Implementation of ISO/IEEE 11073 PHD SpO2 and ECG Device Specializations over Bluetooth HDP following Health Care Profile for Smart Living.

Current m-Health scenarios in the smart living era, as the interpretation of the smart city at each person's level, present several challenges associated with interoperability between different clinical devices and applications. The Continua Health Alliance establishes design guidelines to standardize application communication to guarantee interoperability among medical devices. In this paper, we describe the implementation of two IEEE agents for oxygen saturation level (SpO2) measurements and electrocardiogram (ECG) data acquisition, respectively, and a smartphone IEEE manager for validation. We developed both IEEE agents over the Bluetooth Health Device Profile following the Continua guidelines and they are part of a telemonitoring system. This system was evaluated in a sample composed of 10 volunteers (mean age 29.8 ± 7.1 y/o; 5 females) under supervision of an expert cardiologist. The evaluation consisted of measuring the SpO2 and ECG signal sitting and at rest, before and after exercising for 15 min. Physiological measurements were assessed and compared against commercial devices, and our expert physician did not find any relevant differences in the ECG signal. Additionally, the system was assessed when acquiring and processing different heart rate data to prove that warnings were generated when the heart rate was under/above the thresholds for bradycardia and tachycardia, respectively.

Role of endoplasmic reticulum stress in renal damage after myocardial infarction.

Myocardial infarction (MI) is associated with renal alterations resulting in poor outcomes in patients with MI. Renal fibrosis is a potent predictor of progression in patients and is often accompanied by inflammation and oxidative stress; however, the mechanisms involved in these alterations are not well established. Endoplasmic reticulum (ER) plays a central role in protein processing and folding. An accumulation of unfolded proteins leads to ER dysfunction, termed ER stress. Since the kidney is the organ with highest protein synthesis fractional rate, we herein investigated the effects of MI on ER stress at renal level, as well as the possible role of ER stress on renal alterations after MI. Patients and MI male Wistar rats showed an increase in the kidney injury marker neutrophil gelatinase-associated lipocalin (NGAL) at circulating level or renal level respectively. Four weeks post-MI rats presented renal fibrosis, oxidative stress and inflammation accompanied by ER stress activation characterized by enhanced immunoglobin binding protein (BiP), protein disulfide-isomerase A6 (PDIA6) and activating transcription factor 6-alpha (ATF6α) protein levels. In renal fibroblasts, palmitic acid (PA; 50-200 µM) and angiotensin II (Ang II; 10-8 to 10-6M) promoted extracellular matrix, superoxide anion production and inflammatory markers up-regulation. The presence of the ER stress inhibitor, 4-phenylbutyric acid (4-PBA; 4 µM), was able to prevent all of these modifications in renal cells. Therefore, the data show that ER stress mediates the deleterious effects of PA and Ang II in renal cells and support the potential role of ER stress on renal alterations associated with MI.

The role of mitochondrial oxidative stress in the metabolic alterations in diet-induced obesity in rats.

The impact of the mitochondria-targeted antioxidant MitoQ was evaluated in the metabolic alterations and the adipose tissue remodeling associated with obesity. Male Wistar rats were fed either a high-fat diet (HFD; 35% fat) or a standard diet (3.5% fat) for 7 wk and treated with MitoQ (200 µM). A proteomic analysis of visceral adipose tissue from patients with obesity and patients without obesity was performed. MitoQ partially prevented the increase in body weight, adiposity, homeostasis model assessment index, and adipose tissue remodeling in HFD rats. It also ameliorated protein level changes of factors involved in insulin signaling observed in adipose tissue of obese rats: reductions in adiponectin and glucose transporter 4 (GLUT 4) and increases in dipeptidylpeptidase 4, suppressor of cytokine signaling 3 (SOCS3), and insulin receptor substrate 1 phosphorylation. MitoQ prevented down-regulation of adiponectin and GLUT 4 and increases in SOCS3 levels in a TNF-α-induced insulin-resistant 3T3-L1 adipocyte model. MitoQ also ameliorated alterations in mitochondrial proteins observed in obese rats: increases in cyclophylin F and carnitine palmitoyl transferase 1A and reductions in mitofusin1, peroxiredoxin 4, and fumarate hydratase. The proteomic analysis of the visceral adipose tissue from patients with obesity show alterations in mitochondrial proteins similar to those observed in obese rats. Therefore, the data show the beneficial effect of MitoQ in the metabolic dysfunction induced by obesity.-Marín-Royo, G., Rodríguez, C., Le Pape, A., Jurado-López, R., Luaces, M., Antequera, A., Martínez-González, J., Souza-Neto, F. V., Nieto, M. L., Martínez-Martínez, E., Cachofeiro, V. The role of mitochondrial oxidative stress in the metabolic alterations in diet-induced obesity in rats.

