Psychological interventions for healthcare professionals during the COVID-19 pandemic: A systematic review.

Healthcare professionals were especially vulnerable to pandemic, both to become infected and to develop a psychological problem. The aim of this systematic review is to analyze the effectiveness of psychological interventions for healthcare professionals in reducing the experienced psychological impact. From the 405 identified studies, 10 were included in this review. Four databases were searched and the risk of bias of included studies was assessed. The studies considered were randomized controlled trials. The screening and selection process was conducted by two independent reviewers. All studies presented results related with depression, anxiety, and stress during pandemic. Six were delivered using new technologies. The most effective were two psychological interventions with frequent contact and feedback provided by a mental health professional. The psychological interventions compared with non-intervention groups presented more significant results than those compared with another intervention. The highlights of this systematic review were the urgency of designing effectiveness psychological interventions for healthcare professionals to reduce the emotional burden associate with this job. These interventions should be maintained over the time, supported by a professional and provided from the workplace. These proposals presented promising results but were more psychological resources than psychological interventions.

Epidemiología de la anemia en adultos: estudio observacional de base poblacional / Epidemiology of anemia in adults: A population based study

Objetivo Determinar la prevalencia de la anemia y las características definitorias de los individuos que la padecen. Diseño Estudio observacional descriptivo de base poblacional. Variables extraídas de la base de datos informatizada de historias clínicas de atención primaria. Emplazamiento El presente estudio se realizó en la región sanitaria Metropolitana Nord, Barcelona. Participantes Pacientes con anemia evaluada mediante hemoglobina durante el año 2019. Criterios inclusión: mayores de 14 años, con determinaciones de hemoglobina por debajo del valor recomendado por la OMS. Criterio exclusión: no realizar seguimiento por la sanidad pública. Mediciones principales Variables demográficas, variables clínicas (fármacos, diagnóstico de anemia, paciente crónico complejo o enfermedad crónica avanzada. Variables consumo de recursos (número de visitas a atención primaria, número de ingresos hospitalarios y número de consultas a urgencias). Las variables demográficas y clínicas se evaluaron mediante frecuencias y porcentajes, media y desviación estándar para las variables cuantitativas. Las características de los diferentes subgrupos se compararon con la t de Student. Resultados La prevalencia de la anemia fue del 3,78%. Media de edad 64,5 años, el 60,8% mujeres. El 15,8% identificados como pacientes crónicos complejos. La hipertensión arterial presente en el 51,46%. El 50,97% fueron anemias ferropénicas. Consultaron al médico de familia 2,25 veces de media y a la enfermera de familia 1,49 veces. De las personas con criterios analíticos de anemia, solo el 46,57% tenían registrado un diagnóstico de anemia. Conclusiones En el territorio estudiado se ha objetivado un infraregistro del diagnóstico de anemia. Se observan diferencias en la caracterización por género y edad (AU)

Objective To determine the prevalence of anemia and the defining characteristics of the individuals who suffer from it. Design Population-based descriptive observational study. Variables extracted from the computerized database of primary care medical records. Setting This study was conducted in the Metropolitana Nord health region, Barcelona. Participants Patients with anemia evaluated by hemoglobin, during the year 2019. Inclusion criteria: older than 14 years, with hemoglobin determinations below the value recommended by the WHO. Exclusion criteria: no follow-up by public health. Main measurements Demographic variables, clinical variables (drugs, diagnosis of anemia, complex chronic patient or advanced chronic disease. Resource consumption variables (number of visits to primary care, number of hospital admissions, and number of visits to the emergency room). The variables demographic and clinical variables were evaluated using frequencies and percentages, mean and standard deviation for quantitative variables. The characteristics of the different subgroups were compared with Student's t-test. Results The prevalence of anemia was 3.78%. Mean age 64.5 years and 60.8% women. 15.8% identified as complex chronic patients. Arterial hypertension present in 51.46%. 50.97 were iron deficiency anemias. They consulted the family doctor 2.25 times on average and the family nurse 1.49. Of the people with analytical criteria for anemia, only 46.57 had a registered diagnosis of anemia. Conclusions In the territory studied, an under-reporting of the diagnosis of anemia has been observed. Differences are observed in the characterization by gender and age (AU)

