Characterization of oral yeasts isolated from healthy individuals attended in different Colombian dental clinics

The aim of this study was to identify the most frequent yeasts in the oral cavity of adult individuals without immune disorders and to associate the presence of these oral yeasts with different characteristics of each individual. Oral rinse samples were obtained from 96 healthy adults and cultured in Sabouraud dextrose agar media and CHROMagar. Yeasts were identified by sequencing the D1/D2 region of the 28S rRNA gene. Probable association among the socio-demographic characteristics, body mass index, family and personal medical history, oral hygiene, tobacco and/or alcohol consumption habits and presence of oral fungi was analyzed. Contingency tables and logistic regression were employed to evaluate possible relationships between the presence of oral fungi and mixed colonization with these variables. 57.3% of the healthy individuals had oral yeasts and 21.8% had mixed colonization. The most prevalent yeasts were Candida albicans (52%), C. parapsilosis (17.9%), and C. dubliniensis (7.57%). Yeasts with most frequently mixed colonization were C. albicans and C. parapsilosis. No relationships were found among the variables analyzed. However, the presence of mixed colonization was related to the presence of dental prostheses (P less than 0.006), dental apparatuses (P=0.016) and O'Leary index (P=0.012). This is the first study that characterized oral yeasts in Colombian healthy individuals, determined the most prevalent oral yeasts C. albicans, C. parapsilosis and C. dublinensis and an association of mixed colonization with the use of dental prostheses and aparatology and poor hygiene. © 2019 by the Journal of Biomedical Research

Global overview of the management of acute cholecystitis during the COVID-19 pandemic (CHOLECOVID study)

Background: This study provides a global overview of the management of patients with acute cholecystitis during the initial phase of the COVID-19 pandemic. Methods: CHOLECOVID is an international, multicentre, observational comparative study of patients admitted to hospital with acute cholecystitis during the COVID-19 pandemic. Data on management were collected for a 2-month study interval coincident with the WHO declaration of the SARS-CoV-2 pandemic and compared with an equivalent pre-pandemic time interval. Mediation analysis examined the influence of SARS-COV-2 infection on 30-day mortality. Results: This study collected data on 9783 patients with acute cholecystitis admitted to 247 hospitals across the world. The pandemic was associated with reduced availability of surgical workforce and operating facilities globally, a significant shift to worse severity of disease, and increased use of conservative management. There was a reduction (both absolute and proportionate) in the number of patients undergoing cholecystectomy from 3095 patients (56.2 per cent) pre-pandemic to 1998 patients (46.2 per cent) during the pandemic but there was no difference in 30-day all-cause mortality after cholecystectomy comparing the pre-pandemic interval with the pandemic (13 patients (0.4 per cent) pre-pandemic to 13 patients (0.6 per cent) pandemic; P = 0.355). In mediation analysis, an admission with acute cholecystitis during the pandemic was associated with a non-significant increased risk of death (OR 1.29, 95 per cent c.i. 0.93 to 1.79, P = 0.121). Conclusion: CHOLECOVID provides a unique overview of the treatment of patients with cholecystitis across the globe during the first months of the SARS-CoV-2 pandemic. The study highlights the need for system resilience in retention of elective surgical activity. Cholecystectomy was associated with a low risk of mortality and deferral of treatment results in an increase in avoidable morbidity that represents the non-COVID cost of this pandemic

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

Involving end users in adapting the spanish version of the mental health eClinic for young people in Colombia : A pilot study using participatory design methodologies

