GB smoking cessation training for health care providers in LA: midterm confidence in competencies and estimation of population impact

Background Between 2011 and 2016, Global Bridges (GB) in Latin America successfully trained health care providers (HCP) in declarative and procedural knowledge and confidence in competencies (Moore `s level 3A, B and 4). However, a study that explored patients´ reported HCP performance failed to show effect. Methods Cross-sectional study among all trainees between 2011 and 2016. The survey was electronically conducted (Survey Monkey) with 26 questions that explored demography, confidence in skills and practices in smoking cessation. A sample size of 400 individuals was required. Inclusion criteria were: attended at least one day session and a valid email. A mathematical model of impact estimation was developed (subrogate of level 5 of Moore). Abstinence rates for brief advice and intensive intervention of were appraised from Cochrane Review. Results Of 1915 trainees with valid e-mail, 402 surveys were obtained in 2 recruitment rounds. The response rate was different for the two periods 2011-2014 (17%) and 2014-2016 (56%). Countries (Argentina 28%, Uruguay 20% and Mexico 17%) and occupation (physicians 61% and psychologists 18%) were unevenly represented. Among the responses, female gender prevailed (64.7%). 79.4% stated GB training was extremely/very useful and more than 80% expressed to be very confident/ confident to provide SC support. Respondents declared to assist 2.1 smokers per day (CI 1.6-2.6), and to offer brief advice and intensive advice, with or without drugs, in 80% and 69% of cases respectively. The model estimated that 1,564 trainees would have achieved 12,012 quitters with brief advice and 38,788 quitters due to intensive intervention in the following year after training, in the worst case scenario (lower CI). Conclusions GB´s SC program in Latin America exhibited to maintain trainees´ confidence in competences in the medium term and to return at least 50,800 quitters in the following year of the educational intervention

Strategy of the Latin American Thoracic Association (ALAT). Ten strategic goals for development in 2016-2020

Univ Rosario, Fdn Neumol Colombiana, Escuela Med & Ciencias Salud, Bogota, ColombiaCent Univ Venezuela, Hosp Univ Caracas, Caracas, VenezuelaCtr Med ABC & Clin Lomas Altas, Ciudad De Mexico, MexicoHosp Ctr Med, Guatemala City, GuatemalaUniv Sabana, Bogota, ColombiaFdn Neumol Colombiana, Bogota, ColombiaUniv Republica, Hosp Maciel, Montevideo, UruguayFdn Neumol Colombiana, Dept Invest, Bogota, ColombiaInst Nacl Enfermedades Resp Ismael Cosio Villegas, Ciudad De Mexico, MexicoAsociac Latinoamer Torax, Montevideo, UruguayUniv Fed Sao Paulo, Escola Paulista Med, Sao Paulo, BrazilSanat Guemes, Buenos Aires, DF, ArgentinaUniv El Bosque, Hosp Santa Clara, Bogota, ColombiaUniv Nacl Comahue, Neuquen, ArgentinaClin Santa Maria, Inst Nacl Torax, Santiago, ChileUniv Fed Sao Paulo, Escola Paulista Med, Sao Paulo, BrazilWeb of Scienc

Estrategia de la Asociación Torácica Latinoamericana (ALAT). Diez metas estratégicas para el desarrollo en 2016–2020

Introduction Respiratory Health in Latin America faces great challenges. Prevalence and impact of respiratory diseases have been increasing in morbidity. Mortality rates have been rising in the region1 and respiratory medicine practice has been developing in a very fast and disorganized way. Our health systemand institutions are inefficient and fragmented. The Human Resources are insufficient and not well trained.2,3 Ensuring a successful and sustainable development of the respiratory medical specialty in this context is a priority for the Latin American Thoracic Association (Asociación Latinoamericana de Tórax – ALAT).4 Twenty years after its foundation, ALAT proposes an institutional strategy for 2016–2020. This project was led by the President and the General Secretary at a first meeting in Panama City on the 4th and 5th of December 2014 and additional sessions during 2015. It broughttogether the members ofthe Executive Committee, directors ofthe committees in charge of Science and Research, Education, International Relations, Congress, members of the Scientific Departments, Past Presidents, Members of ALAT’s staff and external consultants (Fig. 1). Participants were instructed to visualize the future challenges of ALAT and to propose initiatives, goals and plans that were to be presented to the group with a view on how to implement them successfully. Using methodologies and tools generally accepted in strategic business development,5 and taking into consideration successful case stories from related societies,6,7 the work done enabled the group to redefine the mission and the vision of ALAT. It also enabled the group to propose an integrated strategic plan composed of ten strategic goals

Estrategia de la Asociación Latinoamericana de Tórax (ALAT).Los diez objetivos estratégicos para su desarrollo en el quinquenio 2016-2020

4 páginasLa salud respiratoria en América Latina enfrenta grandes desafíos.La prevalencia y el impacto de las enfermedades respiratorias sobre la morbimortalidad en la región ha aumentado y la práctica de la medicina respiratoria ha crecido de forma vertiginosa y desordenada. Nuestros sistemas de salud son ineficientes y fragmentados, y el recurso humano, insuficiente y poco preparad

Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS : a propensity score analysis