Empleo de ventilación de alta frecuencia oscilatoria intraoperatoria en neonatos con hipoplasia pulmonar / Use of intraoperative high frequency oscillatory ventilation in neonates with pulmonary hypoplasia

La ventilación de alta frecuencia oscilatoria (VAFO) es una modalidad ventilatoria ampliamente utilizada en las unidades de cuidados intensivos neonatales. Su principal indicación es la patología pulmonar restrictiva con dificultad en alcanzar un adecuado intercambio gaseoso en ventilación mecánica convencional (VMC), siendo necesaria una elevada asistencia que puede suponer riesgo de barotrauma y volutrauma en un pulmón inmaduro. Las publicaciones sobre el empleo de VAFO en quirófano son limitadas y se reducen principalmente a su uso durante la reparación de hernia diafragmática congénita. La limitada experiencia de este método ventilatorio en quirófano puede suponer una barrera para el anestesiólogo. Sin embargo, es importante recordar los beneficios que esta modalidad ventilatoria aporta como estrategia de protección pulmonar. Se presentan dos casos de hipoplasia pulmonar neonatal de diferente etiología, en los que se empleó VAFO en el intraoperatorio con buenos resultados en la oxigenación y ventilación.(AU)

High-frequency oscillatory ventilation (HFOV) is a ventilatory modality widely used in neonatal intensive care units. Its main indication is restrictive lung pathology with difficult gas exchange using conventional mechanical ventilation (CMV). Patients receiving CMV require high intensity care, and immature lungs can be at risk for barotrauma and volutrauma. The few studies that have explored the use of HFOV in the operating room are mainly limited to HFVO during congenital diaphragmatic hernia repair. Limited experience of this ventilatory method in the operating room may be a disadvantage for the anesthesiologist. However, it is important to remember the benefits of this technique as a lung protection strategy. We report two cases of neonatal pulmonary hypoplasia of different etiology in which good oxygenation and ventilation was achieved with intraoperative HFOV.(AU)

Use of intraoperative high frequency oscillatory ventilation in neonates with pulmonary hypoplasia.

High-frequency oscillatory ventilation (HFOV) is a ventilatory modality widely used in neonatal intensive care units. Its main indication is restrictive lung pathology with difficult gas exchange using conventional mechanical ventilation (CMV). Patients receiving CMV require high intensity care, and immature lungs can be at risk for barotrauma and volutrauma. The few studies that have explored the use of HFOV in the operating room are mainly limited to HFVO during congenital diaphragmatic hernia repair. Limited experience of this ventilatory method in the operating room may be a disadvantage for the anesthesiologist. However, it is important to remember the benefits of this technique as a lung protection strategy. We report two cases of neonatal pulmonary hypoplasia of different etiology in which good oxygenation and ventilation was achieved with intraoperative HFOV.

[Epidemiology of anemia in adults: A population based study]. / Epidemiología de la anemia en adultos: estudio observacional de base poblacional.

OBJECTIVE: To determine the prevalence of anemia and the defining characteristics of the individuals who suffer from it. DESIGN: Population-based descriptive observational study. Variables extracted from the computerized database of primary care medical records. SETTING: This study was conducted in the Metropolitana Nord health region, Barcelona. PARTICIPANTS: Patients with anemia evaluated by hemoglobin, during the year 2019. INCLUSION CRITERIA: older than 14 years, with hemoglobin determinations below the value recommended by the WHO. EXCLUSION CRITERIA: no follow-up by public health. MAIN MEASUREMENTS: Demographic variables, clinical variables (drugs, diagnosis of anemia, complex chronic patient or advanced chronic disease. Resource consumption variables (number of visits to primary care, number of hospital admissions, and number of visits to the emergency room). The variables demographic and clinical variables were evaluated using frequencies and percentages, mean and standard deviation for quantitative variables. The characteristics of the different subgroups were compared with Student's t-test. RESULTS: The prevalence of anemia was 3.78%. Mean age 64.5 years and 60.8% women. 15.8% identified as complex chronic patients. Arterial hypertension present in 51.46%. 50.97 were iron deficiency anemias. They consulted the family doctor 2.25 times on average and the family nurse 1.49. Of the people with analytical criteria for anemia, only 46.57 had a registered diagnosis of anemia. CONCLUSIONS: In the territory studied, an under-reporting of the diagnosis of anemia has been observed. Differences are observed in the characterization by gender and age.

