Home continuity of care programme after discharge from a domiciliary hospitalisation unit

El PREALT es un programa de continuidad de cuidados para asegurar la continuidad asistencial entre la atención hospitalaria y la Atención Primaria que funciona en el Hospital Germans Trias i Pujol desde el año 2006. La Unidad de Hospitalización a domicilio (UHaD) constituye una de las principales unidades proveedoras de pacientes al programa. Objetivos: analizar las características clínicas principales de los pacientes derivados al programa PREALT desde la UHaD y los problemas de Enfermería presentes al alta y evaluar la adecuación del programa y la detección de oportunidades de mejora. Metodología: estudio descriptivo a partir de las solicitudes de inclusión en el programa durante el año 2007 procedentes de la UHaD. Se analizan las variables de actividad, edad, sexo, patología de ingreso, antecentes patológicos, Charlson, Barthel, valoración de las necesidades básicas y problemas de Enfermería al alta. Resultados: durante el año 2007 se han efectuado un total de 121 solicitudes de inclusión en el PREALT procedentes de la UHaD, 56,2% hombres y 43,8% mujeres, con una edad media de 70 años (Sd 14,31). Los principales motivos de ingreso de los pacientes evaluados son: postoperatorio de cirugía (23,1%), exacerbación de EPOC(19%), otros procesos respiratorios (15,7%), neoplasias o estudios (9,9%), postoperatorios de prótesis de rodilla (8,3%), pie diabético o lesiones cutáneas (8,2%) y otros (15,8%). Los pacientes presentan un comorbilidad media-alta y un perfil de depencia leve-moderada para las actividades de la vida diaria. El principal problema de Enfermería al alta es el déficit de autocuidado, presente en más de la mitad de los casos. Otros problemas prevalentes han sido el manejo ineficaz de la sintomatología, riesgo de manejo ineficaz del régimen terapéutico, deterioro de la integridad cutánea, próximos al 50% de los casos y el riesgo de caída y dolor, presentes en más de un tercio de los pacientes. Conclusiones: los resultados de actividad obtenidos permiten asegurar que el programa de continuidad de cuidados es de gran utilidad para los pacientes ingresados en la UHaD que necesitan continuidad asistencial. Del análisis de los resultados se identifican las siguientes oportunidades de mejora: incluir a los cuidadores en los planes de cuidados, sugiriendo que se valore la sobrecarga del cuidador y la calidad de vida percibida por el paciente y el cuidador principal y realizar una valoración de riesgos sistematizada que permita detectar, entre otros, el riesgo de desnutrición del paciente y el riesgo de morbilidad psíquica del cuidador

Cost‐effectiveness and cost‐utility evaluation of individual vs. group transdiagnostic psychological treatment for emotional disorders in primary care (PsicAP‐Costs): a multicentre randomized controlled trial protocol

Background: Emotional disorders are common, and they have become more prevalent since the COVID‐19 pan‐ demic. Due to a high attendance burden at the specialized level, most emotional disorders in Spain are treated in primary care, where they are usually misdiagnosed and treated using psychotropic drugs. This contributes to perpetu‐ ate their illness and increase health care costs. Following the IAPT programme and the transdiagnostic approach, the PsicAP project developed a brief group transdiagnostic cognitive‐behavioural therapy (tCBT) as a cost‐effective alternative. However, it is not suitable for everyone; in some cases, one‐on‐one sessions may be more effective. The objective of the present study is to compare, in cost‐benefit terms, group and individual tCBT with the treatment usu‐ ally administered in Spanish primary care (TAU). Methods: A randomized, controlled, multicentre, and single‐blinded trial will be performed. Adults with mild to moderate emotional disorders will be recruited and placed in one of three arms: group tCBT, individual tCBT, or TAU. Medical data and outcomes regarding emotional symptoms, disability, quality of life, and emotion regulation biases will be collected at baseline, immediately after treatment, and 6 and 12 months later. The data will be used to calcu‐ late incremental cost‐effectiveness and cost‐utility ratios. Discussion: This trial aims to contribute to clinical practice research. The involvement of psychologists in primary care and the implementation of a stepped‐care model for mental disorders are recommended. Group therapy and a transdiagnostic approach may help optimize health system resources and unblock waiting lists so that people can spend less time experiencing mental health problems. Trial registration: ClinicalTrials.gov: NCT04847310; Protocols.io: bx2npqde. (April 19, 2021

Protocolo transdiagnóstico PsicAP de entrenamiento cognitivo-conductual en grupo para trastornos emocionales

