Perception of personal protective equipment availability and mental health outcomes in workers from two national hospitals during the COVID-19 pandemic.

Background: During the first wave of the pandemic, a constant concern of healthcare workers, who are more vulnerable to contagion, is their personal safety. This is directly related to the availability of adequate PPE, which led to a perception of dissatisfaction and inequality with government responses. We aim t o determines whether perception of adequate PPE availability is associated with depressive, anxiety, and stress symptoms in different types of healthcare workers. Methods: Analytical cross-sectional study surveyed clinical and non-clinical healthcare workers in two third-level hospitals in Lima, Peru. An online self-survey assessed the perception of adequate PPE availability, using a Likert scale question, which was then dichotomized for the analysis. In addition, we assessed the depressive, anxiety, and stress symptoms using validated questionnaires. Results: 563 participants were included. In general, there is no association between perception of PPE availability and three mental health outcomes. However, in the subgroup analysis, physicians with better perception of PPE availability had less moderate-severe outcomes in mental health; in contrast, nurses had higher moderate-severe outcomes. The type of profession in healthcare workers may modify the effect of this association. Conclusion: The association between perception of PPE availability and mental health outcomes is complex in healthcare workers from two third-level hospitals. This association can vary according to the type of work.

Association between human chorionic gonadotropin (hCG) levels and adverse pregnancy outcomes: A systematic review and meta-analysis.

Human chorionic gonadotropin (hCG), a glycoprotein produced in the placenta, is crucial for a healthy pregnancy. We investigated the relationship between hCG levels and adverse pregnancy outcomes. We conducted a systematic review including studies measuring hCG blood levels in the first or second trimester, reporting on any of the 12 predefined adverse pregnancy outcomes with logistic regression-adjusted association estimates. The primary outcomes were placenta-associated complications, such as miscarriage, preeclampsia, intrauterine growth restriction, and preterm delivery. We searched PubMed, Embase and CINAHL Complete. The hCG levels were analysed as multiple of the median (MoM). Odds ratio (OR) and 95% confidence interval (CI) were used. Risk of bias and the certainty of evidence were assessed using ROBINS-I and GRADE, respectively. Meta-analysis also showed that hCG levels, reported as MoM ≥2/2.31/2.5, might be associated with an increased risk of preeclampsia (OR 2.08, 95% CI 1.26 to 3.44) and preterm delivery (OR 1.29, 95% CI 1.12 to 1.47), but the evidence is very uncertain. High second trimester hCG levels may be associated with preeclampsia and preterm delivery but confidence in evidence is low.

Scoping review of measures of treatment burden in patients with multimorbidity: advancements and current gaps.

OBJECTIVES: To identify, assess, and summarize the measures to assess burden of treatment in patients with multimorbidity (BoT-MMs) and their measurement properties. STUDY DESIGN AND SETTING: MEDLINE via PubMed was searched from inception until May 2021. Independent reviewers extracted data from studies in which BoT-MMs were developed, validated, or reported as used, including an assessment of their measurement properties (e.g., validity and reliability) using the COnsensus-based Standards for the selection of health Measurement INstruments. RESULTS: Eight BoT-MMs were identified across 72 studies. Most studies were performed in English (68%), in high-income countries (90%), without noting urban-rural settings (90%). No BoT-MMs had both sufficient content validity and internal consistency; some measurement properties were either insufficient or uncertain (e.g., responsiveness). Other frequent limitations of BoT-MMs included absent recall time, presence of floor effects, and unclear rationale for categorizing and interpreting raw scores. CONCLUSION: The evidence needed for use of extant BoT-MMs in patients with multimorbidity remains insufficiently developed, including that of suitability for their development, measurement properties, interpretability of scores, and use in low-resource settings. This review summarizes this evidence and identifies issues needing attention for using BoT-MMs in research and clinical practice.

Self-reported perceptions and knowledge of telemedicine in medical students and professionals who enrolled in an online course in Peru.

BACKGROUND: Telemedicine has become more relevant during the COVID-19 pandemic. However, medical students and professionals do not acquire competences in telemedicine during their training. Our objective was to describe the self-reported perception and baseline knowledge of telemedicine among medical students and professionals enrolled in a virtual course. METHODS: Cross-sectional study that included physicians or medical students aged 18 years or older who were interested in a free virtual telemedicine course and who completed the data collection questionnaire. We used a Likert scale to assess the self-reported perceptions of four domains related to telemedicine. The participants were grouped into three levels for each domain: low, medium and high. We also objectively assessed telemedicine knowledge by means of 10 questions, with a cut-off point of 50% of correct answers. The Fisher's exact test, the Chi-square test, and the Mann-Whitney U test were used for the comparison of categorical data. A p-value < 0.05 was considered statistically significant. RESULTS: We included 161 participants: 118 medical students and 43 physicians. We observed no significant differences between medical students and physicians in self-reported perceptions of knowledge, security, or utility of telemedicine. However, students had a high self-reported perception of the disadvantages of telemedicine especially related to patient security (p = 0.018), efficiency of care (p = 0.040), and the possibility of medical malpractice (p = 0.010) compared to physicians. Nearly half of the students (n = 53,44.9%) and physicians (n = 22,51.7%) answered 50% or more of the questions related to telemedicine knowledge correctly. CONCLUSION: Among the physicians and medical students enrolled in the course, the students perceived the disadvantages of telemedicine more frequently. Although physicians and students have limited knowledge of telemedicine, there appears to be no influence of experience and prior training in telemedicine.