Complex interactions between nicotine and resveratrol in the Drosophila melanogaster wing spot test.

Nicotine (NIC) and resveratrol (RES) are chemicals in tobacco and wine, respectively, that are widely consumed concurrently worldwide. NIC is an alkaloid known to be toxic, addictive and to produce oxidative stress, while RES is thought of as an antioxidant with putative health benefits. Oxidative stress can induce genotoxic damage, yet few studies have examined whether NIC is genotoxic in vivo. In vitro studies have shown that RES can ameliorate deleterious effects of NIC. However, RES has been reported to have both antioxidant and pro-oxidant effects, and an in vivo study reported that 0.011 mM RES was genotoxic. We used the Drosophila melanogaster wing spot test to determine whether NIC and RES, first individually and then in combination, were genotoxic and/or altered the cell division. We hypothesized that RES would modulate NIC's effects. NIC was genotoxic in the standard (ST) cross in a concentration-independent manner, but not genotoxic in the high bioactivation (HB) cross. RES was not genotoxic in either the ST or HB cross at the concentrations tested. We discovered a complex interaction between NIC and RES. Depending on concentration, RES was protective of NIC's genotoxic damage, RES had no interaction with NIC, or RES had an additive or synergistic effect, increasing NIC's genotoxic damage. Most NIC, RES, and NIC/RES combinations tested altered the cell division in the ST and HB crosses. Because we used the ST and HB crosses, we demonstrated that genotoxicity and cell division alterations were modulated by the xenobiotic metabolism. These results provide evidence of NIC's genotoxicity in vivo at specific concentrations. Moreover, NIC's genotoxicity can be modulated by its interaction with RES in a complex manner, in which their interaction can lead to either increasing NIC's damage or protecting against it.

Pembrolizumab in soft-tissue sarcomas with tertiary lymphoid structures: a phase 2 PEMBROSARC trial cohort.

Immune checkpoint inhibitors (ICIs) show limited clinical activity in patients with advanced soft-tissue sarcomas (STSs). Retrospective analysis suggests that intratumoral tertiary lymphoid structures (TLSs) are associated with improved outcome in these patients. PEMBROSARC is a multicohort phase 2 study of pembrolizumab combined with low-dose cyclophosphamide in patients with advanced STS (NCT02406781). The primary endpoint was the 6-month non-progression rate (NPR). Secondary endpoints included objective response rate (ORR), progression-free survival (PFS), overall survival (OS) and safety. The 6-month NPR and ORRs for cohorts in this trial enrolling all comers were previously reported; here, we report the results of a cohort enrolling patients selected based on the presence of TLSs (n = 30). The 6-month NPR was 40% (95% confidence interval (CI), 22.7-59.4), so the primary endpoint was met. The ORR was 30% (95% CI, 14.7-49.4). In comparison, the 6-month NPR and ORR were 4.9% (95% CI, 0.6-16.5) and 2.4% (95% CI, 0.1-12.9), respectively, in the all-comer cohorts. The most frequent toxicities were grade 1 or 2 fatigue, nausea, dysthyroidism, diarrhea and anemia. Exploratory analyses revealed that the abundance of intratumoral plasma cells (PCs) was significantly associated with improved outcome. These results suggest that TLS presence in advanced STS is a potential predictive biomarker to improve patients' selection for pembrolizumab treatment.

Assessment of communication and physical exam skills: A comparison of students, faculty and standardized patients.

