14 research outputs found
Influence of the Cumulative Incidence of COVID-19 Cases on the Mental Health of the Spanish Out-of-Hospital Professionals
This study aimed to analyze the psychological affectation of health professionals (HPs) of
Spanish Emergency Medical Services (EMSs) according to the cumulative incidence (CI) of COVID19 cases in the regions in which they worked. A cross-sectional descriptive study was designed,
including all HPs working in any EMS of the Spanish geography between 1 February 2021 and 30 April
2021. Their level of stress, anxiety and depression (DASS-21) and the perception of self-efficacy (GSES) were the study’s main results. A 2-factor analysis of covariance was used to determine if the CI
regions of COVID-19 cases determined the psychological impact on each of the studied variables. A
total of 1710 HPs were included. A third presented psychological impairment classified as severe.
The interaction of CI regions with the studied variables did not influence their levels of stress, anxiety,
depression or self-efficacy. Women, younger HPs or those with less EMS work experience, emergency
medical technicians (EMT), workers who had to modify their working conditions or those who lived
with minors or dependents suffered a greater impact from the COVID-19 pandemic in certain regions.
These HPs have shown high levels of stress, anxiety, depression and medium levels of self-efficacy,
with similar data in the different geographical areas. Psychological support is essential to mitigate
their suffering and teach them to react to adverse events.This research was funded by Fundación ASISA and Sociedad Española de Urgencias y Emergencias (SEMES)
Canagliflozin and renal outcomes in type 2 diabetes and nephropathy
BACKGROUND Type 2 diabetes mellitus is the leading cause of kidney failure worldwide, but few effective long-term treatments are available. In cardiovascular trials of inhibitors of sodium–glucose cotransporter 2 (SGLT2), exploratory results have suggested that such drugs may improve renal outcomes in patients with type 2 diabetes. METHODS In this double-blind, randomized trial, we assigned patients with type 2 diabetes and albuminuric chronic kidney disease to receive canagliflozin, an oral SGLT2 inhibitor, at a dose of 100 mg daily or placebo. All the patients had an estimated glomerular filtration rate (GFR) of 30 to <90 ml per minute per 1.73 m2 of body-surface area and albuminuria (ratio of albumin [mg] to creatinine [g], >300 to 5000) and were treated with renin–angiotensin system blockade. The primary outcome was a composite of end-stage kidney disease (dialysis, transplantation, or a sustained estimated GFR of <15 ml per minute per 1.73 m2), a doubling of the serum creatinine level, or death from renal or cardiovascular causes. Prespecified secondary outcomes were tested hierarchically. RESULTS The trial was stopped early after a planned interim analysis on the recommendation of the data and safety monitoring committee. At that time, 4401 patients had undergone randomization, with a median follow-up of 2.62 years. The relative risk of the primary outcome was 30% lower in the canagliflozin group than in the placebo group, with event rates of 43.2 and 61.2 per 1000 patient-years, respectively (hazard ratio, 0.70; 95% confidence interval [CI], 0.59 to 0.82; P=0.00001). The relative risk of the renal-specific composite of end-stage kidney disease, a doubling of the creatinine level, or death from renal causes was lower by 34% (hazard ratio, 0.66; 95% CI, 0.53 to 0.81; P<0.001), and the relative risk of end-stage kidney disease was lower by 32% (hazard ratio, 0.68; 95% CI, 0.54 to 0.86; P=0.002). The canagliflozin group also had a lower risk of cardiovascular death, myocardial infarction, or stroke (hazard ratio, 0.80; 95% CI, 0.67 to 0.95; P=0.01) and hospitalization for heart failure (hazard ratio, 0.61; 95% CI, 0.47 to 0.80; P<0.001). There were no significant differences in rates of amputation or fracture. CONCLUSIONS In patients with type 2 diabetes and kidney disease, the risk of kidney failure and cardiovascular events was lower in the canagliflozin group than in the placebo group at a median follow-up of 2.62 years
Herramienta de seguimiento online para Trabajos de Fin de Grado en Medicina
El Trabajo de Fin de Grado (TFG) es una materia incluida dentro del plan de estudios del grado de Medicina en la Universidad Europea de Madrid (UEM), consta de 9 ECTS y se realiza en la fase final del plan de estudios; su ejecución durante sexto curso coincide con la preparación del examen MIR, que constituye la pieza fundamental del Graduado en Medicina para continuar su formación. Teniendo en cuenta este hecho y sin omitir las horas de tutorías presenciales, hemos diseñado una herramienta para seguimiento Online de los TFG, que le permita al estudiante tener una retroalimentación metodológica facilitando ubicuidad. En este trabajo describimos la herramienta, analizamos de los resultados del comportamiento en su utilización y proponemos mejoras. La herramienta ha sido usada por el 86% de los estudiantes que presentarán su TFG en este curso 2114-2015, pudiéndose interpretar como buena aceptación. La herramienta ha permitido una comunicación virtual facilitando al alumno el desarrollo consecutivo de su TFG. Además de permitir un control, esta herramienta servirá para almacenar de forma electrónica los TFG definitivos. Se puede proponer que para próximos cursos, el uso de esta herramienta tenga carácter evaluativo y que se definan objetivos siguiendo una temporalidad.SIN FINANCIACIÓNNo data 2015UE