Undergraduate courses of evidence-based medicine in Peruvian medical schools: Characteristics and addressed topics.

Background: Medical schools are increasingly including evidence-based medicine (EBM) courses in their curricula. However, little is known about the characteristics of these courses in Peru. Therefore, the present study aimed to describe the characteristics and topics addressed by undergraduate courses on EBM in Peruvian medical schools, and to compare the content of these courses with predefined EBM competencies. Methods: We conducted a cross-sectional study. We obtained the syllabi of undergraduate EBM courses from all medical schools for the latest year available. We extracted their characteristics and categorized the topics they included according to the five steps necessary to apply EBM, divided into 22 competencies. Results: In 2021, Peru had 47 universities with active undergraduate medical schools, of which 9 (19.1%) had EBM courses. These courses were not mandatory in three of the universities, and were typically offered between the 2nd and 5th year of the degree program. When analysing the topics covered in the syllabi, we found that they addressed 7 to 13 of the 22 core competencies evaluated. The least addressed topics belonged to steps 4 (apply) and 5 (evaluate) of the EBM process. Conclusion: We found that few Peruvian universities offer EBM courses, and that these courses have heterogeneous characteristics, with syllabi that do not include all essential topics for applying the five steps of EBM.

Central and peripheral mechanisms of pain in fibromyalgia: scoping review protocol.

Fibromyalgia is characterised by widespread musculoskeletal pain, which may present with fatigue, depression, anxiety, sleep and cognitive disturbances. It is the second most prevalent rheumatic disease. An accurate diagnosis is challenging, since its symptoms may resemble diverse conditions such as carpal tunnel syndrome, Raynaud syndrome, Sjögren syndrome, amongst others. Neuropathic pain and autonomic dysfunction in fibromyalgia suggest the involvement of the nervous system. Ion channels, neurotransmitters and neuromodulators may play a role. Small fibre neuropathy (SFN) may also cause chronic widespread pain. SFN may occur in 50% of fibromyalgia patients, but its role in the disease is unknown. Despite several efforts to synthesise the evidence on the mechanisms for pain in fibromyalgia, there are few studies applying an integrative perspective of neurochemical, immunological, and neuroanatomical characteristics, and their relevance to the disease. This protocol aims to clarify the mechanisms of the central and peripheral nervous system associated with pain in fibromyalgia. We will retrieve published studies from Web of Science, MEDLINE, Scopus, EBSCOhost, Ovid and Google Scholar. All clinical studies or experimental models of fibromyalgia reporting imaging, neurophysiological, anatomical, structural, neurochemical, or immunological characteristics of the central or peripheral nervous systems associated with pain will be included. Exclusion criteria will eliminate studies evaluating pain without a standardised measure, studies written in languages different from Spanish or English that could not be appropriately translated, and studies whose full-text files could not be retrieved after all efforts made. A narrative synthesis will be performed.

One-year follow-up of depression, anxiety, and quality of life of Peruvian patients who survived COVID-19.

PURPOSE: To assess health-related quality of life (HRQoL) and its associated factors in patients who survived COVID-19 and to assess a prospective evaluation of the prevalence and severity of their depression and anxiety symptoms. METHODS: We followed up a sample of hospitalized patients who survived COVID-19 at 3 and 12 months after discharge. We assessed HRQoL (Euroqol-5D-5L) through telephone interviews. Any problem in any dimension of Euroqol-5D-5L was considered as low HRQoL. The depression and anxiety symptoms were measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 tools, respectively. We estimated the adjusted prevalence ratios (aPR) to low HRQoL using Poisson regression and the changes on their depression and anxiety symptoms during the follow-up. RESULTS: We included 119 patients with a mean follow-up time of 363.6 days. 74% of the participants had low HRQoL at one year after hospital discharge and were associated with being ≥ 41 years old (aPR: 1.95), having a previous history of psychiatric diagnoses before COVID-19 infection (aPR: 1.47), having any COVID-19 symptom during the follow-up at one year (aPR: 1.84), and having a family member who had died from COVID-19 during the first wave (aPR: 1.24). In addition, the clinically relevant depression symptoms were frequent, and they increased from 3 (14.3%) to 12 months (18.5%). CONCLUSION: One year after COVID-19 hospitalization discharge, patients had low HRQoL, and their depression symptoms increased. These findings acknowledge the need to provide services that adequately address mental health sequels and HRQoL to reduce the burden of the COVID-19.