Barriers and facilitators to obesity prevention dissemination and implementation efforts in the childcare centre setting from the provider perspective.

BACKGROUND: It has been established that the childcare centre (CCC) is a setting suitable for healthy weight promotion efforts. As the field advances, it is important to understand the barriers and facilitators to early childhood obesity prevention implementation and dissemination efforts from the CCC providers' perspective. This is especially true among those who serve low-income and diverse populations to maximize scalability success. METHODS: Focus groups were held in English or Spanish with CCC providers across six CCCs who implemented healthy caregivers-healthy children (HC2), an early childhood healthy weight promotion programme targeting 2- to 5-year-olds from low-resource backgrounds. Centres represented both rural and urban environments. Focus groups were audio recorded, transcribed, and coded. A thematic analysis that combined a deductive and inductive approach was conducted. Codes were analysed using Dedoose to identify general themes and subthemes. RESULTS: CCC providers stated that (a) children understood the nutritional benefits of healthy foods; (b) improved cognitive development as a result of HC2; (c) parents were barriers to HC2 implementation efforts, particularly in terms of cooperative healthy lifestyle efforts; and (d) modelling healthy eating and making healthy CCC environmental changes facilitated HC2 implementation. Overall, HC2 was well received by CCC teachers, and they shared creative classroom HC2 adaptions and improvements. CONCLUSIONS: CCC providers can provide valuable insight to guide early childhood healthy weight promotion programme dissemination and implementation efforts. Although they value the implementation of HC2 programme in their classroom settings, they perceive parents as somewhat obstructive. This information is critical to informing future healthy weight promotion efforts in this setting, especially among low-resource families. It is important to continue to include the CCC provider viewpoint in future obesity prevention efforts to maximize scalability and sustainability efforts.

Discongruence Index　- Simple Indicator to Predict Prosthesis-Patient Mismatch After Transcatheter Aortic Valve Replacement.

BACKGROUND: Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) remains an important issue. The aim of this study was to assess the value of a new discongruence index, to predict PPM after TAVR.Methods and Results: A total of 185 patients with severe aortic stenosis who underwent TAVR with the Edwards Sapien prosthesis or CoreValve Revalving system were included (Edwards valve, n=119; Core Valve Revalving system, n=66). Discongruence index was calculated pre-procedurally as the ratio of selected transcatheter valve size (mm) to body surface area (cm2). PPM was defined as effective orifice area (EOA) ≤0.85 cm2/m2 on transthoracic echocardiography before hospital discharge. Mean age was 82±5 years and 72 patients (38.9%) were men. The overall incidence of post-TAVR PPM was 35.1% (n=65). Discongruence index correlated with post-TAVR indexed EOA (y=0.18+0.057x; P<0.001). On multivariate logistic regression analysis, discongruence index was the only independent predictor of post-TAVR PPM (OR, 0.15; 95% CI: 0.03-0.66; P=0.012), and the area under the receiver operating characteristic curve was 0.62 (95% CI: 0.54-0.70, P=0.003), with an optimal cut-off point of 15.02 (sensitivity, 86.2%; specificity, 72.5%; positive predictive value, 74.3%; negative predictive value, 83.4%). CONCLUSIONS: The new discongruence index may be useful tool to predict PPM after TAVR.

The lysyl oxidase inhibitor (ß-aminopropionitrile) reduces leptin profibrotic effects and ameliorates cardiovascular remodeling in diet-induced obesity in rats.

