The Influence of Patient Experience with Healthcare on the Health-Related Quality of Life of People Living with HIV: An Observational Cross-Sectional Survey

[Abstract] Introduction Patient experience is central to the quality of healthcare delivery, showing positive associations with several outcome measures. The main objectives of this study are to analyze the influence of patient experience on the health-related quality of life in people living with HIV and the role played by treatment complexity and clinical care. Methods We conducted a cross-sectional survey with 467 patients with HIV. We used the Instrument for Evaluation of the Experience of Chronic Patients and the Health-related Quality of Life Questionnaire (EQ-5D-5L). We analyzed a predictive model through the partial least squares (PLS) method. Results The patient self-management scores showed the highest positive relationship with the patient’s health-related quality of life (β = 0.24, β = 0.32, p  50 years old (p < 0.05). Conclusions Patient experience mainly influenced the health-related quality of life of older people living with HIV. The treatment and clinical care complexity played an important role in degrading the patients' experience and their quality of life. More integrated care would benefit the health-related quality of life of people living with HIV

Recomendaciones basadas en la evidencia del grupo andaluz para la reflexión e investigación en nutrición (Garin) para el manejo del paciente con síndrome de intestino corto

In order to develop evidence-based recommendations and expert consensus for the nutritional management of patients with short bowel syndrome (SBS), we conducted a systematic literature search using the PRISMA methodology plus a critical appraisal following the GRADE scale procedures. Pharmacological treatment with antisecretory drugs, antidiarrheal drugs, and somatostatin contributes to reducing intestinal losses. Nutritional support is based on parenteral nutrition; however, oral intake and/or enteral nutrition should be introduced as soon as possible. In the chronic phase, the diet should have as few restrictions as possible, and be adapted to the SBS type. Home parenteral nutrition (HPN) should be individualized. Single-lumen catheters are recommended and taurolidine should be used for locking the catheter. The HPN’s lipid content must be greater than 1 g/kg per week but not exceed 1 g/kg per day, and omega-6 fatty acids (ω6 FAs) should be reduced. Trace element vials with low doses of manganese should be used. Patients with chronic SBS who require long-term HPN/fluid therapy despite optimized treatment should be considered for teduglutide treatment. All patients require a multidisciplinary approach and specialized follow-up. These recommendations and suggestions regarding nutritional management in SBS patients have direct clinical applicability

Amplified Spontaneous Emission in Pentathienoacene Dioxides by Direct Optical Pump and by Energy Transfer: Correlation with Photophysical Parameters

Amplified spontaneous emission (ASE) is observed, under optical pump, in polystyrene films doped with two pentathienoacene derivatives functionalised with thienyl-S,S-dioxide groups (compounds 2 and 3). The effect of the dioxide groups on the ASE properties is analysed by comparing the performance with that of its corresponding non-oxidized analogue (1). Films containing either 2 or 3 show ASE at 511 and 574 nm, respectively, when excited directly (at 435 nm) on their absorption bands, showing thresholds and linewidths larger than those obtained from films doped with 1, pumped at 355 nm. ASE is also observed under excitation at 355 nm, in samples containing 1 (host) and either 2 or 3 (guests), due to energy transfer from host to guest. For the blends with 3, the ASE threshold is lower than that obtained when the films are excited directly. Results are interpreted in terms of the photophysical parameters such as absorption capacity, fluorescence efficiency, singlet-to-triplet intersystem crossing leading to triplet-triplet re-absorptions, bimolecular energy-transfer efficiency, efficiency of internal conversion process, etc. State-of-the-art quantum chemical calculations are used in the interpretation of the experimental results.Authors from the University of Alicante acknowledge support from the Spanish Government (MINECO) and the European Community (FEDER) through grants MAT2008–06648-C02–01 and MAT2011–28167-C02–01. The work at the University of Málaga is supported by the MEC projects CTQ2012–33733 and by the PO9–4708 project by the Junta de Andalucía. Raquel Rondão acknowledges FCT for a PhD grant (SFRH/BD/38882/2007). D.A.S.F. gratefully acknowledges the financial support from the Brazilian Research Councils: CAPES, CNPq (grant 303084/2010–3) and FAP-DF (Fundação de Apoio à Pesquisa do Distrito Federal)