Mental Health in COVID-2019 Survivors from a General Hospital in Peru: Sociodemographic, Clinical, and Inflammatory Variable Associations.

The current coronavirus disease-2019 (COVID-19) pandemic constitutes a significant public health problem worldwide, as well as mental health problems. This study aimed to evaluate the mental health of COVID-19 survivors, considering their sociodemographic, clinical, and immune variables. A cross-sectional and correlational study was conducted on 318 COVID-19 survivors from one hospital in Peru. Through telephone interviews, evaluation of the presence of depressive symptoms using the Patient Health Questionnaire-9, anxiety symptoms through the Generalized Anxiety Disorder-7, somatic symptoms through Patient Health Questionnaire-15, and posttraumatic stress disorder (PTSD) symptoms through Impact of Event Scale-Revised was carried out. Poisson regression analyses were performed with their adjusted variances to calculate the prevalence ratio (PR) with their 95% confidence interval. All regression models were adjusted (PRa) for follow-up time. A significant proportion of patients have depressive (30.9%), anxious (31.1%), somatic (35.2%), and PTSD (29.5%) symptoms. The variables associated with a higher frequency of clinically relevant mental symptoms were female sex, self-perception of greater COVID-19 severity, presence of persistent COVID-19 symptoms, loss of a family member due to COVID-19, and prior psychiatric diagnosis or treatment. In addition, the neutrophil-to-lymphocyte ratio was significantly higher in patients with clinically relevant symptoms of depression. COVID-19 survivors showed a high prevalence of negative mental symptoms. Our findings help to identify patients who are vulnerable and require psychiatric care.

Lupus de inicio tardío neurológico asociado a accidente cerebrovascular en el adulto mayor: Reporte de caso y revisión sistemática rápida

Antecedentes: El Lupus Eritematoso Sistémico (LES) de inicio tardío es raro y afecta a adultos mayores. Reporte del caso: Se reporta a una mujer de 71 años con debilidad generalizada y pérdida de fuerza muscular, que aumentó súbitamente luego de un accidente cerebrovascular hemorrágico. La paciente presentó evolución tórpida por seis meses. El diagnóstico de LES de inicio tardío fue confirmado con anticuerpos antinucleares (+) y cumplimiento de criterios para LES y neurolupus, teniendo una mejoría significativa a las dos semanas de tratamiento. Luego de realizar una revisión sistemática rápida se encontraron pocos casos similares con neuropatía periférica. Conclusión: Es necesario considerar al LES de inicio tardío con neuropatía periférica en adultos mayores con debilidad muscular, como una presentación clínica atípica y la necesidad de exámenes confirmatorios.

Background: Late-onset Systemic Lupus Erythematosus (SLE) is rare and affects older adults. Case report: A 71-year-old woman is reported with generalized weakness and muscle strength loss, which increased suddenly after a hemorrhagic stroke. The patient presented a torpid evolution for six months. The diagnosis of late-onset SLE was confirmed with antinuclear antibodies (+) and compliance with criteria for SLE and neurolupus, with significant improvement after two weeks of treatment. We made a rapid systematic review and found few similar cases with peripheral neuropathy. Conclusion: It is necessary to consider late-onset SLE with peripheral neuropathy in older adults with muscle weakness, as an atypical clinical presentation and the need for confirmatory tests.

Características clínicas y genéticas de un paciente con síndrome de Noonan y una mutación de novo en el gen MAP2K1: Reporte de caso

Introducción: El síndrome de Noonan es un trastorno genético relacionado principalmente con la mutación del gen PTPN11. Reporte del caso: Recién nacido varón de 34 semanas de edad gestacional con ultrasonidos obstétricos que muestran higroma quístico, hidronefrosis renal bilateral, y polihidramnios. Al nacimiento, presentó edema nucal, puente nasal ancho, pabellón auricular de implantación baja, y criptorquidia derecha. Además, defecto del tabique auricular, ausencia de vena cava inferior, hipertensión pulmonar, conducto arterioso persistente y dificultad respiratoria. El resultado del análisis del panel de 14 genes mostró una mutación del gen MAP2K1 y una variante de significado incierto en el gen CBL, confirmando el diagnóstico del síndrome de Noonan negativo para PTPN11. Durante el seguimiento, también se le diagnosticó blefaroptosis izquierda y reflujo gastroesofágico. Conclusión: El presente caso destaca la amplia variedad de características fenotípicas en un paciente con síndrome de Noonan, con sospecha al nacimiento y confirmado durante el seguimiento.