Lysyl oxidase (LOX) is an extracellular matrix (ECM)-modifying enzyme that has been involved in cardiovascular remodeling. We explore the impact of LOX inhibition in ECM alterations induced by obesity in the cardiovascular system. LOX is overexpressed in the heart and aorta from rats fed a high-fat diet (HFD). ß-Aminopropionitrile (BAPN), an inhibitor of LOX activity, significantly attenuated the increase in body weight and cardiac hypertrophy observed in HFD rats. No significant differences were found in cardiac function or blood pressure among any group. However, HFD rats showed cardiac and vascular fibrosis and enhanced levels of superoxide anion (O2(-)), collagen I and transforming growth factor ß (TGF-ß) in heart and aorta and connective tissue growth factor (CTGF) in aorta, effects that were attenuated by LOX inhibition. Interestingly, BAPN also prevented the increase in circulating leptin levels detected in HFD fed animals. Leptin increased protein levels of collagen I, TGF-ß and CTGF, Akt phosphorylation and O2(-) production in both cardiac myofibroblasts and vascular smooth muscle cells in culture, while LOX inhibition ameliorated these alterations. LOX knockdown also attenuated leptin-induced collagen I production in cardiovascular cells. Our findings indicate that LOX inhibition attenuates the fibrosis and the oxidative stress induced by a HFD on the cardiovascular system. The reduction of leptin levels by BAPN in vivo and the ability of this compound to inhibit leptin-induced profibrotic mediators and ROS production in cardiac and vascular cells suggest that interactions between leptin and LOX regulate downstream events responsible for myocardial and vascular fibrosis in obesity.

Prenatal Decision-Making in Patients with Limited English Proficiency: What Factors are Involved?

Introduction: A comprehensive definition of culture encompasses shared norms, beliefs, expectations, language, and customs, all of which are crucial considerations when working with patients with limited English proficiency (LEP). In this study, the authors examined how language, external influences, and patient-provider relational factors associated with decisional conflict in prenatal care patients. Methods: The authors conducted a cross-sectional study to assess decisional conflict related to postpartum contraception, elective induction, and newborn feeding methods. The survey included questions about demographics, communication methods, external influences, and provider trust, and was distributed to prenatal care patients who spoke either English or Spanish. Data analysis involved using descriptive statistics and chi-square analyses. Results: Out of the 23 respondents, 12 were Spanish-speaking and 11 were English-speaking. Spanish-speaking participants were less likely to have health insurance compared to English-speaking participants (χ2(1, N = 23) = 3.67, p = 0.016). There was no statistically significant difference in decisional conflict between English- and Spanish-speaking participants. Religion affected 11 of 23 participants' decisions, while partner expectations influenced 10 of 23 participants. Working with an interpreter and the quality of interpretation were crucial for Spanish-speaking individuals. Most participants (59%) felt that the provider's understanding of the patient's cultural background was important for decision-making. Conclusions: While there was no association between language discordance and decisional conflict, several factors influencing prenatal decision-making were identified. The use and quality of interpretation significantly affected decision-making and should be prioritized for patients with LEP. Religion and partner expectations were found to be highly influential in decision-making. Respondents also emphasized the importance of the provider's understanding of the patient's cultural background.

Methodology for the induction of myocardial infarction and cardiac function evaluation.

Cardiovascular disease (CVD) is the main cause of death worldwide, with myocardial infarction (MI) being the most prevalent pathology involved in CVD. MI is characterized by a deficiency in oxygen supply to the myocardium, thereby promoting ventricular remodeling of the ischemic and remote zone of the heart. Cardiac remodeling associated with MI could promote the development of heart failure and finally death. For these reasons, it is important to develop animal models that mimic human cardiac disease which could help to identify new mechanisms involved in the pathology and, consequently, develop new therapeutic strategies. We herein describe in detail a protocol for MI induction with low mortality rate (<15%) in rats by ligation of the left anterior descending artery. In addition, we also describe two imaging techniques which allow to evaluate cardiac structure and function-including deformation parameters in rats such as transthoracic echocardiography and cardiac magnetic resonance. This animal model could be useful for acute and chronic studies and for evaluating the potential usefulness of different treatments.