Anxiety disorders and depression are highly prevalent today. The PsicAP clinical trial showed that adding 7 sessions of group cognitive-behavioural training with a transdiagnostic approach to the usual treatment of emotional disorders in adult primary care patients increased efficacy and cost-effectiveness in reducing symptom levels, reduced disability and improved quality of life. In this work, these 7 sessions of the PsicAP protocol of transdiagnostic treatment are described, aimed at intervening on the factors common to the different disorders: cognitive distortions and emotional regulation strategies. It is an intervention based on learning through psychoeducation, cognitive restructuring, relaxation, behavioural techniques and relapse prevention. It concludes by arguing about the usefulness of this protocol to reduce the gap between research and clinical practice, something necessary in today's societyLos trastornos de ansiedad y la depresión son altamente prevalentes en la sociedad actual. El ensayo clínico PsicAP demostró que añadir 7 sesiones de entrenamiento cognitivo-conductual en grupo con enfoque transdiagnóstico al tratamiento habitual de trastornos emocionales en pacientes adultos de atención primaria aumentó la eficacia y coste-efectividad para reducir los niveles de síntomas, redujo la discapacidad y mejoró la calidad de vida. En este trabajo se describen esas 7 sesiones del protocolo PsicAP de tratamiento transdiagnóstico, dirigido a la intervención sobre los factores comunes a los distintos trastornos: las distorsiones cognitivas y las estrategias de regulación emocional. Se trata de una intervención basada en el aprendizaje mediante psicoeducación, reestructuración cognitiva, relajación, técnicas conductuales y prevención de recaídas. Se concluye argumentando sobre la utilidad de este protocolo para reducir la brecha entre investigación y práctica clínica, algo necesario en la sociedad actua

Tratamientos psicológicos empíricamente apoyados para adultos: Una revisión selectiva

Antecedentes: los tratamientos psicológicos han mostrado su eficacia, efectividad y eficiencia para el abordaje de los trastornos mentales; no obstante, considerando el conocimiento científico generado en los últimos años, no se dispone de trabajos de actualización en español sobre cuáles son los tratamientos psicológicos con respaldo empírico. El objetivo fue realizar una revisión selectiva de los principales tratamientos psicológicos empíricamente apoyados para el abordaje de trastornos mentales en personas adultas. Método: se recogen niveles de evidencia y grados de recomendación en función de los criterios propuestos por el Sistema Nacional de Salud de España (en las Guías de Práctica Clínica) para diferentes trastornos psicológicos. Resultados: los resultados sugieren que los tratamientos psicológicos disponen de apoyo empírico para el abordaje de un amplio elenco de trastornos psicológicos. El grado de apoyo empírico oscila de bajo a alto en función del trastorno psicológico analizado. La revisión sugiere que ciertos campos de intervención necesitan una mayor investigación. Conclusiones: a partir de esta revisión selectiva, los profesionales de la psicología podrán disponer de información rigurosa y actualizada que les permita tomar decisiones informadas a la hora de implementar aquellos procedimientos psicoterapéuticos empíricamente fundamentados en función de las características de las personas que demandan ayuda. Background: Psychological treatments have shown their efficacy, effectiveness, and efficiency in dealing with mental disorders. However, considering the scientific knowledge generated in recent years, in the Spanish context, there are no updating studies about empirically supported psychological treatments. The main goal was to carry out a selective review of the main empirically supported psychological treatments for mental disorders in adults. Method: Levels of evidence and degrees of recommendation were collected based on the criteria proposed by the Spanish National Health System (Clinical Practice Guidelines) for different psychological disorders. Results: The results indicate that psychological treatments have empirical support for the approach to a wide range of psychological disorders. These levels of empirical evidence gathered range from low to high depending on the psychological disorder analysed. The review indicates the existence of certain fields of intervention that need further investigation. Conclusions: Based on this selective review, psychology professionals will be able to have rigorous, up-to-date information that allows them to make informed decisions when implementing empirically based psychotherapeutic procedures based on the characteristics of the people who require help

Sample and library preparation approaches for the analysis of the virome of irrigation water

The virome (i.e. community of mainly RNA and DNA eukaryotic viruses and bacteriophages) of waters is yet to be extensively explored. In particular, the virome of waters used for irrigation could therefore potentially carry viral pathogens that can contaminate fresh produce. One problem in obtaining viral sequences from irrigation waters is the relatively low amount of virus particles, as well as the presence of human, bacterial and protozoan cells. The present aimed study was to compare different processing, amplification, and sequencing approaches for virome characterization in irrigation waters.This study was supported by the ‘VIRIDIANA’ project AGL2017-82909 (AEI/FEDER, UE) funded by Spanish Ministry of Science, Innovation and Universities; the ‘MAGIC’ project from the Center of Produce Safety (CPS, no. 2018CPS10); and the APOTI grant (APOTIP/2018/007) from the Generalitat Valenciana. IATA-CSIC is a Centre of Excellence Severo Ochoa (CEX2021-001189-S MCIN/AEI/10.13039/501100011033). AP-C is recipient of a postdoctoral grant from the Generalitat Valenciana (APOSTD/2021/292).With funding from the Spanish government through the ‘Severo Ochoa Centre of Excellence’ accreditation (CEX2021-001189-S).Peer reviewe

An infant milk formula supplemented with heat-treated probiotic bifidobacterium animalis subsp. lactis CECT 8145, reduces fat deposition in C. elegans and augments acetate and lactate in a fermented infant slurry