COPD Clinical Control: predictors and long-term follow-up of the CHAIN cohort

CHAIN Study Investigators.[Background] Control in COPD is a dynamic concept that can reflect changes in patients’ clinical status that may have prognostic implications, but there is no information about changes in control status and its long-term consequences.[Methods] We classified 798 patients with COPD from the CHAIN cohort as controlled/uncontrolled at baseline and over 5 years. We describe the changes in control status in patients over long-term follow-up and analyze the factors that were associated with longitudinal control patterns and related survival using the Cox hazard analysis.[Results] 134 patients (16.8%) were considered persistently controlled, 248 (31.1%) persistently uncontrolled and 416 (52.1%) changed control status during follow-up. The variables significantly associated with persistent control were not requiring triple therapy at baseline and having a better quality of life. Annual changes in outcomes (health status, psychological status, airflow limitation) did not differ in patients, regardless of clinical control status. All-cause mortality was lower in persistently controlled patients (5.5% versus 19.1%, p = 0.001). The hazard ratio for all-cause mortality was 2.274 (95% CI 1.394–3.708; p = 0.001). Regarding pharmacological treatment, triple inhaled therapy was the most common option in persistently uncontrolled patients (72.2%). Patients with persistent disease control more frequently used bronchodilators for monotherapy (53%) at recruitment, although by the end of the follow-up period, 20% had scaled up their treatment, with triple therapy being the most frequent therapeutic pattern.[Conclusions] The evaluation of COPD control status provides relevant prognostic information on survival. There is important variability in clinical control status and only a small proportion of the patients had persistently good control. Changes in the treatment pattern may be relevant in the longitudinal pattern of COPD clinical control. Further studies in other populations should validate our results.[Trial registration] Clinical Trials.gov: identifier NCT01122758.This study has been funded by AstraZeneca.Peer reviewe

Remote ischemic preconditioning ameliorates anthracycline-induced cardiotoxicity and preserves mitochondrial integrity

Aims: Anthracycline-induced cardiotoxicity (AIC) is a serious adverse effect among cancer patients. A central mechanism of AIC is irreversible mitochondrial damage. Despite major efforts, there are currently no effective therapies able to prevent AIC. Methods and results: Forty Large-White pigs were included. In Study 1, 20 pigs were randomized 1:1 to remote ischaemic preconditioning (RIPC, 3 cycles of 5 min leg ischaemia followed by 5 min reperfusion) or no pretreatment. RIPC was performed immediately before each intracoronary doxorubicin injections (0.45 mg/kg) given at Weeks 0, 2, 4, 6, and 8. A group of 10 pigs with no exposure to doxorubicin served as healthy controls. Pigs underwent serial cardiac magnetic resonance (CMR) exams at baseline and at Weeks 6, 8, 12, and 16, being sacrifice after that. In Study 2, 10 new pigs received 3 doxorubicin injections (with/out preceding RIPC) and were sacrificed at week 6. In Study 1, left ventricular ejection fraction (LVEF) depression was blunted animals receiving RIPC before doxorubicin (RIPC-Doxo), which had a significantly higher LVEF at Week 16 than doxorubicin treated pigs that received no pretreatment (Untreated-Doxo) (41.5 ± 9.1% vs. 32.5 ± 8.7%, P = 0.04). It was mainly due to conserved regional contractile function. In Study 2, transmission electron microscopy (TEM) at Week 6 showed fragmented mitochondria with severe morphological abnormalities in Untreated-Doxo pigs, together with upregulation of fission and autophagy proteins. At the end of the 16-week Study 1 protocol, TEM revealed overt mitochondrial fragmentation with structural fragmentation in Untreated-Doxo pigs, whereas interstitial fibrosis was less severe in RIPC+Doxo pigs. Conclusion: In a translatable large-animal model of AIC, RIPC applied immediately before each doxorubicin injection resulted in preserved cardiac contractility with significantly higher long-term LVEF and less cardiac fibrosis. RIPC prevented mitochondrial fragmentation and dysregulated autophagy from AIC early stages. RIPC is a promising intervention for testing in clinical trials in AIC.Fil: Galán Arriola, Carlos. Centro de Investigacion Biomedica En Red.; EspañaFil: Villena Gutiérrez, Rocio. Centro de Investigacion Biomedica En Red.; EspañaFil: Higuero Verdejo, María I.. Centro Nacional de Investigaciones Cardiovasculares; EspañaFil: Díaz Rengifo, Iván A.. Centro Nacional de Investigaciones Cardiovasculares; EspañaFil: Pizarro, Gonzalo. Centro de Investigacion Biomedica En Red.; EspañaFil: López, Gonzalo J.. Centro Nacional de Investigaciones Cardiovasculares; EspañaFil: de Molina Iracheta, Antonio. Centro Nacional de Investigaciones Cardiovasculares; EspañaFil: Pérez Martínez, Claudia. Universidad de Leon. Facultad de Veterinaria; ArgentinaFil: García, Rodrigo Damián. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Mendoza. Instituto de Medicina y Biología Experimental de Cuyo; ArgentinaFil: González Calle, David. Centro de Investigacion Biomedica En Red.; EspañaFil: Lobo, Manuel. Centro de Investigacion Biomedica En Red.; EspañaFil: Sánchez, Pedro L.. Centro de Investigacion Biomedica En Red.; EspañaFil: Oliver, Eduardo. Centro de Investigacion Biomedica En Red.; EspañaFil: Córdoba, Raúl. Hospital Fundacion Jimenez Diaz; EspañaFil: Fuster, Valentin. Centro Nacional de Investigaciones Cardiovasculares; EspañaFil: Sánchez González, Javier. No especifíca;Fil: Ibanez, Borja. Centro de Investigacion Biomedica En Red.; Españ

