Serum lipid mediator profiles in COVID-19 patients and lung disease severity: a pilot study.

Coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 infection is highly heterogeneous, ranging from asymptomatic to severe and fatal cases. COVID-19 has been characterized by an increase of serum pro-inflammatory cytokine levels which seems to be associated with fatal cases. By contrast, the role of pro-resolving lipid mediators (SPMs), involved in the attenuation of inflammatory responses, has been scarcely investigated, so further studies are needed to understand SPMs metabolism in COVID-19 and other infectious diseases. Our aim was to analyse the lipid mediator metabolome, quantifying pro- and anti-inflammatory serum bioactive lipids by LC-MS/MS in 7 non-infected subjects and 24 COVID-19 patients divided into mild, moderate, and severe groups according to the pulmonary involvement, to better understand the disease outcome and the severity of the pulmonary manifestations. Statistical analysis was performed with the R programming language (R Foundation for Statistical Computing, Vienna, Austria). All COVID-19 patients had increased levels of Prostaglandin E2. Severe patients showed a significant increase versus controls, mild- and moderate-affected patients, expressed as median (interquartile range), in resolvin E1 [112.6 (502.7) vs 0.0 (0.0) pg/ml in the other groups], as well as in maresin 2 [14.5 (7.0) vs 8.1 (4.2), 5.5 (4.3), and 3.0 (4.0) pg/ml, respectively]. Moreover, 14-hydroxy docosahexaenoic acid (14-HDHA) levels were also increased in severe vs control and mild-affected patients [24.7 (38.2) vs 2.4 (2.2) and 3.7 (6.4) ng/mL, respectively]. Resolvin D5 was also significantly elevated in both moderate [15.0 (22.4) pg/ml] and severe patients [24.0 (24.1) pg/ml] versus controls [0.0 (0.0) pg/ml]. These results were confirmed by sparse partial least squares discriminant analysis which highlighted the contribution of these mediators to the separation between each of the groups. In conclusion, the potent inflammatory response to SARS-CoV-2 infection involves not only pro- but also anti-inflammatory lipid mediators that can be quantified in easily accessible serum samples, suggesting the need to perform future research on their generation pathways that will help us to discover new therapeutic targets.

COVID 19 and high pregnancy and perinatal complications in Panama.

OBJECTIVES: To report the maternal and neonatal results of patients infected with COVID-19 in Panama. METHODS: The study is based on the analysis of pregnant women with COVID-19, in five hospitals in the Republic of Panama. The inclusion criteria were: patients with or without symptoms, positive RT-PCR for SARS-CoV-2 in the period from March 23 to 6 months after, whose births were attended in one of those five hospitals and who signed the consent. Data were obtained at the time of diagnosis of the infection and at the time of termination of pregnancy for the mother and newborn. RESULTS: Two hundred and fifty-three patients met the inclusion criteria. Most were diagnosed in the third trimester (89.3%). 10.3% of the patients presented in a severe form of COVID-19. The most frequent complication was pre-eclampsia and if we add gestational hypertension they represent 21.2%; most of the patients terminated the pregnancy by cesarean section (58%). 26.9% (95% CI 21.3-32.9%) of the births were premature, and perinatal mortality was 5.4% (95% CI 3.0-9.0%). There was a need for mechanical ventilation in 5.9% (95% CI 3.6-9.6%) of the cohort and there were four maternal deaths (1.6% - 95% CI 0.6-4.0%). CONCLUSIONS: This study of pregnant women infected with COVID-19 and diagnosed with RT-PCR shows serious maternal complications such as high admission to the ICU, need for mechanical ventilation and one death in every 64 infected. Frequent obstetric complications such as hypertension, premature rupture of membranes, high rate of prematurity, and perinatal lethality were also seen.

Automatic generation of minimum dataset and quality indicators from data collected routinely by the clinical information system in an intensive care unit.