Pediatric obesity has a growing health and socio-economical impact due to cardiovascular and metabolic complications in adult life. Some recent studies suggest that live or heat-treated probiotics have beneficial effects in preventing fat deposition and obesity in preclinical and clinical sets. Here, we have explored the effects of heat-treated probiotic Bifidobacterium animalis subsp. lactis CECT 8145 (HT-BPL1), added as a supplement on an infant milk formula (HT-BPL1-IN), on Caenorhabditis elegans fat deposition and short-chain fatty acids (SCFAs) and lactate, using fermented baby fecal slurries. We have found that HT-BPL1-IN significantly reduced fat deposition in C. elegans, at the time it drastically augmented the generation of some SCFAs, particulary acetate and organic acid lactate. Data suggest that heat-treated BPL1 maintains its functional activities when added to an infant powder milk formula.This research was supported by Cátedra UAM-Alter Nutrinfant, Madrid, Spain

Evaluation of Changes in Gut Microbiota in Patients with Crohn’s Disease after Anti-Tnfα Treatment: Prospective Multicenter Observational Study

Background: Crohn’s disease is believed to result from the interaction between genetic susceptibility, environmental factors and gut microbiota, leading to an aberrant immune response. The objectives of this study are to evaluate the qualitative and quantitative changes in the microbiota of patients with Crohn’s disease after six months of anti-tumor-necrosis factor (anti-TNFα) (infliximab or adalimumab) treatment and to determine whether these changes lead to the recovery of normal microbiota when compared to a control group of healthy subjects. In addition, we will evaluate the potential role of the Faecalibacterium prausnitzii/Escherichia coli and Faecalibacterium prausnitzii/Clostridium coccoides ratios as indicators of therapeutic response to anti-TNFα drugs. Methods/Design: This prospective multicenter observational study will comprise a total of 88 subjects: 44 patients with Crohn’s disease scheduled to start anti-TNFα treatment as described in the drug specifications to control the disease and 44 healthy individuals who share the same lifestyle and eating habits. The presence of inflammatory activity will be determined by the Harvey-Bradshaw index, analytical parameters in blood, including C-reactive protein, and fecal calprotectin levels at commencement of the study, at three months and at six months, allowing the classification of patients into responders and non-responders. Microbiota composition and the quantitative relationship between Faecalibacterium prausnitzii and Escherichia coli and between Faecalibacterium prausnitzii and Clostridium coccoides group as indicators of dysbiosis will be studied at inclusion and six months after initiation of treatment using ultra sequencing with Illumina technology and comparative bioinformatics analysis for the former relationship, and digital droplet PCR using stool samples for the latter. Upon inclusion, patients will complete a survey of dietary intake for the three days prior to stool collection, which will be repeated six months later in a second collection to minimize dietary bias. Discussion: In this study, massive sequencing, a reliable new tool, will be applied to identify early biomarkers of response to anti-TNF treatment in patients with Crohn’s disease to improve clinical management of these patients, reduce morbidity rates and improve efficiency

Complete genome sequence of the new urolithin-producing bacterium Gordonibacter urolithinfaciens DSM 27213T.

Peer reviewe

Amiloride, an old diuretic drug, is a potential therapeutic agent for multiple myeloma

[Purpose]: The search for new drugs that control the continuous relapses of multiple myeloma is still required. Here, we report for the first time the potent antimyeloma activity of amiloride, an old potassium-sparing diuretic approved for the treatment of hypertension and edema due to heart failure. [Experimental Design]: Myeloma cell lines and primary samples were used to evaluate cytotoxicity of amiloride. In vivo studies were carried out in a xenograft mouse model. The mechanisms of action were investigated using RNA-Seq experiments, qRT-PCR, immunoblotting, and immunofluorescence assays. [Results]: Amiloride-induced apoptosis was observed in a broad panel of multiple myeloma cell lines and in a xenograft mouse model. Moreover, amiloride also had a synergistic effect when combined with dexamethasone, melphalan, lenalidomide, and pomalidomide. RNA-Seq experiments showed that amiloride not only significantly altered the level of transcript isoforms and alternative splicing events, but also deregulated the spliceosomal machinery. In addition, disruption of the splicing machinery in immunofluorescence studies was associated with the inhibition of myeloma cell viability after amiloride exposure. Although amiloride was able to induce apoptosis in myeloma cells lacking p53 expression, activation of p53 signaling was observed in wild-type and mutated TP53 cells after amiloride exposure. On the other hand, we did not find a significant systemic toxicity in mice treated with amiloride. [Conclusions]: Overall, our results demonstrate the antimyeloma activity of amiloride and provide a mechanistic rationale for its use as an alternative treatment option for relapsed multiple myeloma patients, especially those with 17p deletion or TP53 mutations that are resistant to current therapies.This study was partially supported by the Instituto de Salud Carlos III-Cofinanciacion with funding from FEDER (PI13/00111 and PI16/01074), Asociacion Española Contra el Cancer (AECC, GCB120981SAN), Gerencia Regional de Salud, Junta de Castilla y Leon (BIO/SA57/13 and BIO/SA22/15), and the INNOCAMPUS Program (CEI10-1-0010). I. Misiewicz-Krzeminska was supported by a Black Swan R esearch Initiative grant from the International Myeloma Foundation. L.A. Corchete was supported by a grant from the Fundacion Española de Hematología y Hemoterapia.Peer Reviewe