Background: Noonan syndrome is a genetic disorder mostly related to PTPN11 gene mutation. Report Case: Newborn male of 34 weeks of gestational age with obstetric ultrasounds showing cystic hygroma, bilateral renal hydronephrosis, and polyhydramnios. At born, he presented nuchal edema, wide nose, low-set ears, and right cryptorchidism. Additionally, he presented atrial septum defect, absence of inferior vena cava, mild pulmonary hypertension, persistent ductus arteriosus, and respiratory distress. The result of the 14-gene panel analysis showed a MAP2K1 gene mutation and a variation of uncertain significance in the CBL gene, confirming the diagnosis of PTPN11- negative Noonan syndrome. During the follow-up, he was additionally diagnosed with blepharoptosis of left eye and gastroesophageal reflux disease. Conclusion:This report highlights the wide variety of phenotypical characteristics in a Noonan syndrome patient, which was suspected upon birth and developed during the follow-up.

Enfermedad de Kawasaki, enfermedad similar a Kawasaki y MIS-C asociado a COVID-19 en niños: revisión sistemática / Kawasaki disease, Kawasaki-like disease, and MIS-C associated with COVID-19 in children: systematic review

Resumen Objetivo: Sintetizar las características epidemiológicas y clínicas de los niños de COVID-19 con EK, KLD y MIS-C. Métodos: Se realizó una búsqueda en 4 bases de datos y preprints hasta el 31 de Mayo del 2021. Se incluyeron reportes/series de caso que evaluaron las caracte rísticas clínicas del EK, KLD o MIS-C en pacientes pediátricos con COVID-19. Resultados: Se incluyeron 16 estudios (seis informes de casos y diez series de casos, 367 pacientes en total, 58 pacientes con EK, 87 con KLD y 290 pacientes con MIS-C); con edades entre los 6 meses y los 10 años, y el 62% eran mujeres. Se observó COVID-19 positivo en 75,2%. Respecto a EK, KLD y MIS-C, las características clínicas repor tadas fueron compatibles con los cuadros diagnósticos estandarizados en el contexto de COVID-19. La duración de la hospitalización fue de 5 a 14 días para EK y de 4,3 a 13 para MIS-C. Once pacientes con MIS-C (2,8%) necesitaron ECMO. Seis pacientes con MIS-C fueron reportados muertos. Ocho estudios reportaron pacientes en la UCI. Conclusiones: EK o KLD puede asociarse a COVID-19 en niños, y pueden complicarse con MIS-C. El tiempo de hospitalización es prolongado si se presenta EK o KLD asociado a COVID-19 en niños.

Abstract Objective: To synthesize the epidemiological and clinical characteristics of COVID-19 children with MIS-C, KLD and EK. Methods: Databases and preprints were searched until May 31, 2021. Reports/case series that evaluated the clinical features of EK, KLD, or MIS-C in pediatric patients with COVID-19 were included. Results: Sixteen studies were included (six case reports and ten case series, 367 patients total, 58 patients with EK, 87 with KLD, and 290 patients with MIS-C); with ages ranging from 6 months to 10 years, and 62% were female. Positive COVID-19 was observed in 75.2%. Regarding EK, KLD and MIS-C, the reported clinical characteristics were compatible with the standardized diagnostic pictures in the context of COVID-19. The duration of hospitalization was 5 to 14 days for EK and 4.3 to 13 for MIS-C. Eleven patients with MIS-C (2.8%) needed ECMO. Eleven patients with MIS-C (2.8%) needed ECMO. Six patients with MIS-C were reported dead. Eight studies reported patients in the ICU. Conclusions: Children with COVID-19 develop EK or KLD, and can be complicated by MIS-C. Prevention, diagnosis, and treatment measures are needed.

Vitamin E supplementation improves testosterone, glucose- and lipid-related metabolism in women with polycystic ovary syndrome: a meta-analysis of randomized clinical trials.

AIM: This systematic review and meta-analysis assessed the effect of vitamin E supplementation on testosterone, glucose, lipid profile, pregnancy rate, hirsutism, and body mass index (BMI) in women with polycystic ovary syndrome (PCOS). METHODS: A multi-database search was performed from inception to January 2022 for randomized controlled trials (RCTs) reporting the effects of vitamin E supplementation with or without another nutritional supplement on women with PCOS. A random-effects model was used to obtain mean differences (MDs) and its 95% confidence intervals (95%CI). Evidence certainty was assessed with GRADE methodology. RESULTS: We meta-analyzed eight RCTs reporting vitamin E supplementation alone or combined with other individual substances like omega-3, vitamin D3, or magnesium oxide in adult women ≤40 years old with PCOS. Vitamin E supplementation reduced fasting glucose (MD: -1.92 mg/dL, 95%CI: -3.80 to -0.05), fasting insulin (MD: -2.24 µIU/mL, 95%CI: -3.34 to -1.14), HOMA-IR (MD: -0.42, 95%CI: -0.65 to -0.19), total cholesterol (MD: -18.12 mg/dL, 95%CI: -34.37 to -1.86), LDL-cholesterol (MD: -15.92 mg/dL, 95%CI: -29.93 to -1.90), triglycerides (MD: -20.95 mg/dL, 95%CI: -37.31 to -4.58), total testosterone (MD: -0.42 ng/mL, 95%CI: -0.55 to -0.29), and increased sex hormone-binding globulin (MD: 7.44 nmol/L, 95%CI: 2.68 to 12.20). However, it had no impact on female sex hormones, HDL-cholesterol, BMI, and hirsutism. Two RCTs assessed pregnancy and implantation rates with inconsistent results. The certainty of the evidence was very low to moderate. CONCLUSION: Vitamin E supplementation improves glucose, lipid, and androgenic-related biomarkers in women with PCOS.