Prediction of poor outcome in clostridioides difficile infection: A multicentre external validation of the toxin B amplification cycle

Producción CientíficaClassification of patients according to their risk of poor outcomes in Clostridioides difficile infection (CDI) would enable implementation of costly new treatment options in a subset of patients at higher risk of poor outcome. In a previous study, we found that low toxin B amplification cycle thresholds (Ct) were independently associated with poor outcome CDI. Our objective was to perform a multicentre external validation of a PCR-toxin B Ct as a marker of poor outcome CDI. We carried out a multicentre study (14 hospitals) in which the characteristics and outcome of patients with CDI were evaluated. A subanalysis of the results of the amplification curve of real-time PCR gene toxin B (XpertTM C. difficile) was performed. A total of 223 patients were included. The median age was 73.0 years, 50.2% were female, and the median Charlson index was 3.0. The comparison of poor outcome and non–poor outcome CDI episodes revealed, respectively, the following results: median age (years), 77.0 vs 72.0 (p = 0.009); patients from nursing homes, 24.4% vs 10.8% (p = 0.039); median leukocytes (cells/μl), 10,740.0 vs 8795.0 (p = 0.026); and median PCR-toxin B Ct, 23.3 vs 25.4 (p = 0.004). Multivariate analysis showed that a PCR-toxin B Ct cut-off <23.5 was significantly and independently associated with poor outcome CDI (p = 0.002; OR, 3.371; 95%CI, 1.565–7.264). This variable correctly classified 68.5% of patients. The use of this microbiological marker could facilitate early selection of patients who are at higher risk of poor outcome and are more likely to benefit from newer and more costly therapeutic options

Natural Course of the Diffusing Capacity of the Lungs for Carbon Monoxide in COPD: Importance of Sex

[Background] The value of the single-breath diffusing capacity of the lungs for carbon monoxide (Dlco) relates to outcomes for patients with COPD. However, little is known about the natural course of Dlco over time, intersubject variability, and factors that may influence Dlco progression.[Research Question] What is the natural course of Dlco in patients with COPD over time, and which other factors, including sex differences, could influence this progression?[Study Design and Methods] We phenotyped 602 smokers (women, 33%), of whom 506 (84%) had COPD and 96 (16%) had no airflow limitation. Lung function, including Dlco, was monitored annually over 5 years. A random coefficients model was used to evaluate Dlco changes over time.[Results] The mean (± SE) yearly decline in Dlco % in patients with COPD was 1.34% ± 0.015%/y. This was steeper compared with non-COPD control subjects (0.04% ± 0.032%/y; P = .004). Sixteen percent of the patients with COPD, vs 4.3% of the control subjects, had a statistically significant Dlco % slope annual decline (4.14%/y). At baseline, women with COPD had lower Dlco values (11.37% ± 2.27%; P < .001) in spite of a higher FEV1 % than men. Compared with men, women with COPD had a steeper Dlco annual decline of 0.89% ± 0.42%/y (P = .039).[Interpretation] Patients with COPD have an accelerated decline in Dlco compared with smokers without the disease. However, the decline is slow, and a testing interval of 3 to 4 years may be clinically informative. The lower and more rapid decline in Dlco values in women, compared with men, suggests a differential impact of sex in gas exchange function.[Trial Registry] ClinicalTrials.gov; No.: NCT01122758; URL: www.clinicaltrials.govThis study was funded in part by an unrestricted grant from AstraZeneca, and also by the COPD Research Program of the Spanish Respiratory Society (PII de EPOC of SEPAR).Peer reviewe