Background: The role of neuromuscular blocking agents (NMBAs) in coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) is not fully elucidated. Therefore, we aimed to investigate in COVID-19 patients with moderate-to-severe ARDS the impact of early use of NMBAs on 90-day mortality, through propensity score (PS) matching analysis. Methods: We analyzed a convenience sample of patients with COVID-19 and moderate-to-severe ARDS, admitted to 244 intensive care units within the COVID-19 Critical Care Consortium, from February 1, 2020, through October 31, 2021. Patients undergoing at least 2 days and up to 3 consecutive days of NMBAs (NMBA treatment), within 48 h from commencement of IMV were compared with subjects who did not receive NMBAs or only upon commencement of IMV (control). The primary objective in the PS-matched cohort was comparison between groups in 90-day in-hospital mortality, assessed through Cox proportional hazard modeling. Secondary objectives were comparisons in the numbers of ventilator-free days (VFD) between day 1 and day 28 and between day 1 and 90 through competing risk regression. Results: Data from 1953 patients were included. After propensity score matching, 210 cases from each group were well matched. In the PS-matched cohort, mean (± SD) age was 60.3 ± 13.2 years and 296 (70.5%) were male and the most common comorbidities were hypertension (56.9%), obesity (41.1%), and diabetes (30.0%). The unadjusted hazard ratio (HR) for death at 90 days in the NMBA treatment vs control group was 1.12 (95% CI 0.79, 1.59, p = 0.534). After adjustment for smoking habit and critical therapeutic covariates, the HR was 1.07 (95% CI 0.72, 1.61, p = 0.729). At 28 days, VFD were 16 (IQR 0–25) and 25 (IQR 7–26) in the NMBA treatment and control groups, respectively (sub-hazard ratio 0.82, 95% CI 0.67, 1.00, p = 0.055). At 90 days, VFD were 77 (IQR 0–87) and 87 (IQR 0–88) (sub-hazard ratio 0.86 (95% CI 0.69, 1.07; p = 0.177). Conclusions: In patients with COVID-19 and moderate-to-severe ARDS, short course of NMBA treatment, applied early, did not significantly improve 90-day mortality and VFD. In the absence of definitive data from clinical trials, NMBAs should be indicated cautiously in this setting.</p

At-admission prediction of mortality and pulmonary embolism in an international cohort of hospitalised patients with COVID-19 using statistical and machine learning methods

By September 2022, more than 600 million cases of SARS-CoV-2 infection have been reported globally, resulting in over 6.5 million deaths. COVID-19 mortality risk estimators are often, however, developed with small unrepresentative samples and with methodological limitations. It is highly important to develop predictive tools for pulmonary embolism (PE) in COVID-19 patients as one of the most severe preventable complications of COVID-19. Early recognition can help provide life-saving targeted anti-coagulation therapy right at admission. Using a dataset of more than 800,000 COVID-19 patients from an international cohort, we propose a cost-sensitive gradient-boosted machine learning model that predicts occurrence of PE and death at admission. Logistic regression, Cox proportional hazards models, and Shapley values were used to identify key predictors for PE and death. Our prediction model had a test AUROC of 75.9% and 74.2%, and sensitivities of 67.5% and 72.7% for PE and all-cause mortality respectively on a highly diverse and held-out test set. The PE prediction model was also evaluated on patients in UK and Spain separately with test results of 74.5% AUROC, 63.5% sensitivity and 78.9% AUROC, 95.7% sensitivity. Age, sex, region of admission, comorbidities (chronic cardiac and pulmonary disease, dementia, diabetes, hypertension, cancer, obesity, smoking), and symptoms (any, confusion, chest pain, fatigue, headache, fever, muscle or joint pain, shortness of breath) were the most important clinical predictors at admission. Age, overall presence of symptoms, shortness of breath, and hypertension were found to be key predictors for PE using our extreme gradient boosted model. This analysis based on the, until now, largest global dataset for this set of problems can inform hospital prioritisation policy and guide long term clinical research and decision-making for COVID-19 patients globally. Our machine learning model developed from an international cohort can serve to better regulate hospital risk prioritisation of at-risk patients

Characteristics and outcomes of COVID-19 patients admitted to hospital with and without respiratory symptoms

Background: COVID-19 is primarily known as a respiratory illness; however, many patients present to hospital without respiratory symptoms. The association between non-respiratory presentations of COVID-19 and outcomes remains unclear. We investigated risk factors and clinical outcomes in patients with no respiratory symptoms (NRS) and respiratory symptoms (RS) at hospital admission. Methods: This study describes clinical features, physiological parameters, and outcomes of hospitalised COVID-19 patients, stratified by the presence or absence of respiratory symptoms at hospital admission. RS patients had one or more of: cough, shortness of breath, sore throat, runny nose or wheezing; while NRS patients did not. Results: Of 178,640 patients in the study, 86.4&nbsp;% presented with RS, while 13.6&nbsp;% had NRS. NRS patients were older (median age: NRS: 74 vs RS: 65) and less likely to be admitted to the ICU (NRS: 36.7&nbsp;% vs RS: 37.5&nbsp;%). NRS patients had a higher crude in-hospital case-fatality ratio (NRS 41.1&nbsp;% vs. RS 32.0&nbsp;%), but a lower risk of death after adjusting for confounders (HR 0.88 [0.83-0.93]). Conclusion: Approximately one in seven COVID-19 patients presented at hospital admission without respiratory symptoms. These patients were older, had lower ICU admission rates, and had a lower risk of in-hospital mortality after adjusting for confounders