Pérdida de pacientes con infección por el virus de la Hepatitis C (VHC) en el sistema sanitario: Cuantificación del problema y análisis de los factores relacionados

2030 es el año fijado por la OMS para eliminar la infección por el virus de la hepatitis C (VHC). El papel de los programas de búsqueda activa podría resultar crucial para lograr alcanzar la meta, al permitir identificar y rescatar a los sujetos con diagnóstico ya iniciado en el pasado que actualmente se encuentren perdidos u ocultos en el sistema sanitario, un problema cuya dimensión no ha sido bien cuantificada hasta la fecha.Los objetivos del trabajo fueron: 1) determinar la tasa de pacientes con anticuerpos frente al VHC (AntiVHC+) que se pierden a lo largo de la cascada de cuidados, 2) identificar y rescatar a los sujetos perdidos en el sistema, 3) estudiar factores relacionados tanto con la ausencia de derivación a AE (Atención Especializada) como con la interrupción del seguimiento, 4) evaluar el nivel de conocimiento sobre la infección y enfermedad por el VHC en los pacientes aflorados, y 5) valorar la aceptación y adherencia de los pacientes rescatados al programa de afloramiento.Para poder dar respuesta a estos objetivos se llevó a cabo un programa de búsqueda activa de forma manual a partir de un registro de datos del laboratorio de Microbiología. Se incluyeron todos los resultados serológicos positivos (técnica ELISA y confirmación por inmunoblot) realizados en el Sector sanitario Zaragoza III entre enero 2009 y diciembre de 2013. Se excluyeron las serologías procedentes de centros penitenciarios y Pediatría así como a los sujetos menores de 14 años en el momento de la inclusión. Se trata de un estudio observacional ambispectivo dividido en tres fases consecutivas que se ejecutaron entre abril de 2017 y enero 2020 y que consistieron en la identificación y clasificación de los sujetos perdidos según el problema detectado (ausencia de vinculación con AE o interrupción del seguimiento por Digestivo/Infecciosas), invitación por carta (intervención) y reintroducción en el sistema mediante la creación de un circuito de derivación directo. Se recogieron variables demográficas, analíticas, clínicas y relacionadas con la intervención a partir de la Historia Clínica Electrónica (HCE). En la tercera fase (reintroducción) se solicitó la realización de cuestionarios a los pacientes rescatados.Se revisaron un total de 1092 pacientes con serología positiva para el VHC, encontrando una tasa de pérdida del 33,2%. En el 39,9% (N=145) de los casos el problema radicó en la ausencia de derivación a AE, mientras que en el 60,1% restante (N=218) la pérdida se produjo durante el seguimiento. El proceso diagnóstico quedó incompleto en el 63,1% (sin determinación del ARN viral). Los pacientes coinfectados (VIH+) presentaron mayor tasa de derivación y menor tasa de interrupción del seguimiento (pConclusiones: La pérdida de pacientes seropositivos, ya sea con diagnóstico incompleto (Anti-VHC+ sin confirmación virológica) o virémicos, constituye un problema real y de gran magnitud en nuestro medio. Entre aquellos que escapan y quedan al margen del sistema, es posible caracterizar un perfil de paciente con ausencia de derivación distinto al de aquel con interrupción del seguimiento. A pesar de la elevada aceptación, el impacto podría verse limitado por la existencia de factores que impiden la localización de los pacientes perdidos y de abandonos voluntarios tras el rescate, lo que sugiere la necesidad de diseñar estrategias futuras que permitan abordar ambos desafíos. Bibliografía:1. World Health Organization. Global Health Sector Strategy on viral hepatitis,2016–2021. Geneva: World Health Organization; 2016.2. World Health Organization. Global hepatitis report 2017. Geneva: World Health Organization; 2017.3. World Health Organization. WHO guidelines on hepatitis B and C testing. Geneva: World Health Organization; 2017.4. World Health Organization. Guidelines for the care and treatment of persons diagnosed with chronichepatitis C virus infection. Geneva: World Health Organization; 2018.5. European Centre for Disease Prevention and Control. Systematic review on hepatitis B and C prevalence in the EU/EEA. Stockholm: ECDC; 2016.6. POLARIS OBSERVATORY [Internet]. [cited 29 enero 2020]. Available from: https://cdafound.org/polaris/.7. Razavi H, Sanchez-Gonzalez Y, Pangerl A, Cornberg M. Global timing of hepatitis C virus elimination: estimating the year countries will achievethe World Health Organization elimination targets. International LIver Congress; Vienana: ; April 2019.8. Pawlotsky J, Negro F, Aghemo A, Berenguer M, Dalgard O, Dusheiko G, et al. EASL recommendations on treatment of hepatitis C: Final update of the series. Journal of hepatology. 2020 Nov;73(5):1170-218.9. Plan Estratégico para el Abordaje de la Hepatitis C en el Sistema Nacional de Salud (PEAHC). Secretaría General de Sanidad y Consumo Ministerio de Sanidad, Consumo y Bienestar Social. 2015.10. Gobierno de Aragón. Dirección General de Asistencia Sanitaria. Plan para la Eliminación de la Hepatitis C en Aragón; 2019.11. Grupo de trabajo del estudio de prevalencia de la infección por hepatitis C en población general en España, 2017-2018. Resultados del2º Estudio de Seroprevalencia en España (2017-2018). Ministerio de Sanidad, Consumo y Bienestar Social; 201912. Crespo J, Albillos A, Buti M, Calleja JL, García-Samaniego J, Hernández-Guerra M, Serrano T, Turnes J, Acín E, et al. Eliminación de la hepatitis C. Documento de posicionamiento de la Asociación Española para el Estudio del Hígado (AEEH). Gastroenterología y Hepatología. 2019 /11/01;42(9):579-92.13. Ministerio de Sanidad. Guía de cribado de la infección por el VHC. 2020 Julio.<br /