PURPOSE/OBJECTIVES: The objective of this retrospective study was twofold: it aimed to investigate dental students' communication and physical exam self-assessment skills by comparing students' self-evaluations with those completed by faculty and standardized patients (SPs). Second, it aimed to compare faculty and SPs assessment of students' communication skills. METHODS: At the end of their first year of training, students (n = 127), participated in one SP encounter about an initial dental consultation. Students completed self-assessment before receiving feedback from faculty (n = 19) and SPs (n = 19). The data source included evaluation forms submitted by students, faculty and SPs. The Wilcoxon signed rank test was used to compare the overall scores between groups. Agreement between evaluations items were analyzed with McNemar's test (p < 0.05). RESULTS: Overall, there were no statistically significant differences in how students and faculty graded for either communication (p = 0.6724) or physical exam (p = 0.1921) skills. However, both students and faculty provided less favorable marks than SPs for communication skills with a statistically significant difference in the overall grading between both students and SPs (p = 0.0146) and between faculty and SPs (p = 0.0045). CONCLUSIONS: While there was disagreement between students and faculty versus SPs, they weren't meaningful differences in scores and the dissimilarities mainly consisted of ratings of explanation skills. We suggest that, when applicable, dental student's self-evaluations may represent an alternative to faculty assessments of communication and physical exam skills. Nonetheless, we recommend that SPs be included in the assessment of communication skills to provide students with comprehensive feedback that more realistically represents the natural patient-provider relationship.

Surgeon-led 7-VINCut Antibiotic Stewardship Intervention Decreases Duration of Treatment and Carbapenem Use in a General Surgery Service.

Antibiotic stewardship programs optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. In this prospective interventional study, a multidisciplinary team led by surgeons implemented a program aimed at shortening the duration of antibiotic treatment <7 days. The impact of the intervention on antibiotic consumption adjusted to bed-days and discharges, and the isolation of multiresistant bacteria (MRB) was also studied. Furthermore, the surgeons were surveyed regarding their beliefs and feelings about the program. Out of 1409 patients, 40.7% received antibiotic therapy. Treatment continued for over 7 days in 21.5% of cases, and, as can be expected, source control was achieved in only 48.8% of these cases. The recommendations were followed in 90.2% of cases, the most frequent being to withdraw the treatment (55.6%). During the first 16 months of the intervention, a sharp decrease in the percentage of extended treatments, with R2 = 0.111 was observed. The program was very well accepted by surgeons, and achieved a decrease in both the consumption of carbapenems and in the number of MRB isolations. Multidisciplinary stewardship teams led by surgeons seem to be well received and able to better manage antibiotic prescription in surgery.

Bloqueo del nervio peneano ecoguiado en pediatría / Ultrasound-guided penile nerve block in paediatrics

No disponible

Programmed cell death 1 (PD-1) targeting in patients with advanced osteosarcomas: results from the PEMBROSARC study.

PURPOSE: There are some lines of evidence suggesting a potential role of immunotherapy for treating patients with osteosarcomas. PATIENTS AND METHODS: This was an open-label, multicentre, phase 2 study of pembrolizumab in combination with metronomic cyclophosphamide in patients with advanced osteosarcomas. All patients received 50 mg b.i.d. of cyclophosphamide one week on and one week off and 200 mg of intravenous pembrolizumab (every 3 weeks). There was a dual primary end-point, encompassing both the non-progression and objective responses at 6 months per Response Evaluation Criteria in Solid Tumours (RECIST), version 1.1. An objective response rate of 20% and/or a 6-month non-progression rate of 60% were determined as reasonable objectives for treatment with meaningful effect. Correlative studies of immune biomarkers were planned from the patients' tumour samples. RESULTS: Between October 13 2015 and July 3 2017, 17 patients were included. Fifty were assessable for the efficacy end-point. Four patients experienced tumour shrinkage, resulting in a partial response (PR) in one patient (6.7%). The 6-month non-progression rate was 13.3% (95% confidence interval [CI]: 1.7-40.5). The most frequent adverse events were grade I or II nausea, anaemia, anorexia and fatigue. programmed death-ligand 1 (PD-L1) expression rate was low, observed in only 2 cases of 14 with available tumour material. The only patient who experienced PR had a PD-L1-negative tumour. CONCLUSION: Programmed cell death 1 (PD-1) inhibition has limited activity in osteosarcomas. Further studies investigating PD-1 inhibitor in combination with agents modulating the microenvironment are warranted. TRIAL REGISTRATION: This study is registered with ClinicalTrials.gov, number NCT02406781.

