Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Development of ergonomic training materials for workers in the construction sector

[EN] In the last years, Fundación Laboral de la Construcción and the Instituto de Biomecánica de Valencia have worked together to developed materials to improve ergonomic conditions in the construction sector [1-4]. The present article shows the results of the project carried out during 2009. The main objective of the project was to improve the ergonomic conditions of the construction sector. In order to achieve the objective, training material about ergonomic issues was carried out. The training material was provided to the Trained Technician so that, they have available ergonomic training material to train workers of the construction sector.[ES] En los últimos años la Fundación Laboral de la Construcción y el Instituto de Biomecánica (IBV) han elaborado conjuntamente una serie de materiales para contribuir a la mejora de las condiciones ergonómicas en el sector de la construcción [1-4]. Este artículo pretende mostrar los resultados obtenidos en el proyecto para el desarrollo de contenidos formativos que ambas entidades han elaborado durante 2009. Su objetivo ha consistido en facilitar a los técnicos de formación del sector de la Construcción las herramientas necesarias para incluir los aspectos ergonómicos como parte de la formación que se imparte a los trabajadores. Con ello se persigue contribuir a la mejora de las condiciones ergonómicas del sector. Además, estos contenidos permitirán preparar materiales de formación que puedan ser entregados a los trabajadores del sector.Agradecemos a la Fundación para la Prevención de Riesgos Laborales la asignación de recursos sin los cuales este presente proyecto no podría haberse desarrollado, así como a todas las personas y empresas que han colaborado en el mismo.Piedrabuena Cuesta, A.; Sendra Pérez, R.; Ferreras Remesal, A.; Ruiz Folgado, R.; Oltra Pastor, A.; Cortés Jiménez, B.; Santander Iñigo, A.... (2011). Desarrollo de materiales para la formación ergonómica de los trabajadores del sector de la construcción. Revista de biomecánica. (55):51-54. http://hdl.handle.net/10251/38795S51545

Educational nurse-led telephone intervention shortly before colonoscopy as a salvage strategy after previous bowel preparation failure : a multicenter randomized trial

Altres ajuts: This study was supported by grants from the Asociación Española de Gastroenterología and the Societat Catalana de Digestología.Background The most important predictor of unsuccessful bowel preparation is previous failure. For those patients with previous failure, we hypothesized that a nurse-led educational intervention by telephone shortly before the colonoscopy appointment could improve cleansing efficacy. Methods We performed a multicenter, endoscopist-blinded, randomized controlled trial. Consecutive outpatients with previous inadequate bowel preparation were enrolled. Both groups received the same standard bowel preparation protocol. The intervention group also received reinforced education by telephone within 48 hours before the colonoscopy. The primary outcome was effective bowel preparation according to the Boston Bowel Preparation Scale. Intention-to-treat (ITT) analysis included all randomized patients. Per-protocol analysis included patients who could be contacted by telephone and the control cases. Results 657 participants were recruited by 11 Spanish hospitals. In the ITT analysis, there was no significant difference between the intervention and control groups in the rate of successful bowel preparation (77.3 % vs. 72 %; P = 0.12). In the intervention group, 267 patients (82.9 %) were contacted by telephone. Per-protocol analysis revealed significantly improved bowel preparation in the intervention group (83.5 % vs. 72.0 %; P = 0.001). Conclusion Among all patients with previous inadequate bowel preparation, nurse-led telephone education did not result in a significant improvement in bowel cleansing. However, in the 83 % of patients who could be contacted, bowel preparation was substantially improved. Phone education may therefore be a useful tool for improving the quality of bowel preparation in those cases

Educational nurse-led telephone intervention shortly before colonoscopy as a salvage strategy after previous bowel preparation failure: a multicenter randomized trial

Background: The most important predictor of unsuccessful bowel preparation is previous failure. For those patients with previous failure, we hypothesized that a nurse-led educational intervention by telephone shortly before the colonoscopy appointment could improve cleansing efficacy. Methods: We performed a multicenter, endoscopist-blinded, randomized controlled trial. Consecutive outpatients with previous inadequate bowel preparation were enrolled. Both groups received the same standard bowel preparation protocol. The intervention group also received reinforced education by telephone within 48 hours before the colonoscopy. The primary outcome was effective bowel preparation according to the Boston Bowel Preparation Scale. Intention-to-treat (ITT) analysis included all randomized patients. Per-protocol analysis included patients who could be contacted by telephone and the control cases. Results: 657 participants were recruited by 11 Spanish hospitals. In the ITT analysis, there was no significant difference between the intervention and control groups in the rate of successful bowel preparation (77.3 % vs. 72 %; P = 0.12). In the intervention group, 267 patients (82.9 %) were contacted by telephone. Per-protocol analysis revealed significantly improved bowel preparation in the intervention group (83.5 % vs. 72.0 %; P = 0.001). Conclusion: Among all patients with previous inadequate bowel preparation, nurse-led telephone education did not result in a significant improvement in bowel cleansing. However, in the 83 % of patients who could be contacted, bowel preparation was substantially improved. Phone education may therefore be a useful tool for improving the quality of bowel preparation in those cases