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

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

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Perceived Utility and Learning by Dominican University Students in Virtual Teaching–Learning Environments: An Analysis of Multiple Serial Mediation Based on the Extended Technology Acceptance Model

The global pandemic caused by the SARS-CoV-2 virus brought about a true revolution in the predominant teaching–learning processes (i.e., face-to-face environment) that had been implemented up to that point. In this regard, virtual teaching–learning environments (VTLEs) have gained unprecedented significance. The main objectives of our research were to define an explanatory theoretical model and to test a multiple serial mediation model with four variables in series (one independent variable plus three mediators) to relate perceived utility (independent variable) in the use of a VTLE and perceived learning (dependent or criterion variable) in such contexts, taking into account the mediation of subjective norm (mediator 1), ease of use (mediator 2), and intention to use behavior (mediator 3), and using the extended technology acceptance model as the theoretical framework. Additionally, we aimed to analyze the direct and indirect relationships and effects among the variables that constituted the proposed model. Methodologically, the research can be classified as a cross-sectional causal ex post facto design. A representative sample of students enrolled in higher education institutions in the Dominican Republic was used as the research population, and a standardized Likert scale was administered to measure the five dimensions of the proposed model. Finally, it is worth noting that the obtained results indicate that all direct and indirect effects considered in the model were statistically significant, except for the indirect effect, where the four predictor variables were arranged in series to verify their influence on the criterion variable: perceived learning