Involving society in science: Reflections on meaningful and impactful stakeholder engagement in fundamental research.

Open Science calls for transparent science and involvement of various stakeholders. Here are examples of and advice for meaningful stakeholder engagement.

Clinical and Pharmacological Parameters Determine Relapse During Clopidogrel Treatment of Acute Coronary Syndrome.

The therapeutic efficacy of clopidogrel as an antiplatelet drug varies among individuals, being the mainstream hypothesis that its bioavailability depends on the individual genetic background and/or interactions with other drugs. A total of 477 patients receiving double antiaggregation therapy with aspirin and clopidogrel, after suffering a first event, were followed for 1 year to record relapse, as a surrogate end point to measure their therapeutic response, as defined by presenting with an acute coronary event (unstable angina, ST-segment-elevation myocardial infarction, or non-ST-segment-elevation myocardial infarction), stent thrombosis/restenosis, or cardiac mortality. Anthropometric, clinical, and pharmacological variables along with CYP2C19 genotypes were analyzed for their association with the disease relapse phenotype. Only 75 patients (15%) suffered a relapse, which occurred during the first 6 months of therapy, with a peak at 4.5 months. An initial univariate analysis identified that patients in the relapse group were significantly older (67.4 ± 11.0 vs 61.6 ± 12.3 years old) and presented with diffuse coronary disease, insulin-dependent type 2 diabetes mellitus dyslipidemia, and arterial hypertension. A poor clinical response to the platelet antiaggregation regime also occurred more frequently among patients taking acenocoumarol and calcium channel blockers, along with aspirin and clopidogrel, while no association was found according to CYP2C19 genotypes. A retrospective multivariate analysis indicated that patients belonging to the nonresponder phenotype to treatment with aspirin and clopidogrel were older, presented with diffuse coronary disease, a group largely overlapping with type 2 insulin-dependent diabetes mellitus, and were taking dihidropyrimidinic calcium channel blockers.

Rapid progression of midventricular obstruction in adults with double-chambered right ventricle.

OBJECTIVE: The purpose of this study was to determine the rate of progression of midventricular obstruction in adolescents and adults with double-chambered right ventricle. METHODS: Clinical and echocardiographic findings in 45 patients (mean age 26 +/- 6 years, range 15-44) diagnosed with double-chambered right ventricle were retrospectively analyzed. Twenty patients underwent surgical repair before the age of 15 years. The relationship between Doppler midventricular pressure gradient and patient age was analyzed in 25 patients without previous repair. Sequential change in midventricular obstruction was determined for patients with 2 or more Doppler echocardiographic examinations performed within at least a 2-year interval. RESULTS: Right midventricular pressure gradient in nonrepaired patients was 70 +/- 38 mm Hg (range 25-150). A significant relationship between midventricular obstruction and patient age (r = 0.64, P <.001) was found. Midventricular pressure gradient at initial evaluation was 32 +/- 27 mm Hg in 16 patients < 25 years and 73 +/- 45 mm Hg in 9 patients >/= 25 years (P <.03). After the initial study, 5 patients underwent surgical repair and 13 patients without repair were followed up for a period of 6.1 +/- 2.7 years (range 2-9), in which midventricular pressure gradient increased from 32 +/- 26 mm Hg to 67 +/- 35 mm Hg (P <.001). The slope of the change in midventricular pressure gradient was 6.2 +/- 3 mm Hg per year of follow-up. Seven more patients underwent surgical repair during follow-up due to progression of the obstruction. There was no mortality nor residual midventricular obstruction in surgically repaired patients. CONCLUSIONS: Mild right midventricular obstruction shows a fast rate of progression in adolescents and young adults. Thus, close clinical and echocardiographic follow-up is advised, and surgical repair should be considered if significant progression of obstruction is detected.

[Differences in patient satisfaction by gender in users of hospitals in the Cantabrian Health Service]. / Diferencias en la satisfacción percibida según el sexo en los pacientes ingresados en los hospitales del Servicio Cántabro de Salud.