Superiority of 3D planimetry over pressure half-time method for the assessment of mitral valve area after percutaneous edge-to-edge mitral repair.

INTRODUCTION AND OBJECTIVES: There is limited evidence to identify the most accurate method for measuring the mitral valve area (MVA) after percutaneous edge-to-edge mitral repair. Our objective was to evaluate the optimal method in this context and its correlation with the mean transmitral gradient. METHODS: A registry of patients undergoing percutaneous mitral repair was conducted, analyzing different methods of measuring MVA and their correlation with the mean gradient. RESULTS: We analyzed data from 167 patients. The mean age was 76±10.3 years, 54% were men, and 46% were women. Etiology was degenerative in 45%, functional in 39%, and mixed in 16%. Postclip MVA measurements were 1.89±0.60 cm2 using pressure half-time (PHT), 2.87±0.83 cm2 using 3D planimetry, and the mean gradient was 3±1.19mmHg. MVA using 3D planimetry showed a stronger correlation with the mean gradient (r=0.46, P<.001) than MVA obtained by PHT (r=0.19, P=.048). Interobserver agreement was also higher with 3D planimetry than with PHT (intraclass correlation coefficient of 0.90 vs 0.81 and variation coefficient of 9.6 vs 19.7%, respectively). CONCLUSIONS: Our study demonstrates that the PHT method significantly underestimates MVA after clip implantation compared with direct measurement using transesophageal 3D planimetry. The latter method also correlates better with postimplantation gradients and has less interobserver variability. These results suggest that 3D planimetry is a more appropriate method for assessing postclip mitral stenosis.

Nutrient-based dietary patterns of head and neck squamous cell cancer: a factor analysis in Uruguay.

OBJECTIVE: The aim of this study was to investigate the association between nutrient-based dietary patterns and squamous cell cancers of the head and neck. METHODS: We used a case-control study which included 548 cases and 548 controls. From these participants, we derived 23 nutrients and they were then submitted to a factorability analysis in order to conduct a principal component factor analysis. RESULTS: We were able to identify four nutrient-derived patterns. The first pattern (meat-based pattern) was positively associated with squamous cell cancer of the head and neck (OR 2.85, 95 % CI 1.81-4.15), whereas the third pattern (fruit-based) was strongly protective (OR 0.43, 95 % CI 0.27-0.63). The other nutrient patterns were also significantly associated with head and neck squamous cell carcinoma with minor ORs. CONCLUSION: Both patterns suggest that red meat and fruits are major factors in the etiology of head and neck squamous cell cancer, replicating previous studies in the field.

Cultural Beliefs Regarding Breast Reconstruction in a Minority Group.

Background: The diagnosis and treatment of breast cancer can significantly affect a woman's health and well-being. Several studies have identified factors contributing to disparities in breast reconstruction among ethnic groups, but few have examined the experience of Hispanic women. Methods: Hispanic women who had undergone breast reconstruction were interviewed in retrospective focus groups. Data were collected to identify themes that affected decision-making regarding the type and timing of reconstruction. Results: Most participants chose to undergo reconstruction to regain normalcy and maintain their previous "feminine" appearance. Most (75%) received silicone breast implants, and 25% received autologous reconstruction. Safety was the most important consideration when choosing the type of reconstruction. All but 1 participant relied on a spouse or other family member for support during recovery. Although most found the experience overwhelming, they felt their community was supportive and encouraging throughout the process. Conclusions: Several themes underlying the decision to undergo reconstruction were identified, including maintaining femininity and choosing the safest procedure. Overall, participants described the experience as overwhelming but found support from community and family. These findings, which could be applied broadly to women regardless of ethnicity, can be used to improve communication between surgeon and patient throughout the reconstruction process.

Impacts, Learner Diversity, and Curricular Framework of a Virtual Global Health Elective Catalyzed by the COVID-19 Pandemic.