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

Global disparities in surgeons’ workloads, academic engagement and rest periods: the on-calL shIft fOr geNEral SurgeonS (LIONESS) study

: The workload of general surgeons is multifaceted, encompassing not only surgical procedures but also a myriad of other responsibilities. From April to May 2023, we conducted a CHERRIES-compliant internet-based survey analyzing clinical practice, academic engagement, and post-on-call rest. The questionnaire featured six sections with 35 questions. Statistical analysis used Chi-square tests, ANOVA, and logistic regression (SPSS® v. 28). The survey received a total of 1.046 responses (65.4%). Over 78.0% of responders came from Europe, 65.1% came from a general surgery unit; 92.8% of European and 87.5% of North American respondents were involved in research, compared to 71.7% in Africa. Europe led in publishing research studies (6.6 ± 8.6 yearly). Teaching involvement was high in North America (100%) and Africa (91.7%). Surgeons reported an average of 6.7 ± 4.9 on-call shifts per month, with European and North American surgeons experiencing 6.5 ± 4.9 and 7.8 ± 4.1 on-calls monthly, respectively. African surgeons had the highest on-call frequency (8.7 ± 6.1). Post-on-call, only 35.1% of respondents received a day off. Europeans were most likely (40%) to have a day off, while African surgeons were least likely (6.7%). On the adjusted multivariable analysis HDI (Human Development Index) (aOR 1.993) hospital capacity &gt; 400 beds (aOR 2.423), working in a specialty surgery unit (aOR 2.087), and making the on-call in-house (aOR 5.446), significantly predicted the likelihood of having a day off after an on-call shift. Our study revealed critical insights into the disparities in workload, access to research, and professional opportunities for surgeons across different continents, underscored by the HDI

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological systematic review of health technology assessments

Background: Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods: We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1) what evidence aside from test accuracy was searched for and synthesised, 2) which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3) how/whether threshold effects were explored, 4) how the potential dependency between multiple tests in a pathway was accounted for, and 5) for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results: The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings. Conclusions: The uptake of appropriate meta-analysis methods for synthesising evidence on diagnostic test accuracy in UK NIHR HTAs has improved in recent years. Future research should focus on other evidence requirements for cost-effectiveness assessment, threshold effects for quantitative tests and the impact of multiple diagnostic tests

Erratum to: Methods for evaluating medical tests and biomarkers

[This corrects the article DOI: 10.1186/s41512-016-0001-y.]

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

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Immunocompromised patients with acute respiratory distress syndrome: Secondary analysis of the LUNG SAFE database

Background: The aim of this study was to describe data on epidemiology, ventilatory management, and outcome of acute respiratory distress syndrome (ARDS) in immunocompromised patients. Methods: We performed a post hoc analysis on the cohort of immunocompromised patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE) study. The LUNG SAFE study was an international, prospective study including hypoxemic patients in 459 ICUs from 50 countries across 5 continents. Results: Of 2813 patients with ARDS, 584 (20.8%) were immunocompromised, 38.9% of whom had an unspecified cause. Pneumonia, nonpulmonary sepsis, and noncardiogenic shock were their most common risk factors for ARDS. Hospital mortality was higher in immunocompromised than in immunocompetent patients (52.4% vs 36.2%; p &lt; 0.0001), despite similar severity of ARDS. Decisions regarding limiting life-sustaining measures were significantly more frequent in immunocompromised patients (27.1% vs 18.6%; p &lt; 0.0001). Use of noninvasive ventilation (NIV) as first-line treatment was higher in immunocompromised patients (20.9% vs 15.9%; p = 0.0048), and immunodeficiency remained independently associated with the use of NIV after adjustment for confounders. Forty-eight percent of the patients treated with NIV were intubated, and their mortality was not different from that of the patients invasively ventilated ab initio. Conclusions: Immunosuppression is frequent in patients with ARDS, and infections are the main risk factors for ARDS in these immunocompromised patients. Their management differs from that of immunocompetent patients, particularly the greater use of NIV as first-line ventilation strategy. Compared with immunocompetent subjects, they have higher mortality regardless of ARDS severity as well as a higher frequency of limitation of life-sustaining measures. Nonetheless, nearly half of these patients survive to hospital discharge. Trial registration: ClinicalTrials.gov, NCT02010073. Registered on 12 December 2013