OBJECTIVE: To study differences in patient satisfaction by gender, among users of hospitals in the Cantabrian Health Service, and if differences were found, to modify organizational policies of the centers in order to improve the quality of care. METHODS: A cross-sectional study was performed in October 2006, using the SERVQHOS questionnaire by telephone. The database of the questionnaire was merged with CMBD database, from which we extracted the length of stay and surgical data. The Student-Fisher t-test was used for quantitative variables and the chi(2) test for qualitative variables. Adjustment was carried out by linear regression. RESULTS: The patient satisfaction is similar in male and female users of the hospitals in the Cantabrian Health Service. Although men are more satisfied on the information to relatives on the place and times for clinical information (92% vs 85.2%; p<0.01), the handing over of the discharge report (95.5% vs 90.9%; p=0.01), and that the report was the definitive (71.6% vs 64.7%; p=0.02). CONCLUSIONS: The differences we found in patient satisfaction by gender do not justify changes in hospital organization to try and improve the quality of care.

Cardioverter defibrillator implantation in a pregnant woman guided with transesophageal echocardiography.

This report describes a 28-year-old pregnant woman with mitral valve prolapse and sudden cardiac death due to a ventricular fibrillation who underwent an ICD implantation guided by tranesophageal echocardiography.

Diferencias en la satisfacción percibida según el sexo en los pacientes ingresados en los hospitales del Servicio Cántabro de Salud / Differences in patient satisfaction by gender in users of hospitals in the Cantabrian Health Service

Objetivo: Estudiar diferencias en la calidad percibida, en función del sexo, por los pacientes hospitalizados en alguno de los hospitales del Servicio Cántabro de Salud, para modificar, en el caso de encontrar diferencias, las políticas organizativas de los centros y mejorar la calidad de la asistencia. Métodos: Estudio de corte transversal realizado en octubre de 2006, mediante el cuestionario SERVQHOS, telefónicamente. La base de datos del cuestionario se fusionó con la base del CMBD, de la que se extrajeron los datos sobre estancia media e intervención quirúrgica. Los datos se analizaron mediante la prueba de la t de Student-Fisher para las variables de tipo cuantitativo y la prueba de la χ2 para las variables dicotómicas, y se ajustó mediante regresión lineal. Resultados: La satisfacción percibida por los pacientes del Servicio Cántabro de Saludes similar en varones y mujeres. Los varones están más satisfechos en cuanto a la información a familiares y acompañantes sobre el lugar y los horarios de información clínica(el 92 frente al 85,2%; p < 0,01), la entrega de informe médico al alta (el 95,5 frente al90,9%; p = 0,01) y la proporción de pacientes que recibieron el informe de alta definitivo (el 71,6 frente al 64,7%; p = 0,02).Conclusiones: Las diferencias que se han encontrado en cuanto a la satisfacción percibida entre los varones y las mujeres en los hospitales del Servicio Cántabro de Salud no justifican que se tomen medidas organizativas a la hora de mejorar la calidad asistencial (AU)

Objective: To study differences in patient satisfaction by gender, among users of hospitalsin the Cantabrian Health Service, and if differences were found, to modify organizationalpolicies of the centers in order to improve the quality of care. Methods: A cross-sectional study was performed in October 2006, using the SERVQHOS questionnaire by telephone. The database of the questionnaire was merged with CMBD database, from which we extracted the length of stay and surgical data. The Student-Fisher t-test was used for quantitative variables and the χ2 test for qualitative variables. Adjustment was carried out by linear regression. Results: The patient satisfaction is similar in male and female users of the hospitals in the Cantabrian Health Service. Although men are more satisfied on the information to relatives on the place and times for clinical information (92% vs 85.2%; p < 0.01), the handing over of the discharge report (95.5% vs 90.9%; p = 0.01), and that the report was the definitive (71.6% vs 64.7%; p = 0.02).Conclusions: The differences we found in patient satisfaction by gender do not justify changes in hospital organization to try and improve the quality of care (AU)