ManuscritoBackground: Health information technologies (HIT) hold enormous promise for improving access to, and better quality, mental health care. However, despite rapid spread of such technologies in high-income countries, they have not yet been commonly adopted in low and middle-income countries. People living in these parts of the world are at risk of experiencing not only physical but also technological and social health inequalities. One possible solution is to utilise already available (and successfully implemented) HITs developed in other counties. Objective: Using participatory design methodologies with Colombian end users (young people, their supportive others, health professionals), this study aimed to: conduct co-design workshops to culturally adapt an online mental health clinic (MHeC) for young people; perform one-on-one user testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC, and adapt it to the Colombian context; and, inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). Methods: Utilisation of a research and development (R&D) cycle including four iterative phases: co-design workshops; knowledge translation; tailoring to language, culture and place (or context); rapid prototyping; and then, one-on-one user testing sessions. Results: Two co-design workshops were held with 18 users (young people n=7, health professionals n=11). A total of 10 participated in one-on-one user-testing sessions (young people n=5, supportive others n=2, health professionals n=3). 203 source documents were collected and 605 annotations were coded. A thematic analysis resulted in six main themes (i.e. opinions about the MHeC-C, Colombian context, functionality, content, user interface and technology platforms). Participants liked the idea of having a MHeC specially designed and adapted for Colombian young people and its five key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video visit system and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop some additional functionality (eg. phone network backup, chat, geolocation, and integration with electronic medical records, apps or e-tools) as well as adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. Conclusions: The application of an iterative R&D cycle that also included processes for adaptation to Colombia (language, culture, context), resulted in the development of an evidence-based, language-appropriate, culturally-sensitive, context-adapted HIT that is relevant, applicable, engaging and usable in both the short- and longer-term. The resultant R&D cycle allowed for the adaptation of an already available HIT (i.e. MHeC) to the MHeC-C – a low-cost and scalable technology solution for low-tomiddle income countries such as Colombia, which has the potential to provide young people with accessible, available, affordable and integrated mental health care at the right time

Involving end users in adapting a spanish version of a Web-Based Mental Health Clinic for young people in Colombia : exploratory study using participatory design methodologies

Artículo original1-21BACKGROUND: Health information technologies (HITs) hold enormous promise for improving access to and providing better quality of mental health care. However, despite the spread of such technologies in high-income countries, these technologies have not yet been commonly adopted in low- and middle-income countries. People living in these parts of the world are at risk of experiencing physical, technological, and social health inequalities. A possible solution is to utilize the currently available HITs developed in other counties. OBJECTIVE: Using participatory design methodologies with Colombian end users (young people, their supportive others, and health professionals), this study aimed to conduct co-design workshops to culturally adapt a Web-based Mental Health eClinic (MHeC) for young people, perform one-on-one user-testing sessions to evaluate an alpha prototype of a Spanish version of the MHeC and adapt it to the Colombian context, and inform the development of a skeletal framework and alpha prototype for a Colombian version of the MHeC (MHeC-C). METHODS: This study involved the utilization of a research and development (R&D) cycle including 4 iterative phases: co-design workshops; knowledge translation; tailoring to language, culture, and place (or context); and one-on-one user-testing sessions. RESULTS: A total of 2 co-design workshops were held with 18 users-young people (n=7) and health professionals (n=11). Moreover, 10 users participated in one-on-one user-testing sessions-young people (n=5), supportive others (n=2), and health professionals (n=3). A total of 204 source documents were collected and 605 annotations were coded. A thematic analysis resulted in 6 themes (ie, opinions about the MHeC-C, Colombian context, functionality, content, user interface, and technology platforms). Participants liked the idea of having an MHeC designed and adapted for Colombian young people, and its 5 key elements were acceptable in this context (home page and triage system, self-report assessment, dashboard of results, booking and video-visit system, and personalized well-being plan). However, to be relevant in Colombia, participants stressed the need to develop additional functionality (eg, phone network backup; chat; geolocation; and integration with electronic medical records, apps, or electronic tools) as well as an adaptation of the self-report assessment. Importantly, the latter not only included language but also culture and context. CONCLUSIONS: The application of an R&D cycle that also included processes for adaptation to Colombia (language, culture, and context) resulted in the development of an evidence-based, language-appropriate, culturally sensitive, and context-adapted HIT that is relevant, applicable, engaging, and usable in both the short and long term. The resultant R&D cycle allowed for the adaptation of an already available HIT (ie, MHeC) to the MHeC-C-a low-cost and scalable technology solution for low- and middle-income countries like Colombia, which has the potential to provide young people with accessible, available, affordable, and integrated mental health care at the right time. ©Laura Ospina-Pinillos, Tracey A Davenport, Alvaro Andres Navarro-Mancilla, Vanessa Wan Sze Cheng, Andrés Camilo Cardozo Alarcón, Andres M Rangel, German Eduardo Rueda-Jaimes, Carlos Gomez-Restrepo, Ian B Hickie. Originally published in JMIR Mental Health (http://mental.jmir.org), 01.02.2020. KEYWORDS: Colombia; community-based participatory research; consumer health information; cultural characteristics; cultural competency; eHealth; ethnic groups; medical informatics; mental health; methods; patient participation; patient preference; patient satisfaction; primary health care; quality of health care; research design; telemedicin