Background: Place-based international electives that build global health competencies have existed for decades. However, these electives require travel and are infeasible for many trainees around the world, particularly those with insufficient financial resources, logistical complexities, or visa limitations. The emergence of virtual approaches to global health electives, catalyzed by the travel pause related to the COVID-19 pandemic, necessitates the exploration of learner impacts, participant diversity, and curricular frameworks. Child Family Health International (CFHI), a non-profit global health education organization that partners with universities to expand immersive educational offerings, launched a virtual global health elective in 2021. The elective drew on faculty from Bolivia, Ecuador, Ghana, Mexico, the Philippines, Uganda, and the United States. Objective: This study aimed to describe a newly developed virtual global health elective curriculum and evaluate the demographics of and impacts on trainee participants. Methods: Eighty-two trainees who were enrolled in the virtual global health elective from January to May 2021 completed both 1) pre- and post-elective self-assessments of domains of competency mapped to the elective curriculum and 2) free text responses to standardized questions. Data were analyzed through descriptive statistical analysis, paired t-testing, and qualitative thematic analysis. Findings: The virtual global health elective had 40% of its participants hail from countries other than the United States. Self-reported competency in global health broadly, planetary health, low resource clinical reasoning, and overall composite competency significantly increased. Qualitative analysis revealed learner development in health systems, social determinants of health, critical thinking, planetary health, cultural humility, and professional practice. Conclusion: Virtual global health electives effectively develop key competencies in global health. This virtual elective had a 40-fold increase in the proportion of trainees from outside the United States, compared to pre-pandemic place-based electives. The virtual platform facilitates accessibility for learners from a variety of health professions and a wide range of geographic and socioeconomic environments. Further research is needed to confirm and expand on self-reported data, and to pursue approaches to greater diversity, equity, and inclusion in virtual frameworks.

Redefining cardiac damage staging in aortic stenosis: the value of GLS and RVAc.

AIMS: Cardiac damage staging has been postulated as a prognostic tool in patients undergoing transcatheter aortic valve replacement (TAVR). The aims of our study are (i) to validate cardiac damage staging systems previously described to stratify patients with aortic stenosis (AS), (ii) to identify independent risk factors for 1-year mortality in patients with severe AS undergoing TAVR, and (iii) to develop a novel staging model and compare its predictive performance to that of the above mentioned. METHODS AND RESULTS: Patients undergoing TAVR from 2017 to 2021 were included in a single-centre prospective registry. Transthoracic echocardiography was performed in all patients before TAVR. Logistic and Cox's regression analysis were used to identify predictors of 1-year all-cause mortality. In addition, patients were classified based on previously published cardiac damage staging systems, and the predictive performance of the different scores was measured.Four hundred and ninety-six patients (mean age 82.1 ± 5.9 years, 53% female) were included. Mitral regurgitation (MR), left ventricle global longitudinal strain (LV-GLS) and right ventricular-arterial coupling (RVAc) were independent predictors of all-cause 1-year mortality. A new classification system with four different stages was developed using LV-GLS, MR, and RVAc. The area under the receiver operating characteristic curve was 0.66 (95% confidence interval 0.63-0.76), and its predictive performance was superior compared with the previously published systems (P < 0.001). CONCLUSION: Cardiac damage staging might have an important role in patients' selection and better timing for TAVR. A model that includes LV-GLS, MR, and RVAc may help to improve prognostic stratification and contribute to better selection of patients undergoing TAVR.

Current Usefulness of Transesophageal Echocardiography in Patients Undergoing Transcatheter Aortic Valve Replacement.

This review article describes in depth the current usefulness of transesophageal echocardiography in patients who undergo transcatheter aortic valve replacement. Pre-intervention, 3D-transesophageal echocardiography allows us to accurately evaluate the aortic valve morphology and to measure the valve annulus, helping us to choose the appropriate size of the prosthesis, especially useful in cases where the computed tomography is not of adequate quality. Although it is not currently used routinely during the intervention, it remains essential in those cases of greater complexity, such as for patients with greater calcification and bicuspid valve, mechanical mitral prosthesis, and "valve in valve" procedures. Three-dimensional transesophageal echocardiography is the best technique to detect and quantify paravalvular regurgitation, a fundamental aspect to decide whether immediate valve postdilation is needed. It also allows to detect early any immediate complications such as cardiac tamponade, aortic hematoma or dissection, migration of the prosthesis, malfunction of the prosthetic leaflets, or the appearance of segmental contractility disorders due to compromise of the coronary arteries ostium. Transesophageal echocardiography is also very useful in follow-up, to check the proper functioning of the prosthesis and to rule out complications such as thrombosis of the leaflets, endocarditis, or prosthetic degeneration.

