratamiento Antirretroviral; CESTA) para evaluar la satisfacción de los pacientes que cambiaban a un régimen terapéutico de simplificación. Posteriormente se ha validado el cuestionario mediante un estudio observacional con 312 pacientes divididos en dos cohortes: pacientes que simplificaban su régimen terapéutico y pacientes estables que no variaban su pauta de tratamiento. Resultados. El cuestionario fue completado por más del 99% de los pacientes en la visita basal y por el 93% en la final. En los parámetros de consistencia interna se obtuvo un coeficiente a de Cronbach de 0,82 y una fiabilidad test-retest de 0,69. Los pacientes del grupo de simplificación obtuvieron puntuaciones significativamente más altas a los 3 meses de seguimiento respecto a los valores basales. Conclusiones. El cuestionario CESTA es un instrumento válido para su aplicación en el contexto de la práctica clínica proporcionando información sobre la importancia que cada paciente asigna a cada uno de los aspectos o cuestiones relacionadas con la satisfacción del tratamiento antirretroviral (AU)

Background. Assessment of patient satisfaction with antiretroviral therapy is generating increasing interest in clinical practice, since the outcome is directly related with compliance with therapy and its effectiveness. Currently, there is no validated patient satisfaction questionnaire to evaluate this factor as related to control of the disease Patients and methods. An "ad hoc" questionnaire --Cuestionario Español de Satisfacción con el Tratamiento Antiretroviral (CESTA), Spanish Antiretroviral Treatment Satisfaction Questionnaire-- was developed to evaluate satisfaction in patients switching to a simplified regimen. In a second phase, the questionnaire was validated in an observational study including 321 patients divided into two cohorts (patients switching to a simplified regimen and patients maintaining the same regimen). Results. A total of 99% and 93% patients, respectively, completed the questionnaire at baseline and at the end-of-study visit. Cronbach's alpha coefficient for internal consistency and test-retest reliability were 0.82 and 0.69, respectively. Patients switching to a simplified regimen showed a statistically significant higher overall satisfaction score at the third-month visit than at baseline. Conclusions. The CESTA questionnaire is a valid instrument for use in clinical practice and provides valuable information on patient satisfaction with antiretroviral therapy (AU)

Lipid disorders in antiretroviral-naive patients treated with lopinavir/ritonavir-based HAART: frequency, characterization and risk factors.

OBJECTIVES: The aim of this study was to evaluate the frequency, characteristics and risk factors of lipid changes associated with lopinavir/ritonavir treatment in antiretroviral-naive patients. METHODS: A prospective cohort of 107 antiretroviral-naive HIV-infected patients was followed for 12 months after starting lopinavir/ritonavir-based highly active antiretroviral therapy. RESULTS: At 12 months, percentages of patients with hypercholesterolaemia and hypertriglyceridaemia were 17.4% and 40%, respectively. Mean increases in total cholesterol and triglycerides were 40.7 and 73.3 mg/dL. There was a significant increase in both low-density and high-density (HDL) cholesterol, and no increase in the total cholesterol/HDL ratio (from 4.16 at baseline to 4.49 after 12 months). Baseline cholesterol > 200 mg/dL and triglycerides > 150 mg/dL were independent risk factors for dyslipidaemia, while hepatitis C coinfection appeared to be protective. CONCLUSIONS: Patients with elevated lipid values at baseline have the greatest risk of developing hypercholesterolaemia and hypertriglyceridaemia after starting lopinavir/ritonavir. Antiretroviral-naive patients coinfected with hepatitis C have a low risk of developing hyperlipidaemia after starting lopinavir/ritonavir.

Características clinicoepidemiológicas de los pacientes recién diagnosticados de infección por el VIH / Clinico-epidemiological characterístic of recently diagnoses HIV-infected patients

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