Complementary music therapy for cancer patients in at-home palliative care and their caregivers: protocol for a multicentre randomised controlled trial

Background Patients with advanced cancer, receiving at-home palliative care, are subject to numerous symptoms that are changeable and often require attention, a stressful situation that also impacts on the family caregiver. It has been suggested that music therapy may benefit both the patient and the caregiver. We propose a study to analyse the efficacy and cost utility of a music intervention programme, applied as complementary therapy, for cancer patients in palliative care and for their at-home caregivers, compared to usual treatment. Method A randomised, double-blind, multicentre clinical trial will be performed in cancer patients in at-home palliative care and their family caregivers. The study population will include two samples of 40 patients and two samples of 41 caregivers. Participants will be randomly assigned either to the intervention group or to the control group. The intervention group will receive a seven-day programme including music sessions, while the control group will receive seven sessions of (spoken word) therapeutic education. In this study, the primary outcome measure is the assessment of patients' symptoms, according to the Edmonton Symptom Assessment System, and of the overload experienced by family caregivers, measured by the Caregiver Strain Index. The secondary outcomes considered will be the participants' health-related quality of life, their satisfaction with the intervention, and an economic valuation. Discussion This study is expected to enhance our understanding of the efficacy and cost-utility of music therapy for cancer patients in palliative care and for their family caregivers. The results of this project are expected to be applicable and transferrable to usual clinical practice for patients in home palliative care and for their caregivers. The approach described can be incorporated as an additional therapeutic resource within comprehensive palliative care. To our knowledge, no previous high quality studies, based on a double-blind clinical trial, have been undertaken to evaluate the cost-effectiveness of music therapy. The cost-effectiveness of the project will provide information to support decision making, thereby improving the management of health resources and their use within the health system

Fiebre de malta: reporte de caso

Introduction: Malta fever (brucellosis) is a zoonotic infection produced by intracellular gram-negative coccobacilli, which is transmitted by the consumption of infected unpasteurized animal products, skin contact or mucous membranes with infected animal tissues and fluids, and inhalation of infected aerosolized particles. Case: A 34-year-old man living in a rural area, who works in livestock, was admitted to the emergency department for presenting a clinical picture of 15 days of evolution of unquantified febrile peaks associated with symptoms such as chills, asthenia, adynamia and myalgia. The diagnosis of infection with Brucella Abortus was given through clinical-pathological correlation. Conclusion: This pathology is more frequent in adult males. Serological studies (antibodies, agglutination and immunochromatographic assay) prove to have the highest sensitivity and diagnostic specificity in the clinical picture. The treatment is given with medication that acts on intracellular acidic environment (tetracyclines, aminoglycosides, fluoroquinolones), this in order to control the disease, and prevent complications and relapses.  Introducción: La fiebre de malta (brucelosis) es una infección zoonótica producida por cocobacilos gramnegativos, intracelulares facultativos, los cuales se transmiten por el consumo de productos animales no pasteurizados infectados, el contacto de la piel o las membranas mucosas con tejido animal infectado, fluidos animales infectados e inhalación de partículas aerosolizadas infectadas. Caso: Hombre de 34 años residente en zona rural, quien se dedicaba a la ganadería, ingreso a urgencias por presentar cuadro clínico de 15 días de evolución consistente en picos febriles no cuantificados asociados a escalofríos, astenia, adinamia y mialgias. Mediante la correlación clínico-patológica se llegó al diagnóstico de infección por Brucella Abortus. Conclusión: Esta patología es más frecuente en varones adultos. Dentro del cuadro clínico, Los estudios de serológicos (anticuerpos, aglutinación y ensayo inmunocromatográfico) tienen la mayor sensibilidad y especificidad diagnostica. El tratamiento se da con medicamentos que actúen en entornos intracelulares ácidos (tetraciclinas, aminoglucosidos, fluoroquinolonas), esto con el fin de controlar la enfermedad, prevenir las complicaciones y evitar las recaídas. &nbsp