Factors Associated with Mental Health Outcomes in Hospital Workers during the COVID-19 Pandemic: A Mixed-Methods Study.

BACKGROUND: We investigated some of the factors associated with depression, perceived stress, and anxiety in clinical and nonclinical healthcare workers of two hospitals. METHODS: A mixed-methods approach was used. The sample included clinical (physicians, nurses, and others) and nonclinical (security and cleaning staff) healthcare workers of two tertiary hospitals in Peru. Participants completed an online self-survey. In the qualitative analysis, data were subjected to thematic analysis. RESULTS: We analyzed data from 613 participants, of which 8.6%, 9.0%, and 78.2% had moderate-to-severe anxiety, depression, and perceived stress, respectively. Having a previous mental health problem, being concerned about losing one's job, having at least two COVID-19 symptoms in the preceding two weeks, and being afraid of infecting family members increased the prevalence of experiencing moderate-to-severe depression and anxiety. The qualitative analysis allowed us to identify five recurring factors that caused a negative impact on workers' lives during the pandemic: emotional distress linked to hospital experiences of suffering and death, modification of routines, fear of COVID-19, exacerbation of mental disorders, and physical problems associated with emotional distress. CONCLUSIONS: Clinical and nonclinical healthcare workers in Peru have experienced depression, anxiety, and stress during the COVID-19 pandemic. Future research and interventions are necessary to improve psychological support for hospital workers.

Alineamiento de la producción científica a las prioridades de investigación en el Seguro Social de Salud del Perú: Propuesta de fortalecimiento y descentralización de la investigación / Alignment of scientific production to research priorities in the Peruvian Health Social Health Insurance: Purpose to strengthening and decentralization of research

Introducción: Uno de los indicadores del impacto del establecimiento de prioridades en investigación en salud es la producción científica. EsSalud planteó nueve temas de investigación prioritarios (TIP) y 20 preguntas de investigación prioritarias (PIP) 2017-2019. Evaluamos el alineamiento a estas prioridades de investigación en los artículos científicos publicados con filiación de EsSalud durante 2017-2020, y caracterizamos aquellos financiados por esta institución. Material y Métodos: Análisis de los artículos científicos registrados en la base de datos de producción científica de EsSalud 2017-2020. Empleamos una metodología estandarizada y por duplicado para evaluar el alineamiento a los TIP y PIP 2017-2019 de EsSalud. La evaluación del alineamiento a las PIP sólo lo realizamos en artículos originales y resúmenes de congreso. Reportamos frecuencias de alineamiento a cada TIP y PIP, y frecuencia de alineamiento a por lo menos un TIP según características de los artículos. Además, se reportó las características de los artículos financiados por EsSalud. Resultados: Un total de 170 de 1283 artículos se alinearon a al menos un TIP. Ocho de las veinte PIP no fueron respondidas. Los artículos con autores que pertenecen o recibieron financiamiento del IETSI-EsSalud tuvieron la mayor tasa de alineación. Finalmente, los artículos financiados por EsSalud fueron principalmente estudios observacionales, guías de práctica clínica y revisiones sistemáticas. Conclusión: Los artículos científicos publicados con filiación de EsSalud durante el 2017 al 2020 tienen baja alineación con las prioridades de investigación de la institución. Por lo tanto, es necesario generar un proceso de gestión de implementación, seguimiento y evaluación de las prioridades de investigación en la institución.

Background: One of the impact indicators of priorities in health research-setting is the scientific production that refers to these priorities. EsSalud raised nine priority research topics (PRT) and 20 priority research questions (PRQ) for the 2017-2019 period. We assess the alignment to these research priorities in the scientific articles published during the 2017-2020 period by EsSalud, and we characterize those financed by this institution. Material and Methods: Analysis of the scientific articles registered in the EsSalud scientific production database for the period 2017-2020. We used a standardized methodology and in duplicate to evaluate the alignment of a scientific article to the PRTand PRQ 2017-2019 of EsSalud. The evaluation of the alignment to the PRQs is only carried out in original articles and congress summaries. We report alignment frequencies to each PRTand PRQ, and we report the frequency of alignment to at least one PRT according to the articles' characteristics. In addition, the characteristics of the articles financed by EsSalud were reported. Results: 170 out of 1283 articles were aligned to at least one PRT. Eight of the twenty PRQs went unanswered. Articles with authors who belong to or received funding from IETSI-EsSalud had the highest alignment rate. Finally, the highly cited articles financed by EsSalud were mainly observational studies, clinical practice guidelines and systematic reviews. Conclusion: The articles published by EsSalud during 2017 to 2020 have low alignment with institutional research priorities. Furthermore, it is necessary a process of implementation, monitoring, and evaluation of research priorities in the institution.