Meat consumption, cooking methods, mutagens, and risk of squamous cell carcinoma of the esophagus: a case-control study in Uruguay.

The role of meat in squamous cell carcinoma of the esophagus (ESCC) has been considered conflictive. For this reason, we decided to conduct a case-control study on meat consumption and ESCC. Data included 234 newly diagnosed and microscopically examined ESCC and 2,020 controls with conditions not related to tobacco smoking nor alcohol drinking and without changes in their diets. We studied total meat, red meat, beef, lamb, processed meat, poultry, fish, total white meat, liver, fried meat, barbecued meat, boiled meat, heterocyclic amines, nitrosodimethylamine, and benzo[a]pyrene in relation with the risk of ESCC. Red meat, lamb, and boiled meat were directly associated with the risk of ESCC, whereas total white meat, poultry, fish, and liver were mainly protective against this malignancy.

The impact of bariatric surgery on renal and cardiac functions in morbidly obese patients.

BACKGROUND: Cardiac adaptation to obesity includes both structural and functional alterations in the heart. The kidneys also suffer the consequence of excessive increase of body weight. This study aims to assess the functional, cardiac and renal changes in a cohort of morbidly obese patients, as well as changes after bariatric surgery-the last therapeutic option for these patients. METHODS: Patients referred for bariatric surgery were prospectively included. In each case, transthoracic echocardiography and a blood test were performed before the procedure and repeated 1 year after surgery. The estimation of the glomerular filtration rate (GFR) was addressed by the Cockroft-Gault lean body weight formula. RESULTS: Sixty-one patients completed the 1-year follow-up. Of these, 81.9% were female. The mean age was 41.1 ± 9.8 years and the mean body mass index was 47.4 ± 5 kg/m(2), decreasing to 30.5 ± 5.07 kg/m(2) after the procedure. Before surgery, the estimated GFR was 92.7 ± 25.4 mL/min, with hyperfiltration being present in 14.8% of patients, whereas an impaired GFR was detected in 8.3%. Patients showed preserved systolic function and cardiac remodelling. Diastolic function was abnormal in 27.9% of patients. At the 1-year follow-up, favourable changes in the left ventricular geometry and related haemodynamic status were observed. There was no significant change in the estimated GFR in the overall group, although hyperfiltration was ameliorated in 9.8% and a poor GFR was improved in 3.3.%. The improvement was not associated with changes in either blood pressure or the BMI. However, in this group of patients the amelioration of the GFR was associated with an increased stroke volume and improvement in diastolic function. CONCLUSIONS: In morbidly obese patients, GFR is usually normal and only a small percentage of them show hyperfiltration or a reduced GFR. Bariatric surgery has a favourable impact on renal function in only a reduced group of patients who also experience an improvement in cardiac performance.

Exercise during pregnancy improves maternal glucose screen at 24-28 weeks: a randomised controlled trial.

OBJECTIVE: The influence of an exercise programme performed by healthy pregnant women on maternal glucose tolerance was studied. STUDY DESIGN: A physical activity (PA, land/aquatic activities) programme during the entire pregnancy (three sessions per week) was conducted by a qualified instructor. 83 healthy pregnant women were randomly assigned to either an exercise group (EG, n=40) or a control (CG, n=43) group. 50 g maternal glucose screen (MGS), maternal weight gain and several pregnancy outcomes were recorded. RESULTS: Significant differences were found between study groups on the 50 g MGS. Values corresponding to the EG (103.8 ± 20.4 mg/dl) were better than those of the CG (126.9 ± 29.5 mg/dl), p=0.000. In addition, no differences in maternal weight gain and no cases of gestational diabetes in EG versus 3 in CG (7%) (p>0.05) were found. CONCLUSION: A moderate PA programme performed during pregnancy improves levels of maternal glucose tolerance.