Intervention to improve quality of sleep of palliative patient carers in the community: protocol for a multicentre randomised controlled trial

Background: Sleep disorders are commonly experienced by community caregivers for persons with cancer, with at least 72% reporting moderate to severe disorders. A consequence of this condition, which is associated with the presence of overload in the caregiver, is the increased risk of clinical depression. The aim of this study is to evaluate the effects of music on the sleep quality achieved by informal caregivers for cancer patients receiving home palliative care. In addition, we will assess the influence of specific variables that could modify these effects, analyse the correlates related to nocturnal wakefulness and consider the diurnal consequences according to the sleep characteristics identified. Methods: This single-blind, multicentre, randomised clinical trial will focus on informal providers of care for cancer patients. Two samples of 40 caregivers will be recruited. The first, intervention, group will receive seven music-based sessions. The control group will be masked with seven sessions of therapeutic education (reinforcing previous sessions). Outcomes will be evaluated using the Pittsburgh Sleep Quality Index, a triaxial accelerometer, EuroQol-5D-5L, the Caregiver Strain Index, the Epworth Sleepiness Scale and the Client Satisfaction Questionnaire. The caregivers' satisfaction with the intervention performed will also be examined. Discussion: This study is expected to extend our understanding of the efficacy of music therapy in enhancing the sleep quality of caregivers for patients receiving home palliative care. To our knowledge, no reliable scientific investigations of this subject have previously been undertaken. Music is believed to benefit certain aspects of sleep, but this has yet to be proven and, according to a Cochrane review, high-quality research in this field is necessary. One of the main strengths of our study, which heightens the quality of the randomised clinical trial design, is the objective assessment of physical activity by accelerometry and the use of both objective and subjective measures of sleep in caregivers. Music therapy for the caregivers addressed in this study is complementary, readily applicable, provokes no harmful side effects and may produce significant benefits

Optimizando la Transmisión de Datos Ip Mediante la Conmutación de Etiquetas Multiprotocolo

This document shows the data transmission study results with different characterization (better effort, better effort with high priority, as well as two types of real time traffic), made through the use of label commutation multiprotol in IP nets, compared to the IP data transmission using Asynchronous Transfer Mode, the study illustrates the best performance that MPLS presents in network cogestion states. The discret events simulator NS_2, was used as the experimentation tool running on Linux operative system.El presente artículo muestar los resultdos del estudio de transmisión de datos con diferente caracterización (mejir esfuerzo, mejor esfuerzo con alta prioridad así como dos tipos de trafico de tiempo real) mediante el protocolo de conmutación de etiquetas multi-protocolo en redes IP, comparado con la transmisión de datos IP utilizando el Modo de Transferencia Asincrónico, el estudio ilustra el mejor rendimiento que presenta MPLS en condiciones de congestión de la red. Como herramienta de experimentación se utilizo el simulador de eventos discretos NS_2 sobre sistema operativo Linux

Efectividad del índice de Brass en la planificación del alta por enfermeras gestoras de casos