Development of a Framework for the Implementation of Synchronous Digital Mental Health: Realist Synthesis of Systematic Reviews.

BACKGROUND: The use of technologies has served to reduce gaps in access to treatment, and digital health interventions show promise in the care of mental health problems. However, to understand what and how these interventions work, it is imperative to document the aspects related to their challenging implementation. OBJECTIVE: The aim of this study was to determine what evidence is available for synchronous digital mental health implementation and to develop a framework, informed by a realist review, to explain what makes digital mental health interventions work for people with mental health problems. METHODS: The SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) framework was used to develop the following review question: What makes digital mental health interventions with a synchronous component work on people with mental health problems, including depression, anxiety, or stress, based on implementation, economic, quantitative, qualitative, and mixed methods studies? The MEDLINE, EBM Reviews, PsycINFO, EMBASE, SCOPUS, CINAHL Complete, and Web of Science databases were searched from January 1, 2015, to September 2020 with no language restriction. A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) was used to assess the risk of bias and Confidence in Evidence from Reviews of Qualitative Research (CERQual) was used to assess the confidence in cumulative evidence. Realist synthesis analysis allowed for developing a framework on the implementation of synchronous digital mental health using a grounded-theory approach with an emergent approach. RESULTS: A total of 21 systematic reviews were included in the study. Among these, 90% (n=19) presented a critically low confidence level as assessed with AMSTAR-2. The realist synthesis allowed for the development of three hypotheses to identify the context and mechanisms in which these interventions achieve these outcomes: (1) these interventions reach populations otherwise unable to have access because they do not require the physical presence of the therapist nor the patient, thereby tackling geographic barriers posed by in-person therapy; (2) these interventions reach populations otherwise unable to have access because they can be successfully delivered by nonspecialists, which makes them more cost-effective to implement in health services; and (3) these interventions are acceptable and show good results in satisfaction because they require less need of disclosure and provide more privacy, comfortability, and participation, enabling the establishment of rapport with the therapist. CONCLUSIONS: We developed a framework with three hypotheses that explain what makes digital mental health interventions with a synchronous component work on people with mental health problems. Each hypothesis represents essential outcomes in the implementation process. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42020203811; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020203811. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.12688/f1000research.27150.2.

Self-perceived competencies on evidence-based medicine in medical students and physicians registered in a virtual course: a cross-sectional study.

BACKGROUND: Evidence-based medicine (EBM) is defined as the integration of the best available evidence from scientific studies with clinical experience (and context) and with patients' values and preferences. The objective of the present study was to describe self-perceived EBM competencies in physicians and medical students enrolled in a massive virtual EBM course. METHODS: Analytical cross-sectional study. People interested in a free virtual EBM course fulfilled their data in a virtual form for their registration in September 2020. In this form, 22 competencies related to four dimensions of EBM were evaluated: asking a clinical question, search, analysis, and application; using a 5-option Likert scale. The resulting database was analyzed, selecting people who claimed to be physicians or medical students of 18 years or more. RESULTS: 1793 participants were included: 1130 medical students and 663 physicians; more than 80% lived in Peru. The frequency of participants who agreed or strongly agreed with feeling qualified in each competence ranged: from 39.2% to 57.8% for the competencies of the 'Asking a clinical question' dimension, from 39.2% to 56.1% for 'Search,' from 19.9% to 32.0% for 'Analysis,' and from 19.6% to 29.9% for 'Application.' Both in physicians and students, the lowest frequencies were for the competencies of interpretation of impact measures, graphs, and results of systematic reviews; as well as shared decision making and calculation of expected benefit. Physicians who graduated more recently scored better on competencies from search and analysis dimensions. CONCLUSION: Among physicians and medical students enrolled in the course, self-perception of competencies was lower in the dimensions of analysis and application. More recently graduated physicians seem to have a greater self-perception of their research and analysis skills, probably due to curricular updates.List of abbreviations: EBM: Evidence-based medicine; CIMBE, for its acronym in Spanish: International Course on Evidence-Based Medicine; SOCIMEP, for its acronym in Spanish: Peruvian Medical Student Scientific Society.

Effects of decision aids for depression treatment in adults: systematic review.