Mortality risk and complications relating to interhospital transfers of patients with acute coronary syndrome receiving primary coronary angioplasty performed by the Medical Emergency Service of Madrid 112: a group comparison study
The performance of a primary percutaneous coronary intervention is the practice
recommendation with the highest level of evidence for the treatment of acute coronary syndrome (ACS). If
this intervention cannot be performed at the hospital where the patient is admitted, the patient must be
transferred to a hospital with a haemodynamic laboratory. This can lead to a decreased availability of a
mobile intensive care unit (MICU), contributing towards a lower survival rate of critical patients due to a
delay in treatment administration. The aim of this study was to describe the risk of mortality, the
complications, and the impact of interhospital transfer (IHT) in patients diagnosed with an ACS. Methods:
A prospective observational study was performed comparing two patient groups: patients diagnosed with
ST-segment elevation (STEMI) and patients diagnosed with non-ST-segment elevation. The variables collected
included sex, age, cardiovascular risk factors, and any complications arising during IHT. Prior to being
transported, the Risk Score for Transport Patients (RSTP) was used, together with the Rapid Emergency
Medicine Score (REMS). The latter scale was repeated upon arrival at the accepting medical facility. Results:
The study included 104 patients, of whom 67 were men (64.42%). Of these, 52.88% were diagnosed with
STEMI. Patients with ACS presented an intermediate risk of mortality and the need for transfer to a MICU
was indicated. The incidence of complications registered during transfers was 16.35%. Conclusions: The use
of scales such as the REMS and the RSTP are helpful for obtaining a more objective risk profile, suited to
the real needs of patients diagnosed with an ACS.Sin financiación0.202 JCR (2017) Q4, 25/26 Emergency medicineUE
Intratissue Percutaneous Electrolysis vs Corticosteroid Infiltration for the Treatment of Plantar Fasciosis
BACKGROUND:
Corticosteroid infiltration (CI) is commonly used for treatment of plantar fasciosis. In recent years, however, interest has grown in the use of intratissue percutaneous electrolysis (EPI) for the treatment of tendinopathies. The aim of our study was to compare the effectiveness of the above techniques in the treatment of plantar fasciosis.
METHODS:
The results achieved over a period of 1 year following the use of these techniques to treat plantar fasciosis were examined. There were 64 patients; 32 of whom were treated with ultrasound-guided EPI and 32 with ultrasound-guided CI. A clinical examination was performed and ultrasound taken before treatment and at 3, 6, and 12 months. Clinical assessments were made using a visual analog scale (VAS) to record pain and the Foot and Ankle Disability Index (FADI) to evaluate function. Ultrasound was used to determine the thickness of the plantar fascia.
RESULTS:
Both the ultrasound-guided EPI and CI techniques were associated with significant clinical and echographic improvements at 12 months post-treatment ( P < .001).
CONCLUSION:
Both techniques were effective in the treatment of PF, providing excellent VAS pain and FADI results at 12 months. However, CI required fewer patient visits and appeared to provide somewhat better VAS and FADI results
Influence of the Cumulative Incidence of COVID-19 Cases on the Mental Health of the Spanish Out-of-Hospital Professionals
This study aimed to analyze the psychological affectation of health professionals (HPs) of Spanish Emergency Medical Services (EMSs) according to the cumulative incidence (CI) of COVID19 cases in the regions in which they worked. A cross-sectional descriptive study was designed, including all HPs working in any EMS of the Spanish geography between 1 February 2021 and 30 April 2021. Their level of stress, anxiety and depression (DASS-21) and the perception of self-efficacy (GSES) were the study’s main results. A 2-factor analysis of covariance was used to determine if the CI regions of COVID-19 cases determined the psychological impact on each of the studied variables. A total of 1710 HPs were included. A third presented psychological impairment classified as severe. The interaction of CI regions with the studied variables did not influence their levels of stress, anxiety, depression or self-efficacy. Women, younger HPs or those with less EMS work experience, emergency medical technicians (EMT), workers who had to modify their working conditions or those who lived with minors or dependents suffered a greater impact from the COVID-19 pandemic in certain regions. These HPs have shown high levels of stress, anxiety, depression and medium levels of self-efficacy, with similar data in the different geographical areas. Psychological support is essential to mitigate their suffering and teach them to react to adverse events.Sin financiación4.964 JCR (2021) Q2, 55/172 Medicine, General & Internal1.040 SJR (2021) Q1, 438/2489 Medicine (miscellaneous)No data IDR 2021UE