Classifying patients according to complexity and frailty during hospitalization allows efficient planning of the scope of care required by the patient at discharge. The aim of this study was to measure the screening validity of the Blaylock Risk Assessment Screening Score and its effectiveness in discharge planning.Methods: We analyzed the variables hospital stay, destination at discharge, use of healthcare resources and mortality in 370 patients. Results: Analysis of the relationship between mortality and the BRASS-Sp index with regard to gender and number of days of stay yielded a hazard ratio of 1.73 (95% CI 1.22-2.46; p=0.002) for male gender and 2.08 (95% CI 1.43-3.04; p<0.001) for the BRASS-Sp score. Patients who continued in case management in Primary Care had a mean BRASS-Sp of 20.97 (standard deviation 6.11), while in the other patients the mean was 19.35 (standard deviation 5.60), p=0.02. Conclusions: The BRASS-Sp proved easy-to-use with verified content validity that is effective for screening hospitalized patients by case management nursesEstratificar a los pacientes en relación con la complejidad y fragilidad durante la hospitalización, nos permite planificar de manera más eficiente los cuidados y el ámbito de atención que precisa al alta. El objetivo de este trabajo es evaluar la efectividad de la traducción al español de índice de BRASS en la planificación del alta hospitalaria por enfermeras gestoras de casos de atención hospitalaria.Método: Se analizaron variables relacionadas con la estancia hospitalaria, destino al alta, utilización de recursos sanitarios y mortalidad en 370 pacientes.. Resultados: La edad media fue 72.6 años (DE 14.05), 191 (51.6%) eran mujeres. Cuando analizamos la relación entre mortalidad e índice de BRASS-Sp en relación al sexo y número de días de ingreso encontramos una HR=1.73 (95% CI de 1.22 a 2.46) con una p=0.002 para sexo masculino y una HR=2.08 (95% CI 1.43 a 3.04) con una p<0.001 para puntuación del índice de BRASS_Sp. Los pacientes que continuaron en gestión de casos en Atención Primaria obtuvieron una media del BRASS-Sp de 20.97 (DE 6.11) mientras que en los demás fue de 19.35 (DE 5.60), p=0.02. Conclusiones: La traducción al español del índice de BRASS se muestra como un instrumento fácil de usar y con validez de contenido y efectividad para cribado de pacientes hospitalizados por enfermeras gestoras de casos. &nbsp

KRAS Mutations in Primary Colorectal Cancer Tumors and Related Metastases: A Potential Role in Prediction of Lung Metastasis

BACKGROUND:KRAS mutations in colorectal cancer primary tumors predict resistance to anti-Epidermal Growth Factor Receptor (EGFR) monoclonal antibody therapy in patients with metastatic colorectal cancer, and thus represent a true indicator of EGFR pathway activation status. METHODOLOGY/PRINCIPAL FINDINGS:KRAS mutations were retrospectively studied using polymerase chain reactions and subsequent sequencing of codons 12 and 13 (exon 2) in 110 patients with metastatic colorectal tumors. These studies were performed using tissue samples from both the primary tumor and their related metastases (93 liver, 84%; 17 lung, 16%). All patients received adjuvant 5-Fluorouracil-based polychemotherapy after resection of metastases. None received anti-EGFR therapy. Mutations in KRAS were observed in 37 (34%) of primary tumors and in 40 (36%) of related metastases, yielding a 94% level of concordance (kappa index 0.86). Patients with primary tumors possessing KRAS mutations had a shorter disease-free survival period after metastasis resection (12.0 vs 18.0 months; P = 0.035) than those who did not. A higher percentage of KRAS mutations was detected in primary tumors of patiens with lung metastases than in patients with liver metastases (59% vs 32%; p = 0.054). To further evaluate this finding we analyzed 120 additional patients with unresectable metastatic colorectal cancer who previously had their primary tumors evaluated for KRAS mutational status for clinical purposes. Separately, the analysis of these 120 patients showed a tendency towards a higher degree of KRAS mutations in primary tumors of patients with lung metastases, although it did not reach statistical significance. Taken together the group of 230 patients showed that KRAS was mutated significantly more often in the primary tumors of patients with lung metastases (57% vs 35%; P = 0.006). CONCLUSIONS/SIGNIFICANCE:Our results suggest a role for KRAS mutations in the propensity of primary colorectal tumors to metastasize to the lung

Identificación de un instrumento para evaluación de la personalidad, como herramienta clínica y de investigación