AIM AND METHOD: To determine the effect on decisional-related and clinical outcomes of decision aids for depression treatment in adults in randomised clinical trials. In January 2019, a systematic search was conducted in five databases. Study selection and data extraction were performed in duplicate. Meta-analyses were performed, and standardised and weighted mean differences were calculated, with corresponding 95% confidence intervals. The certainty of the evidence was evaluated with GRADE methodology. RESULTS: Six randomised clinical trials were included. The pooled estimates showed that decision aids for depression treatment had a beneficial effect on patients' decisional conflict, patient knowledge and information exchange between patient and health professional. However, no statistically significant effect was found for doctor facilitation, treatment adherence or depressive symptoms. The certainty of the evidence was very low for all outcomes. CLINICAL IMPLICATIONS: Using decision aids to choose treatment in patients with depression may have a a beneficial effect on decisional-related outcomes, but it may not translate into an improvement in clinical outcomes.

Producción de las sociedades científicas de estudiantes de medicina en Perú / Production of the scientific societies of medical students in Peru

Introducción: Las escuelas de medicina en Perú tienen un papel importante en la producción científica y el desarrollo en salud del país. Las Sociedades Científicas de Estudiantes de Medicina promueven la investigación entre sus miembros. Sin embargo, no se conocen la evolución y el impacto de su producción científica en sus respectivas universidades. Objetivo: Describir la producción científica de las Sociedades Científicas de Estudiantes de Medicina en Perú durante el período 2002-2018. Métodos: Estudio descriptivo, que analizó los artículos científicos publicados durante 2002-2018 por alguna de las Sociedades Científicas de Estudiantes de Medicina que estuvieron afiliadas a la Sociedad Científica Médico Estudiantil Peruana. Estos artículos se recolectaron mediante una búsqueda sistemática y por autorreporte de los miembros de las sociedades. Además, en cada caso se calculó el aporte a la producción científica en Scopus de las universidades de origen. Resultados: La Sociedad Científica Médico Estudiantil Peruana registró 39 Sociedades Científicas de Estudiantes de Medicina afiliadas, las cuales publicaron 856 artículos científicos entre 2002 y 2018. Existió una tendencia creciente del número de artículos. Del total de estos, 407 (47,6 por ciento) fueron originales, 390 (45,6 por ciento) estaban indizados a Scopus y 580 (67,8 por ciento) tenían como primer autor a un miembro de alguna sociedad. La mediana de artículos por Sociedades Científicas de Estudiantes de Medicina resultó de 11 (rango: 1 a 154). Durante el período 2015-2018, en 9/34 universidades, las Sociedades Científicas de Estudiantes de Medicina aportaron más de la cuarta parte de la producción científica de su universidad a Scopus. Conclusiones: Las Sociedades Científicas de Estudiantes de Medicina presentaron variable producción científica y en varios casos aportaron significativamente a la producción de artículos científicos de sus universidades(AU)

Introduction: Medical schools in Peru play an important role in scientific production and health development nationwide. The Scientific Societies of Medical Students promote research among their members. However, the evolution and impact of their scientific production in their respective universities are not known. Objective: To describe the scientific production of the Scientific Societies of Medical Students in Peru during the period 2002-2018. Methods: Descriptive study that analyzed the scientific articles published during 2002-2018 by any of the Scientific Societies of Medical Students affiliated with the Peruvian Student Medical Scientific Society. These articles were collected through systematic search and self-report by the members of the societies. Also, in each case, the contribution of the universities of origin to Scopus scientific production was calculated. Results: The Peruvian Student Medical Scientific Society registered 39 affiliated Scientific Societies of Medical Students, which published 856 scientific articles between 2002 and 2018. There was an increasing trend in the number of articles. Of that total, 407 (47.6 percent) were original articles, 390 (45.6 percent) were indexed in Scopus and 580 (67.8 percent) had a member of a Society as their first author. The median number of articles by Scientific Societies of Medical Students was 11 (range: 1 to 154). During the 2015-2018 period, in 9 of 34 universities, the Scientific Societies of Medical Students contributed to Scopus more than a quarter of the scientific production of their university. Conclusions: The Scientific Societies of Medical Students presented a diverse scientific production and, in several cases, contributed significantly to the production of scientific articles at their universities(AU)

Insuficiencia renal y hemodiálisis en pacientes hospitalizados con COVID-19 durante la primera ola en Lima, Perú / Renal failure and hemodialysis in hospitalized patients with COVID-19 during the first wave in Lima, Peru