Lessons Learned from Implementing Unconscious Bias Training at an Academic Medical Center.

Introduction: In 2018, our Midwestern university medical center began offering unconscious bias training. Each session concluded with a standard evaluation. We analyzed two years of data that focused on three areas: 1) whether demographic differences or amount of prior knowledge on the topic influenced the training experience; 2) what participants liked best about the training; and 3) whether participants' stated intentions to apply their learning at the end of the training aligned with institutional goals of the training. Methods: Participants attended sessions open to the campus community pre-scheduled by the Office for Diversity, Equity, and Inclusion and posted on its website. Chi-square tests were utilized to test associations between outcomes and questionnaire responses. Outcome measures included race/ethnicity, prior knowledge level, and overall rating of the training. Thematic analysis was used to code comments and establish themes from two open-ended survey questions. Results: Significant differences were found by race and ethnicity for all questionnaire responses; each were p < 0.001. Those who reported they had advanced/expert knowledge on the topic were less likely to report the training increased their knowledge, and those who reported their race as White/Caucasian tended to give the training the highest overall rating, as did heterosexuals. Through thematic analysis, participants valued the interactive nature of the training sessions, the use of storytelling, and the safety of the learning environment. Participants' intention to apply their learning indicated they had gained general awareness of bias and settings where it might influence their work. Conclusions: In an effort to foster a better working and learning environment for those who are underrepresented in the health professions, training was provide that may not have met the expectations of all participants. At the same time, participants who identified as White clearly increased their awareness of bias. Therefore, it is recommended to move away from one-size-fits-all unconscious bias training and develop a robust training continuum to provide ongoing advancement for diverse audiences.

Impact of previous cardiac function status assessed by echocardiography on the outcome of COVID-19.

More than 91,000 fatalities due to Coronavirus Disease 2019 (COVID-19) have occurred in Spain. Several factors are associated with increased mortality in this disease, including cardiovascular risk factors (CVRF). However, information on the cardiac function of patients prior to the onset of COVID-19 is scarce and the potential impact it may have is uncertain. The aim of the EchoVID study was to describe the potential association between CVRF and cardiac function status prior to SARS-CoV-2 infection and in-hospital mortality. We studied clinical characteristics and cardiac function of patients admitted during the first wave of COVID-19. All patients had a transthoracic echocardiogram performed in the previous 12 months prior to diagnosis; conventional systolic and diastolic function parameters were analyzed. Logistic regression analysis was performed to identify predictors of in-hospital mortality. We included 296 individuals. Median age was higher in the group of patients who died (81.0 vs 76.1 years; p = 0.007). No significant differences were found in CVRF. Survivors were more frequently receiving anticoagulation therapy (52.9% vs 70.8%; p = 0.003). LVEF, although preserved on average in both groups, was significantly lower in the group of deceased patients (56.9% vs 61.1%; p = 0.017). Average E/e' ratio was higher in the deceased group (11.1 vs 10.1; p = 0.049). Five variables were found to be independently associated with in-hospital mortality due to COVID-19: Age, male gender, LVEF, E/e' ratio and anticoagulation therapy. A model including these variables had an area under the ROC curve of 0.756 (CI 0.669-0.843). The echocardiographic variables included in the model significantly improved the discriminative power, compared to a model including only demographic data. Left ventricular ejection fraction and E/e' ratio prior to SARS-CoV-2 infection are two easily-obtained echocardiographic parameters that provide additional prognostic information over clinical factors when assessing patients admitted for SARS-CoV-2 infection.

Business intelligence for the visualization and data analysis of Telepharmacy activity indicators in a hospital pharmacy service scorecard.