Influence of the Cumulative Incidence of COVID-19 Cases on the Mental Health of the Spanish Out-of-Hospital Professionals
This study aimed to analyze the psychological affectation of health professionals (HPs) of Spanish Emergency Medical Services (EMSs) according to the cumulative incidence (CI) of COVID-19 cases in the regions in which they worked. A cross-sectional descriptive study was designed, including all HPs working in any EMS of the Spanish geography between 1 February 2021 and 30 April 2021. Their level of stress, anxiety and depression (DASS-21) and the perception of self-efficacy (G-SES) were the study’s main results. A 2-factor analysis of covariance was used to determine if the CI regions of COVID-19 cases determined the psychological impact on each of the studied variables. A total of 1710 HPs were included. A third presented psychological impairment classified as severe. The interaction of CI regions with the studied variables did not influence their levels of stress, anxiety, depression or self-efficacy. Women, younger HPs or those with less EMS work experience, emergency medical technicians (EMT), workers who had to modify their working conditions or those who lived with minors or dependents suffered a greater impact from the COVID-19 pandemic in certain regions. These HPs have shown high levels of stress, anxiety, depression and medium levels of self-efficacy, with similar data in the different geographical areas. Psychological support is essential to mitigate their suffering and teach them to react to adverse events
Actividad física en relación con la obesidad y el sobrepeso en adolescentes
Estudio de la relación existente entre los niveles de actividad física con respecto al peso (sobrepeso y obesidad) detectados en una muestra significativa de adolescentes de la Comunidad de Madrid.
Analiza los nutrientes en la alimentación, la dieta saludable en los adolescentes, recomendaciones generales de vida saludable y el ejercicio en el adolescentes, necesidades energética y dieta saludable en adolescentes en diferentes deportes, medidas preventivas de la obesidad en adolescentes y trastornos de la conducta alimentaria. Cada uno de estos aspectos está tratado por un especialistaES
Effect of SGLT2 Inhibitors on Stroke and Atrial Fibrillation in Diabetic Kidney Disease: Results From the CREDENCE Trial and Meta-Analysis
BACKGROUND AND PURPOSE: Chronic kidney disease with reduced estimated glomerular filtration rate or elevated albuminuria increases risk for ischemic and hemorrhagic stroke. This study assessed the effects of sodium glucose cotransporter 2 inhibitors (SGLT2i) on stroke and atrial fibrillation/flutter (AF/AFL) from CREDENCE (Canagliflozin and Renal Events in Diabetes With Established Nephropathy Clinical Evaluation) and a meta-analysis of large cardiovascular outcome trials (CVOTs) of SGLT2i in type 2 diabetes mellitus.METHODS: CREDENCE randomized 4401 participants with type 2 diabetes mellitus and chronic kidney disease to canagliflozin or placebo. Post hoc, we estimated effects on fatal or nonfatal stroke, stroke subtypes, and intermediate markers of stroke risk including AF/AFL. Stroke and AF/AFL data from 3 other completed large CVOTs and CREDENCE were pooled using random-effects meta-analysis.RESULTS: In CREDENCE, 142 participants experienced a stroke during follow-up (10.9/1000 patient-years with canagliflozin, 14.2/1000 patient-years with placebo; hazard ratio [HR], 0.77 [95% CI, 0.55-1.08]). Effects by stroke subtypes were: ischemic (HR, 0.88 [95% CI, 0.61-1.28]; n=111), hemorrhagic (HR, 0.50 [95% CI, 0.19-1.32]; n=18), and undetermined (HR, 0.54 [95% CI, 0.20-1.46]; n=17). There was no clear effect on AF/AFL (HR, 0.76 [95% CI, 0.53-1.10]; n=115). The overall effects in the 4 CVOTs combined were: total stroke (HRpooled, 0.96 [95% CI, 0.82-1.12]), ischemic stroke (HRpooled, 1.01 [95% CI, 0.89-1.14]), hemorrhagic stroke (HRpooled, 0.50 [95% CI, 0.30-0.83]), undetermined stroke (HRpooled, 0.86 [95% CI, 0.49-1.51]), and AF/AFL (HRpooled, 0.81 [95% CI, 0.71-0.93]). There was evidence that SGLT2i effects on total stroke varied by baseline estimated glomerular filtration rate (P=0.01), with protection in the lowest estimated glomerular filtration rate (<45 mL/min/1.73 m2]) subgroup (HRpooled, 0.50 [95% CI, 0.31-0.79]).CONCLUSIONS: Although we found no clear effect of SGLT2i on total stroke in CREDENCE or across trials combined, there was some evidence of benefit in preventing hemorrhagic stroke and AF/AFL, as well as total stroke for those with lowest estimated glomerular filtration rate. Future research should focus on confirming these data and exploring potential mechanisms. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02065791