COVID-19 mRNA Based Vaccine Immune-Response Assessment in Nursing Home Residents for Public Health Decision

Nursing home residents (NHR) have been targeted as a vaccination priority due to their higher risk of worse outcome after COVID-19 infection. The mRNA-based vaccine BTN2b2 was first approved in Europe for NHRs. The assessment of the specific vaccine immune response (both humoral and cellular) at long term in NHRs has not been addressed yet. A representative sample of 624 NHR subjects in Northern region of Spain was studied to assess immune response against full vaccination with BTN2b2. The anti-S1 antibody levels and specific T cells were measured at two and six months after vaccination. 24.4% of NHR had a previous infection prior to vaccination. The remaining NHR were included in the full vaccination assessment group (FVA). After two months, a 94.9% of the FVA presented anti-S1 antibodies, whereas those seronegative without specific cellular response were 2.54%. At long-term, the frequency of NHR within the FVA group with anti-S1 antibodies at six months were 88.12% and the seronegative subjects without specific cellular response was 8.07%. The cellular immune assays complement the humoral test in the immune vaccine response assessment. Therefore, the cellular immune assessment in NHRs allows for the fine tuning of those seronegative subjects with potential competent immune responses against the vaccine

Simulación para formar en la competencia de valoración preanestésica: diseño común para residentes de primer año de anestesiología y enfermeras de anestesia

Introducción. La valoración preanestésica (VP) es una competencia compleja que debe adquirir el residente de anestesia tempranamente. La incorporación de enfermería especializada en la VP ha demostrado ser segura y eficaz. No existen recomendaciones para el entrenamiento en VP. La simulación puede ser una metodología apropiada para acortar el tiempo de adquisición de la competencia. Objetivo. Describir detalladamente el diseño y aplicación de un taller de simulación para formar residentes de anestesiología y enfermeras posgraduadas en la competencia VP. Sujetos y métodos. Taller de dos horas de duración con casos clínicos en formato video y ejecutados mediante técnica de role-playing. Los componentes fueron dos videos de grabación propia (el primero, de una VP con errores, y el otro, con una VP correctamente realizada), una plantilla para que cada alumno valorara en los videos los componentes técnicos y no técnicos de las competencias de la VP y una encuesta de satisfacción para alumnos e instructores. En el grupo de residentes se añadieron tres escenarios de VP de pacientes complejos. Resultados. Se analizaron las encuestas de los 10 residentes de dos promociones y de 60 enfermeras. La satisfacción de los dos tipos de alumnos y de los instructores sobre el aprendizaje fue muy alta. En el caso de las enfermeras, más del 85% de las alumnas de las promociones que recibieron el taller superaron la estación VP de la evaluación clínica objetiva estructurada (ECOE) frente a sólo el 20% de la promoción anterior. Conclusiones. El taller de VP con formato video y role-playing permite entrenar la competencia VP a residentes de anestesia y enfermeras posgraduadas, mejorando el rendimiento de éstas en la ECOE

Visual Blood, Visualisation of Blood Gas Analysis in Virtual Reality, Leads to More Correct Diagnoses: A Computer-Based, Multicentre, Simulation Study

Interpreting blood gas analysis results can be challenging for the clinician, especially in stressful situations under time pressure. To foster fast and correct interpretation of blood gas results, we developed Visual Blood. This computer-based, multicentre, noninferiority study compared Visual Blood and conventional arterial blood gas (ABG) printouts. We presented six scenarios to anaesthesiologists, once with Visual Blood and once with the conventional ABG printout. The primary outcome was ABG parameter perception. The secondary outcomes included correct clinical diagnoses, perceived diagnostic confidence, and perceived workload. To analyse the results, we used mixed models and matched odds ratios. Analysing 300 within-subject cases, we showed noninferiority of Visual Blood compared to ABG printouts concerning the rate of correctly perceived ABG parameters (rate ratio, 0.96; 95% CI, 0.92–1.00; p = 0.06). Additionally, the study revealed two times higher odds of making the correct clinical diagnosis using Visual Blood (OR, 2.16; 95% CI, 1.42–3.29; p < 0.001) than using ABG printouts. There was no or, respectively, weak evidence for a difference in diagnostic confidence (OR, 0.84; 95% CI, 0.58–1.21; p = 0.34) and perceived workload (Coefficient, 2.44; 95% CI, −0.09–4.98; p = 0.06). This study showed that participants did not perceive the ABG parameters better, but using Visual Blood resulted in more correct clinical diagnoses than using conventional ABG printouts. This suggests that Visual Blood allows for a higher level of situation awareness beyond individual parameters’ perception. However, the study also highlighted the limitations of today’s virtual reality headsets and Visual Blood

Avatar-based patient monitoring improves information transfer, diagnostic confidence and reduces perceived workload in intensive care units: computer-based, multicentre comparison study