BACKGROUND: Quality indicators (QIs) are being increasingly used in medicine to compare and improve the quality of care delivered. The feasibility of data collection is an important prerequisite for QIs. Information technology can improve efforts to measure processes and outcomes. In intensive care units (ICU), QIs can be automatically measured by exploiting data from clinical information systems (CIS). OBJECTIVE: To describe the development and application of a tool to automatically generate a minimum dataset (MDS) and a set of ICU quality metrics from CIS data. METHODS: We used the definitions for MDS and QIs proposed by the Spanish Society of Critical Care Medicine and Coronary Units. Our tool uses an extraction, transform, and load process implemented with Python to extract data stored in various tables in the CIS database and create a new associative database. This new database is uploaded to Qlik Sense, which constructs the MDS and calculates the QIs by applying the required metrics. The tool was tested using data from patients attended in a 30-bed polyvalent ICU during a six-year period. RESULTS: We describe the definitions and metrics, and we report the MDS and QI measurements obtained through the analysis of 4546 admissions. The results show that our ICU's performance on the QIs analyzed meets the standards proposed by our national scientific society. CONCLUSIONS: This is the first step toward using a tool to automatically obtain a set of actionable QIs to monitor and improve the quality of care in ICUs, eliminating the need for professionals to enter data manually, thus saving time and ensuring data quality.

Validation of the ICU-DaMa tool for automatically extracting variables for minimum dataset and quality indicators: The importance of data quality assessment.

BACKGROUND: Big data analytics promise insights into healthcare processes and management, improving outcomes while reducing costs. However, data quality is a major challenge for reliable results. Business process discovery techniques and an associated data model were used to develop data management tool, ICU-DaMa, for extracting variables essential for overseeing the quality of care in the intensive care unit (ICU). OBJECTIVE: To determine the feasibility of using ICU-DaMa to automatically extract variables for the minimum dataset and ICU quality indicators from the clinical information system (CIS). METHODS: The Wilcoxon signed-rank test and Fisher's exact test were used to compare the values extracted from the CIS with ICU-DaMa for 25 variables from all patients attended in a polyvalent ICU during a two-month period against the gold standard of values manually extracted by two trained physicians. Discrepancies with the gold standard were classified into plausibility, conformance, and completeness errors. RESULTS: Data from 149 patients were included. Although there were no significant differences between the automatic method and the manual method, we detected differences in values for five variables, including one plausibility error and two conformance and completeness errors. Plausibility: 1) Sex, ICU-DaMa incorrectly classified one male patient as female (error generated by the Hospital's Admissions Department). Conformance: 2) Reason for isolation, ICU-DaMa failed to detect a human error in which a professional misclassified a patient's isolation. 3) Brain death, ICU-DaMa failed to detect another human error in which a professional likely entered two mutually exclusive values related to the death of the patient (brain death and controlled donation after circulatory death). Completeness: 4) Destination at ICU discharge, ICU-DaMa incorrectly classified two patients due to a professional failing to fill out the patient discharge form when thepatients died. 5) Length of continuous renal replacement therapy, data were missing for one patient because the CRRT device was not connected to the CIS. CONCLUSIONS: Automatic generation of minimum dataset and ICU quality indicators using ICU-DaMa is feasible. The discrepancies were identified and can be corrected by improving CIS ergonomics, training healthcare professionals in the culture of the quality of information, and using tools for detecting and correcting data errors.

Autoeficacia clínica y creencias sobre la enfermedad en problemas de dolor crónico: El manejo de la Fibromialgia en médicos de Atención Primaria / Clinical self-efficacy and illness beliefs in ambiguous chronic pain conditions: General Practitioners’ management of Fibromyalgia

Objetivos: En problemas de dolor crónico, el comportamiento de los profesionales puede estar influido por sus conocimientos científicos y por sus creencias sobre la enfermedad. Nuestro objetivo es identificar las creencias sobre la Fibromialgia (representación mental y autoeficacia clínica) de los médicos de atención primaria y estudiar sus relaciones con el manejo del paciente. Método: 208 médicos participantes en talleres de formación sobre Fibromialgia, completaron una versión adaptada del "Brief Illness Perception Questionnaire" y diferentes medidas de autoeficacia clínica, conducta clínica y satisfacción. Realizamos correlación de Pearson, regresión múltiple, pruebas t y ANOVA. Resultados: La Fibromialgia se consideró un problema importante, con poco control sobre él y asociado a causas psicológicas; la autoeficacia clínica fue moderada. Los componentes de la representación mental predijeron el manejo clínico, aunque con bajos porcentajes de varianza explicada (entre 3% y 11%) mientras que la autoeficacia clínica predijo la satisfacción con el manejo (entre 46% y 61%). Conclusiones: Es necesario incrementar la percepción de control y de autoeficacia de los médicos de atención primaria. Mientras que la fibromialgia siga siendo un problema ambiguo, las variaciones en las cogniciones de los profesionales serán importantes en el tipo de cuidado que recibe el paciente (AU)