Priorities in Cardio-Oncology Basic and Translational Science

Despite improvements in cancer survival, cancer therapy–related cardiovascular toxicity has risen to become a prominent clinical challenge. This has led to the growth of the burgeoning field of cardio-oncology, which aims to advance the cardiovascular health of cancer patients and survivors, through actionable and translatable science. In these Global Cardio-Oncology Symposium 2023 scientific symposium proceedings, we present a focused review on the mechanisms that contribute to common cardiovascular toxicities discussed at this meeting, the ongoing international collaborative efforts to improve patient outcomes, and the bidirectional challenges of translating basic research to clinical care. We acknowledge that there are many additional therapies that are of significance but were not topics of discussion at this symposium. We hope that through this symposium-based review we can highlight the knowledge gaps and clinical priorities to inform the design of future studies that aim to prevent and mitigate cardiovascular disease in cancer patients and survivors.</p

The integration of Transversal Competences in Higher Education in Engineering through e-learning tools. The case of the ETSII at the UPV

[EN] One of the objectives of Higher Education, increasingly demanded by the labor market, is to guarantee the development of professional, social and ethical skills of students. Making the learning of these type of transversal competences (TC) compatible with the specific competences of the degree in the time frame of the studies, is not an easy task in particular of some of these competences, in engineering profile degrees. For this reason, at the Higher Technical School of Industrial Engineering (ETSII) of the Universitat Politècnica de València (UPV) it has been designed an e-learning platform by the teaching staff, students and employers, coordinated by the SubDirectorate of Educational Innovation and within the framework of a Project of Innovation and Educational Improvement of the UPV,. This platform allows students to train in TC at their own pace according to their needs and teachers to use methodologies appropriate to their subjects and domain level adapted to the engineering framework. In this way, the platform can be used as a vertical coordination axis between subjects, for the development of TC at the different levels of mastery throughout the ETSII students' studies.[ES] Uno de los objetivos de la Educación Superior cada vez más demandado por el mercado laboral es garantizar el desarrollo de habilidades profesionales, sociales y éticas del alumnado. Compatibilizar el aprendizaje de este tipo de competencias de carácter transversal (CT) con las competencias específicas propias de la titulación en el marco temporal de los estudios, no es tarea sencilla especialmente para algunas de estas competencias y en titulaciones de perfil ingenieril. Por este motivo, en la Escuela Técnica Superior de Ingeniería Industrial (ETSII) de la Universitat Politècnica de València (UPV) se ha diseñado una plataforma e-learning por parte del profesorado, estudiantes y empleadores, coordinados por la Subdirección de Innovación Educativa y en el marco de diferentes Proyectos de Innovación y Mejora Educativa de la UPV, Esta plataforma permite al estudiantado formarse en CT de manera autónoma según sus necesidades, y al profesorado recurrir a metodologías adecuadas a sus asignaturas y nivel de dominio adaptadas al ámbito ingenieril. De esta forma, la plataforma puede usarse como eje de coordinación vertical entre asignaturas, para el desarrollo de CT en los distintos niveles de dominio a lo largo de los estudios del alumnado de la ETSII.Este trabajo ha sido desarrollado en el marco de los proyectos "Coordinación metodológica a través de webs de apoyo en títulos ETSII para diferentes CT" de la convocatoria de Proyectos de Innovación y Mejora Educativa Institucionales con código PIME/19-20 Ref.150, Ref.151 y Ref.152, impulsada por el Vicerrectorado de Estudios, Calidad y Acreditación y el Instituto de Ciencias de la Educación de la UPVVillanueva López, JF.; Alemany Díaz, MDM.; Vallés Lluch, A.; García-Serra García, J.; Alarcón Valero, F.; Andrés, J.; Aragonés-Beltrán, P.... (2021). La integración de Competencias Transversales en la Educación Superior en Ingenierías mediante herramientas de e-learning. El caso de la ETSII en la UPV. Servicio de Publicaciones Universidad Zaragoza. 137-142. https://doi.org/10.26754/CINAIC.2021.0029S13714