Patient monitoring is the foundation of intensive care medicine. High workload and information overload can impair situation awareness of staff, thus leading to loss of important information about patients’ conditions. To facilitate mental processing of patient monitoring data, we developed the Visual-Patient-avatar Intensive Care Unit (ICU), a virtual patient model animated from vital signs and patient installation data. It incorporates user-centred design principles to foster situation awareness. This study investigated the avatar’s effects on information transfer measured by performance, diagnostic confidence and perceived workload. This computer-based study compared Visual-Patient-avatar ICU and conventional monitor modality for the first time. We recruited 25 nurses and 25 physicians from five centres. The participants completed an equal number of scenarios in both modalities. Information transfer, as the primary outcome, was defined as correctly assessing vital signs and installations. Secondary outcomes included diagnostic confidence and perceived workload. For analysis, we used mixed models and matched odds ratios. Comparing 250 within-subject cases revealed that Visual-Patient-avatar ICU led to a higher rate of correctly assessed vital signs and installations [rate ratio (RR) 1.25; 95% CI 1.19–1.31; P < 0.001], strengthened diagnostic confidence [odds ratio (OR) 3.32; 95% CI 2.15–5.11, P < 0.001] and lowered perceived workload (coefficient − 7.62; 95% CI − 9.17 to − 6.07; P < 0.001) than conventional modality. Using Visual-Patient-avatar ICU, participants retrieved more information with higher diagnostic confidence and lower perceived workload compared to the current industry standard monitor

Cost-effectiveness of a technology-supported multimodal prehabilitation program in moderate-to-high risk patients undergoing lung cancer resection: randomized controlled trial protocol

Background: Multimodal prehabilitation is a preoperative intervention with the objective to enhance cancer patients' functional status which has been showed to reduce both postoperative morbidity and hospital length of stay in digestive oncologic surgery. However, in lung cancer surgery patients further studies with higher methodological quality are needed to clarify the benefits of prehabilitation. The main aim of the current protocol is to evaluate the cost-effectiveness of a multimodal prehabilitation program supported by information and communication technologies in moderate-to-high risk lung cancer patients undergoing thoracic surgery. Methods: A Quadruple Aim approach will be adopted, assessing the prehabilitation program at the following levels: i) Patients' and professionals' experience outcomes (by means of standardized questionnaires, focus groups and structured interviews); ii) Population health-based outcomes (e.g. hospital length of stay, number and severity of postoperative complications, peak oxygen uptake and levels of systemic inflammation); and, iii) Healthcare costs. Discussion: This study protocol should contribute not only to increase the scientific basis on prehabilitation but also to detect the main factors modulating service adoption. Trial registration: NCT04052100 (August 9, 2019)

User Perceptions of Avatar-Based Patient Monitoring for Intensive Care Units: An International Exploratory Sequential Mixed-Methods Study

Visual Patient Avatar ICU is an innovative approach to patient monitoring, enhancing the user’s situation awareness in intensive care settings. It dynamically displays the patient’s current vital signs using changes in color, shape, and animation. The technology can also indicate patient-inserted devices, such as arterial lines, central lines, and urinary catheters, along with their insertion locations. We conducted an international, multi-center study using a sequential qualitative-quantitative design to evaluate users’ perception of Visual Patient Avatar ICU among physicians and nurses. Twenty-five nurses and twenty-five physicians from the ICU participated in the structured interviews. Forty of them completed the online survey. Overall, ICU professionals expressed a positive outlook on Visual Patient Avatar ICU. They described Visual Patient Avatar ICU as a simple and intuitive tool that improved information retention and facilitated problem identification. However, a subset of participants expressed concerns about potential information overload and a sense of incompleteness due to missing exact numerical values. These findings provide valuable insights into user perceptions of Visual Patient Avatar ICU and encourage further technology development before clinical implementation

User Perceptions of Visual Blood: An International Mixed Methods Study on Novel Blood Gas Analysis Visualization

Blood gas analysis plays a central role in modern medicine. Advances in technology have expanded the range of available parameters and increased the complexity of their interpretation. By applying user-centered design principles, it is possible to reduce the cognitive load associated with interpreting blood gas analysis. In this international, multicenter study, we explored anesthesiologists’ perspectives on Visual Blood, a novel visualization technique for presenting blood gas analysis results. We conducted interviews with participants following two computer-based simulation studies, the first utilizing virtual reality (VR) (50 participants) and the second without VR (70 participants). Employing the template approach, we identified key themes in the interview responses and formulated six statements, which were rated using Likert scales from 1 (strongly disagree) to 5 (strongly agree) in an online questionnaire. The most frequently mentioned theme was the positive usability features of Visual Blood. The online survey revealed that participants found Visual Blood to be an intuitive method for interpreting blood gas analysis (median 4, interquartile range (IQR) 4-4, p < 0.001). Participants noted that minimal training was required to effectively learn how to interpret Visual Blood (median 4, IQR 4-4, p < 0.001). However, adjustments are necessary to reduce visual overload (median 4, IQR 2-4, p < 0.001). Overall, Visual Blood received a favorable response. The strengths and weaknesses derived from these data will help optimize future versions of Visual Blood to improve the presentation of blood gas analysis results

Early detection of deterioration in COVID-19 patients by continuous ward respiratory rate monitoring: a pilot prospective cohort study