Application of BioFire FilmArray Blood Culture Identification panel for rapid identification of the causative agents of ventilator-associated pneumonia.

OBJECTIVE: To evaluate the ability of the BioFire FilmArray Blood Culture Identification (BCID) panel to rapidly detect pathogens producing late-onset ventilator-associated pneumonia (VAP), a severe infection often produced by Gram-negative bacteria. These microorganisms are frequently multidrug resistant and typically require broad-spectrum empiric treatment. METHODS: In the context of an international multicentre clinical trial (MagicBullet), respiratory samples were collected at the time of suspicion of VAP from 165 patients in 32 participating hospitals in Spain, Greece and Italy. Microorganisms were identified using the BCID panel and compared with results obtained by conventional microbiologic techniques. RESULTS: Pseudomonas aeruginosa, Acinetobacter baumannii and Klebsiella pneumoniae were the most commonly identified species, representing 54.7% (70/128) of microorganisms. The BCID panel showed high global specificity (98.1%; 95% confidence interval, 96-100) and negative predictive values (96.6%) and a global sensitivity and positive predictive value of 78.6% (95% confidence interval, 70-88) and 87.3%, respectively, for these microorganisms. Importantly, the BCID panel provided results in only 1 hour directly from respiratory samples with minimal sample processing times. CONCLUSIONS: The BCID panel may have clinical utility in rapidly ruling out microorganisms causing VAP, specifically multidrug-resistant Gram-negative species. This could facilitate the optimization of empiric treatment.

Runoff initiation, soil detachment and connectivity are enhanced as a consequence of vineyards plantations.

Rainfall-induced soil erosion is a major threat, especially in agricultural soils. In the Mediterranean belt, vineyards are affected by high soil loss rates, leading to land degradation. Plantation of new vines is carried out after deep ploughing, use of heavy machinery, wheel traffic, and trampling. Those works result in soil physical properties changes and contribute to enhanced runoff rates and increased soil erosion rates. The objective of this paper is to assess the impact of the plantation of vineyards on soil hydrological and erosional response under low frequency - high magnitude rainfall events, the ones that under the Mediterranean climatic conditions trigger extreme soil erosion rates. We determined time to ponding, Tp; time to runoff, Tr; time to runoff outlet, Tro; runoff rate, and soil loss under simulated rainfall (55 mm h-1, 1 h) at plot scale (0.25 m2) to characterize the runoff initiation and sediment detachment. In recent vine plantations (<1 year since plantation; R) compared to old ones (>50 years; O). Slope gradient, rock fragment cover, soil surface roughness, bulk density, soil organic matter content, soil water content and plant cover were determined. Plantation of new vineyards largely impacted runoff rates and soil erosion risk at plot scale in the short term. Tp, Tr and Tro were much shorter in R plots. Tr-Tp and Tro-Tr periods were used as connectivity indexes of water flow, and decreased to 77.5 and 33.2% in R plots compared to O plots. Runoff coefficients increased significantly from O (42.94%) to R plots (71.92%) and soil losses were approximately one order of magnitude lower (1.8 and 12.6 Mg ha-1 h-1 for O and R plots respectively). Soil surface roughness and bulk density are two key factors that determine the increase in connectivity of flows and sediments in recently planted vineyards. Our results confirm that plantation of new vineyards strongly contributes to runoff initiation and sediment detachment, and those findings confirms that soil erosion control strategies should be applied immediately after or during the plantation of vines.

Lycopene, resveratrol, vitamin C and FeSO4 increase damage produced by pro-oxidant carcinogen 4-nitroquinoline-1-oxide in Drosophila melanogaster: Xenobiotic metabolism implications.