Aims: In ambiguous chronic pain conditions, professional behaviour may be affected not only by scientific knowledge but also by beliefs about illness. In Spain, Fibromyalgia is the most frequent cause of chronic pain at Primary Care level. Our aims are to identify General Practitioners’ beliefs about Fibromyalgia, in terms of mental representation and clinical self-efficacy, and to study their relationships with patient management. Methods: 208 General Practitioners recruited on a voluntarily basis while attending educational workshops on Fibromyalgia, completed an adapted version of the Brief Illness Perception Questionnaire and ad hoc scales of clinical self-efficacy, clinical behaviour and satisfaction. Pearson correlation, multiple regression, t test and ANOVA were performed. Results: Doctors see Fibromyalgia as a severe condition and they perceived low control and moderate clinical self-efficacy. The main causes of Fibromyalgia were seen to be psychological. Regression analysis showed that mental representation components predicted clinical management with low explained variance (from 3% to 11%) while clinical self-efficacy predicted satisfaction with clinical management (from 46% to 61%). Conclusions: GPs self-efficacy and control perception of Fibromyalgia need to be enhanced. While FM continues to be an ambiguous condition, variations in clinicians' cognitions will be important for the care patients receive (AU)

El entrenamiento en habilidades de comunicación podría ser un factor preventivo del síndrome de burnout en médicos de familia / No disponible

Objetivo: Analizar las diferencias entre un grupo de médicosde familia (MF) con formación estándar (FE) y otroanálogo con entrenamiento específico en habilidadescomunicacionales (HHCC) en niveles de desgaste profesional.Diseño: Estudio observacional, transversal y comparativo.Participantes y emplazamiento: 168 médicos de familiamiembros de la SEMFYC en dos grupos de comparación.El grupo de evaluación está formado por sujetos del grupoComunicación y Salud (GHHCC; n=84), y el de comparación(GFE; n=84) conformado por profesionales queno pertenecían al grupo de Comunicación y Salud.Mediciones principales: Se utilizó un cuestionario de datosgenerales y sociodemográficos y otro para medir quemazónprofesional, el Maslach Burnout Inventory (MBI).Resultados: Se han hallado diferencias estadísticamentesignificativas en cansancio emocional (IC=0,414_7,196;p=0,028), despersonalización (IC=0,414_4,213;p=0,021) y realización personal (IC=-5,618_-1,674;p=0,000) entre el grupo de evaluación (GHHCC)y el de referencia (GFE).Conclusiones: Los resultados de este trabajo apuntan aque las habilidades en comunicación estarían asociadasa un menor quemazón profesional y podrían ser un factorprotector del mismo(AU)

Aim: Analyze the differences among a physician groupwith standard training in family medicine as a specialistsand another with the same formation but also with specificcommunication skills training in their burnout levels.Design: Observational, cross and comparative study.Participants and setting: 168 physicians members of theSEMFYC from the different autonomous regions of Spainin two comparison groups. The first one was composedby subjects of the Communication and Health Group(GHHCC; n=84), and the other one by doctors withoutcommunication skills training (GFE; n=84).Measurements: A sociodemographic and general dataquestionnaire and the Maslach Burnout Inventory (MBI)was used.Results: Statistically meaningful differences in emotionalexhaustion (IC=0,414_7,196;p=0,028), despersonalization(IC=0,414_4,213;p=0,021) and personalaccomplishment (IC=-5,618_-1,674; p=0,000) havebeen found between the evaluation group (GHHCC) andthe control group (GFE).Conclusions: The results of this study suggest thatcommunicational skills training was related to low burnoutand could be a protection factor of professional burnout(AU)