BackgroundTachypnea is among the earliest signs of pulmonary decompensation. Contactless continuous respiratory rate monitoring might be useful in isolated COVID-19 patients admitted in wards. We therefore aimed to determine whether continuous monitoring of respiratory patterns in hospitalized patients with COVID-19 predicts subsequent need for increased respiratory support.MethodsSingle-center pilot prospective cohort study in COVID-19 patients who were cared for in routine wards. COVID-19 patients who had at least one escalation of pulmonary management were matched to three non-escalated patients. Contactless respiratory monitoring was instituted after patients enrolled, and continued for 15 days unless hospital discharge, initiation of invasive mechanical ventilation, or death occurred. Clinicians were blinded to respiratory rate data from the continuous monitor. The exposures were respiratory features over rolling periods of 30 min, 24 h, and 72 h before respiratory care escalation. The primary outcome was a subsequent escalation in ventilatory support beyond a Venturi mask.ResultsAmong 125 included patients, 13 exhibited at least one escalation and were each matched to three non-escalated patients. A total of 28 escalation events were matched to 84 non-escalation episodes. The 30-min mean respiratory rate in escalated patients was 23 breaths per minute (bpm) ranging from 13 to 40 bpm, similar to the 22 bpm in non-escalated patients, although with less variability (range 14 to 31 bpm). However, higher respiratory rate variability, especially skewness over 1 day, was associated with higher incidence of escalation events. Our overall model, based on continuous data, had a moderate accuracy with an AUC 0.81 (95%CI: 0.73, 0.88) and a good specificity 0.93 (95%CI: 0.87, 0.99).ConclusionOur pilot observational study suggests that respiratory rate variability as detected with continuous monitoring is associated with subsequent care escalation during the following 24 h. Continuous respiratory monitoring thus appears to be a valuable increment over intermittent monitoring.Strengths and limitationsOur study was the initial evaluation of Circadia contactless respiratory monitoring in COVID-19 patients who are at special risk of pulmonary deterioration. The major limitation is that the analysis was largely post hoc and thus needs to be confirmed in an out-of-sample population

La enseñanza en el máster de abogacía a través del análisis de casos reales de carácter multidisciplinar. Aprendizaje "a partir del estudio de razonamientos parciales temáticos"

Generar blog para publicaciones de alumnos del Máster Abogacía, con "entradas" dirigidas. Habría análisis desde varias disciplinas añadiéndose estudios con enfoque basado en otras áreas de conocimiento, generando interdisciplinariedad

Intervención cognitiva desde las teorías del procesamiento de la información en alumnos con discapacidad intelectual

La psicología cognitiva y del procesamiento de la información estudia, pues, cómo el individuo selecciona y percibe la información, cómo la codifica, la almacena y la transforma, cómo accede a ella y la recupera, cómo la utiliza en la solución de diferentes tareas y soluciones, y cómo controla toda esa actividad mental. Tradicionalmente se vienen distinguiendo en el procesador humano dos aspectos: la estructura, o elementos estructurales (hardware), poco o nada modificable por el entrenamiento, y los procesos funcionales o programas (software), modificables mediante el entrenamiento. En los últimos cuarenta años se ha tratado de comprender la discapacidad intelectual desde esta perspectiva como “un trastorno del aprendizaje en el que intervienen variables cognitivas, afectivas, biológicas y ambientales. Este déficit sería recuperable mediante un entrenamiento adecuado que tenga en cuenta las peculiaridades de cada uno de los tipos de variables enumeradas y sus implicaciones mutuas. Este desorden del aprendizaje sería parcialmente remediable a través de un entrenamiento sistemático de los procesos y estrategias cognitivas” Del mismo modo se parte del acuerdo de que la discapacidad intelectual es algo mucho más amplio y complejo que el mero déficit cognitivo, como en que ese déficit cognitivo es, de algún modo, responsable de las posibilidades y dificultades o limitaciones que se observan en los demás aspectos de las conductas de competencia social de un sujeto. Se plantea en esta comunicación recoger información relevante sobre los tipos de procesamiento, su medida y, los efectos sobre las personas con síndrome de Down, así como presentar un estudio experimental sobre el entrenamiento en estrategias desde los diferentes tipos de procesamiento de la información, simultáneo, secuencial y planificador.Cognitive psychology is a branch of psychology that investigates internal mental processes such as problem solving, memory, and language. The school of thought arising from this approach is known as which is interested in how people mentally represent information processing. Cognitive psychologists use psychophysical and experimental approaches to understand, diagnose, and solve problems, concerning themselves with the mental processes which mediate between stimulus and response. In the last 40 years intellectual disabilities are studied like a learning disorder with social, cultural, environmental, and developmental factors. This learning disorder would be partially remediable through a systematic training in cognitive skills and strategies. In the same way part in the complex agreement of which the intellectual disability is something larger and more complex than the cognitive disorder. In this article we to collect relevant information about the different processing information ways, their measurement and their relation with Downs people, as well as to present an experimental study about information processing skills.peerReviewe