OBJECTIVE: The consolidation of Telepharmacy during the COVID-19 pandemic  has raised the need for managing large volumes of real-time activity data  through data analysis. The aim of this project was to design a dynamic, user- friendly, customizable scorecard in a hospital pharmacy service for the  visualization and analysis of Telepharmacy activity indicators through the use  of advanced business intelligence technology. METHOD: The software tool was developed by a multidisciplinary team between  April and May 2021, driven from the hospital pharmacy service. Once the Telepharmacy indicators of interest were established,  datasets were extracted from raw databases (administrative databases,  Telepharmacy database, outpatient dispensing software, drug catalogues)  through data analysis. The different data sources were integrated in a  scorecard using PowerBI®. The criteria for processing missing and duplicated  data were defined, and data pre-processing, normalization and transformation were performed. Once the pilot scorecard was validated by  different profiles of users, the structure was designed for the panels to  automatically update as databases were updated. RESULTS: Design and implementation of a scorecard of Telepharmacy activity:  general descriptive panel (demographic profile of patients, count and delivery  conditions, program and medical service); geolocation of destination;  pharmacological profile; relative analysis of patients involved in the  Telepharmacy program with respect to the total of outpatients. In the last  updating as of January 2022, data from 16,000 dispensations to more than  4,000 patients had been collected. This means that 21.93% of outpatients had  benefited at some time point from the Telepharmacy service. Filters enable the  visualization of timeline progress and patient characterization, and  measure Telepharmacy activity by program. CONCLUSIONS: The processing of large Telemedicine datasets from various  sources through Business Intelligence in a hospital pharmacy service makes it  possible to synthesize information, generate customized reports, and visualize  information in a dynamic and attractive format. The application of this new  technology will help us improve strategic clinical and management decision  making.

OBJETIVO: La consolidación de la Telefarmacia en el contexto de la pandemia por la COVID-19 exige manejar a tiempo real un gran volumen de datos de actividad mediante análisis de datos. El objetivo de este trabajo fue diseñar un cuadro de mando ágil, personalizable y dinámico para la visualización y análisis de indicadores de actividad en Telefarmacia en un servicio de farmacia de hospital, mediante el empleo de herramientas  avanzadas de inteligencia empresarial (business intelligence).Método: Un equipo de trabajo multidisciplinar desarrolló una herramienta de  software entre abril y mayo de 2021 impulsado desde el servicio de farmacia  de hospital. Una vez consensuados los indicadores de interés en Telefarmacia,  se extrajeron los datos a partir de bases de datos brutas (base de datos de  Telefarmacia, programa de dispensación de pacientes externos, bases de datos  administrativas, catálogos de fármacos) mediante análisis de datos. La  integración de las diferentes fuentes de datos en el cuadro de mando se realizó mediante PowerBI®. Se definió el manejo de los datos perdidos y duplicados y  se aplicó preprocesamiento, normalización y transformación de los datos. Una  vez  validado el piloto por diferentes tipos de usuarios, se diseñó la estructura para actualización automática de los paneles con las sucesivas actualizaciones de las fuentes de datos. RESULTADOS: Diseño e implementación de un cuadro de mando de la actividad  en Telefarmacia: panel descriptivo general (perfil demográfico de pacientes,  recuento y condiciones de envíos, programa y servicio médico); geolocalización  de destino; perfil farmacológico; análisis relativo de los  pacientes beneficiarios de Telefarmacia respecto del total de pacientes  externos. En el último corte, a enero de 2022, se habían incluido datos de  16.000 dispensaciones con entrega informada a más de 4.000 pacientes, lo  que supone que el 21,93% de los pacientes externos han estado en algún momento en el programa de Telefarmacia. La aplicación de filtros permite  visualizar la evolución temporal, caracterizar grupos de pacientes y  dimensionar la actividad por programas. CONCLUSIONES: El procesamiento de paquetes de datos de Telemedicina, de  gran volumen, difícil manejo y procedentes de diversas fuentes relativas a Telefarmacia mediante inteligencia empresarial, en un servicio de farmacia  de hospital, permite sintetizar la información y proporcionar informes  personalizados y visualizaciones dinámicas y atractivas. La aplicación de estas  nuevas tecnologías puede ayudarnos a mejorar la toma de decisiones  estratégicas, tanto clínicas como de gestión.