INTRODUCCIÓN. Se considera que una alta proporción de enfermedades crónicas tiene un componente psicosomático y que algunos rasgos de la personalidad se relacionan con la forma en que las enfermedades se instauran y evolucionan. Para la evaluación objetiva de la personalidad han sido desarrollados instrumentos de frecuente aplicación en Psicología, pero con características que difi cultan su uso como herramientas en atención médica o en investigación. El propósito del studio fue identifi car un instrumento pertinente para la evaluación de la personalidad, con el fi n de ser empleado en investigación, y susceptible de ser utilizado en la clínica. METODOLOGÍA. Se realizó un estudio descriptivo que incluyó una revisión bibliográfi ca y un análisis comparativo sobre cuestionarios de personalidad. Los criterios de comparación fueron: psicometría, dominios o factores, número de preguntas, modo de aplicación, tipos de personalidad, rasgos o estrategias de afrontamiento y validación. RESULTADOS. Se encontró que no existe consenso en el concepto de personalidad, numerosos cuestionarios abordan aspectos patológicos, su aplicación requiere la intervención de psicólogos o psiquiatras, son extensos, de difícil comprensión y la mayoría carece de validación psicométrica en la población colombiana. CONCLUSIONES. Entre los cuestionarios analizados, la Escala de Estrategias de Coping- Modifi cada EEC-M, orientada a establecer las estrategias de afrontamiento en función de los rasgos de personalidad, es un instrumento que se adapta a los objetivos de la presente investigación

Reconocimiento de lengua de señas colombiana mediante redes neuronales convolucionales y captura de movimiento

Context: This article presents the design of a computational predictive model that facilitates the recognition of Colombian Sign Language (LSC) in a hotel and tourism environment. Method: Artificial intelligence techniques and deep neural networks were applied in the learning and prediction of gestures in real time, which allowed the construction of a tool to reduce the gap and strengthen communication. Convolutional neural network algorithms were applied to real-time data capture. Movement was captured using mobile device video cameras, thus obtaining the images that make up the data set. The images were used as training data for an optimal computational model that can predict the meaning of a newly presented image. Results: The performance of the model was evaluated using categorical measures and comparing different configurations for the neural network. In addition to this, everything is supported with the use of tools such as Tensorflow, OpenCV and MediaPipe. Conclusions: Finally, a model capable of identifying and translating 39 different signs between words, numbers and basic phrases focused on the hotel sector was obtained, where a success rate of 97.6% was obtained in a controlled use environment.  Contexto: Este articulo presenta el diseño de un modelo predictivo computacional que facilita el reconocimiento de la lengua de señas colombiana (LSC) en un entorno hotelero y turístico. Método: Se aplicaron técnicas de inteligencia artificial y redes neuronales profundas en el aprendizaje y la predicción de gestos en tiempo real, los cuales permitieron construir una herramienta para disminuir la brecha y fortalecer la comunicación. Se implementaron algoritmos de redes neuronales convolucionales sobre captura de datos en tiempo real. Se capturó movimiento mediante cámaras de video de dispositivos móviles; así, se obtuvieron las imágenes que forman el conjunto de datos. Las imágenes se utilizaron como datos de entrenamiento para un modelo computacional óptimo que puede predecir el significado de una imagen recién presentada. Resultados: Se evaluó el rendimiento del modelo usando medidas categóricas y comparando diferentes configuraciones para la red neuronal. Adicional a esto, todo está soportado con el uso de herramientas como Tensorflow, OpenCV y MediaPipe. Conclusiones: Se obtuvo un modelo capaz de identificar y traducir 39 señas diferentes entre palabras, números y frases básicas enfocadas al sector hotelero, donde se logró una tasa de éxito del 97,6 % en un ambiente de uso controlado

SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome

The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at frst patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confrmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n= 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the fnal multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age≥ 70 years, SpO2, neutrophils > 7.5 × ­103 /µL, lactate dehydrogenase≥ 300 U/L, and C-reactive protein≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome

Epidemiología básica. Material docente para prácticas en ciencias de la salud

Material docente teórico práctico para apoyar la enseñanza de la epidemiología. Consta de 4 unidades, cada una de ellas con una introducción teórica y unos ejercicios basados en artículos publicados en inglés en revistas científicas