RESUMEN Antecedentes y objetivo: La insuficiencia renal es una de las complicaciones extrapulmonares más frecuente en pacientes hospitalizados con COVID-19 condicionando peores desenlaces. Sin embargo, estudios comparan pacientes con insuficiencia renal aguda (IRA) o crónica (ERC) con pacientes sanos. Determinar características clínicas de pacientes con COVID-19 e insuficiencia renal hospitalizados y evaluar el efecto del tipo de insuficiencia renal y el recibir hemodiálisis en los desenlaces clínicos negativos. Métodos: Cohorte descriptiva que incluyó pacientes con algún tipo de insuficiencia renal y COVID-19 hospitalizados durante marzo y julio del 2020, que tuvieron una interconsulta con nefrología. La insuficiencia renal se clasificó como aguda, crónica, y crónica en estadio V con hemodiálisis crónica. Se recolectó información sobre mortalidad, uso de inotrópicos, ventilación mecánica y recibir hemodiálisis aguda. Resultados: Se analizó a 279 pacientes, 22.6 % tenían IRA, 33.3 % tenían ERC, y 44.1 % tenían ERC V. Se describe una mortalidad general de 32.9 %. Entre los pacientes con IRA y ERC el 12.9 % recibió hemodiálisis por primera vez. El desarrollo de IRA se asoció a ventilación mecánica (RPa: 6.46), uso de inotrópicos (RPa: 7.02) y fallecer (RPa: 2.41), en comparación con los que tenían sólo ERC. Entre quienes tenían IRA o ERC, aquellos que recibieron hemodiálisis por primera vez tienen mayor prevalencia de fallecer (RPa: 2.95; IC95%:2.20 a 3.94) en comparación con los que no recibieron hemodiálisis. La hemodiálisis aguda podría ser un modificador de efecto de la asociación entre tipo de insuficiencia renal (IRA o ERC) y desenlaces clínicos negativos (p<0.001). Conclusión: Es importante identificar a pacientes hospitalizados por COVID-19 que desarrollan IRA y/o necesitan hemodiálisis aguda pues se encuentran en alto riesgo de tener una mala evolución clínica.

ABSTRACT Introduction: Kidney failure is one of the most frequent extrapulmonary complications in patients hospitalized with COVID-19, leading to poorer outcomes, and this may have serious consequences for the Peruvian health system. Nonetheless, there are studies comparing patients with acute kidney failure (AKF) and chronic kidney failure (CKF) against healthy subjects. Objective: To determine the clinical characteristics of hospitalized patients with COVID-19 and kidney failure, and to assess the effect of the type of kidney failure and undergo hemodialysis with respect to negative clinical outcomes. Methods: This is a descriptive cohort study that included patients with some kind of kidney failure and COVID-19 who were hospitalized between March and June 2020, and who had a consultation with the nephrology service. Kidney failure was classified as acute, chronic, and stage V chronic undergoing chronic hemodialysis. Data with respect to mortality, inotrope use, mechanical ventilation, and acute hemodialysis was collected. Results: Two-hundred and seventy-nine patients were included, 22.6% had acute kidney failure, 33.3% had chronic kidney failure, and 44.1 had stage V chronic kidney failure. General mortality rate was 32.0%, and 27% received inotrope agents and underwent mechanical ventilation. Amongst patients with AKF and CKF, 12.9% underwent hemodialysis for the first time. Studied adult subjects with CKD and stage V CKD undergoing hemodialysis had lower frequency of diabetes mellitus (23.7% and 43.9%, respectively) and high blood pressure (31.2% and 59.4%, respectively) compared with adult subjects with AKF (81.0 and 73%, respectively) (p<0.001). The occurrence of AKF was associated with mechanical ventilation (RPa: 6.46), inotrope use (RPa: 7.02), and death (RPa: 2.41), compared with those who had CKF. Amongst those subjects who had AKF or CKF, those who underwent dialysis for the first time were more likely to die (RPa: 2.95; 95% CI: 2.20-3.94) compared with those who did not undergo hemodialysis. Acute hemodialysis may be an effect modifier for the association between the type of kidney failure (AKF or CKF) and negative clinical outcomes (p<0.001). Conclusion: It is important to identify hospitalized patients with COVID-19 that may develop AKF and/or who may need acute hemodialysis, since they are at high risk for a poor clinical outcome.

Scoping Review of Clinical Practice Guidelines for the Early Management of Stroke with Focus on Endovascular Treatment.

BACKGROUND: Stroke represents one of the major causes of death and long-term disability worldwide and, even when new treatment strategies have been identified, there is a need of quality clinical practice guidelines (CPGs) to guide and improve acute stroke care. We aim to describe the characteristics and assess the quality of CPGs in endovascular treatment for acute ischemic stroke due to anterior-circulation large-vessel occlusion. METHODS: We conducted a scoping review of CPGs that assessed stroke management. We searched the following databases: PubMed, TripDatabase, Scopus, and Google Scholar to identify CPGs published or updated in the last 3 years and used Appraisal of Guidelines Research and Evaluation II to assess the quality of the guidelines. RESULTS: We found a total of 9 CPGs published or updated between 2018 and 2020, from which only one third had adequate methodologic rigor. Guidelines presented pitfalls related to evidence search, assessment, and methods used to reach the recommendations. All the CPGs considered a 24-hour extended window of treatment and the CPGs considered the use of similar imaging techniques to diagnose and explore the extent of the stroke. However, there were variations regarding the selection criteria for thrombectomy. CONCLUSIONS: The quality of the CPGs varied widely, which issues around the identification and assessment of the evidence used to reach recommendations. Despite this, the recommendations regarding the use of thrombectomy were similar across the CPGs. Readers need to carefully assess the methodologic rigor of CPGs before applying them to their clinical practice.