4-nitroquinoline-1-oxide (4-NQO) is a pro-oxidant carcinogen bioactivated by xenobiotic metabolism (XM). We investigated if antioxidants lycopene [0.45, 0.9, 1.8 µM], resveratrol [11, 43, 172 µM], and vitamin C [5.6 mM] added or not with FeSO4 [0.06 mM], modulate the genotoxicity of 4-NQO [2 mM] with the Drosophila wing spot test standard (ST) and high bioactivation (HB) crosses, with inducible and high levels of cytochromes P450, respectively. The genotoxicity of 4-NQO was higher when dissolved in an ethanol - acetone mixture. The antioxidants did not protect against 4-NQO in any of both crosses. In the ST cross, resveratrol [11 µM], vitamin C and FeSO4 resulted in genotoxicity; the three antioxidants and FeSO4 increased the damage of 4-NQO. In the HB cross, none of the antioxidants, neither FeSO4, were genotoxic. Only resveratrol [172 µM] + 4-NQO increased the genotoxic activity in both crosses. We concluded that the effects of the antioxidants, FeSO4 and the modulation of 4-NQO were the result of the difference of Cyp450s levels, between the ST and HB crosses. We propose that the basal levels of the XM's enzymes in the ST cross interacted with a putative pro-oxidant activity of the compounds added to the pro-oxidant effects of 4-NQO.

Empleo de adrenalina tópica en hematuria persistente por neoplasia vesical-infiltrante / Use of topical adrenaline in persistent hematuria due to infiltrating bladder cancer

La hematuria es un problema habitual en los tumores vesicales, y en ocasiones origina dolor irruptivo por la formación de coágulos. Las diferentes opciones terapéuticas incluyen quimioterapia, radioterapia o cirugía, así como tratamiento sintomático médico. Sin embargo, el manejo paliativo puede resultar complicado. Presentamos un caso de hematuria persistente tratada ambulatoriamente con adrenalina tópica con buen resultado

Hematuria and urinary obstruction are common problem in bladder tumors, and occasionally causes irruptive or breakthrough pain. Therapeutic options include chemotherapy, radiotherapy, surgery, or symptomatic medical treatment. However, palliative management can be complicated. The case is presented of a patient with persistent hematuria treated with topical adrenaline as an out-patient with positive results

Evening chronotype associates with obesity in severely obese subjects: interaction with CLOCK 3111T/C.

BACKGROUND: Chronotype has been related to obesity and metabolic disturbances. However, little is known about the relationship between circadian preferences and genetic background in CLOCK genes with obesity and weight loss among severely obese patients after bariatric surgery. OBJECTIVES: The research goals were (1) to examine whether evening chronotype is related to obesity and weight loss evolution in severely obese followed during 6 years after bariatric surgery and (2) to examine potential interactions between circadian preferences and CLOCK 3111T/C for obesity in this population. SUBJECTS/METHODS: Participants (n=252, 79% female; age (mean±s.d.): 52±11 years; body mass index (BMI): 46.4±6.0 kg m-2) were grouped into evening and morning types. Obesity and weight loss parameters, energy and macronutrients intake, energy expenditure, chronotype, meal timing, sleep duration and CLOCK genotype were studied. RESULTS: Evening-type subjects showed significantly higher initial body weight (P=0.015) and BMI (P=0.014) than morning types. Moreover, evening-type, when compared with morning types, lost less weight (percentage of excess weight loss) after bariatric surgery (P=0.015). Weight-loss progression between the two chronotype groups differed significantly from the fourth year after the bariatric surgery toward a higher weight regain among evening types (P<0.05). We also detected a significant interaction between CLOCK 3111T/C SNP and chronotype for body weight at baseline (P<0.001). Specifically, among carriers of the risk allele C, evening types showed higher body weight than morning types (P=0.012). In addition, CLOCK 3111T/C SNP significantly associated with obesity and sleep duration in the older subjects. CONCLUSIONS: Evening chronotype is associated with higher obesity in severely obese subjects and with lower weight loss effectiveness after bariatric surgery. In addition, circadian preferences interact with CLOCK 3111T/C for obesity. The circadian and genetic assessment could provide tailored weight loss recommendations in subjects who underwent bariatric surgery.