The well-fit for the FET model : understanding training transfer factors in Spain

Learning transfer evaluation is a necessary process for practitioners to assess the effectiveness of training, and the outcomes of training produces in workers' behaviors. In this paper, we explore an alternative way to evaluate transfer: through the study of transfer facilitators and barriers. Our aim is to validate the Factors to Evaluate Transfer (FET) model in a large sample of Spanish employees using confirmatory factor analysis. We applied the Spanish version of the FET scale to a sample of 2,745 Spanish workers of public service institutions and private companies. The results show a seven-factor model as the best choice according to the adjustment indices presented in the paper. We obtained a shorter version of the instrument, with adequate construct validity as well as good reliability and internal consistency. This model is a step forward in the measurement of indirect transfer and allows keeping working on the FET model to diagnosis transfer factors and increase the probabilities of higher learning transfer levels.L'avaluació de la transferència de l'aprenentatge és un procés necessari perquè els professionals avaluïn l'eficàcia de la formació i els seus resultats en els treballadors. Aquest article explora una forma alternativa d'avaluar la transferència: a través de l'estudi de facilitadors i obstacles de la transferència. L'objectiu és validar el model FET (factors per avaluar la transferència), en una mostra de treballadors espanyols amb una anàlisi factorial confirmatòria. Es va aplicar l'escala FET en espanyol a una mostra de 2.745 treballadors espanyols de l'Administració pública i l'empresa privada. Els resultats mostren un model de set factors com la millor opció sobre la base dels índexs d'ajust presentats en l'article. Vam obtenir una versió més reduïda de l'instrument, amb una validació de constructe adequada, així com una bona fiabilitat i consistència interna. Aquest model és un pas endavant en la mesura de la transferència indirecta i permet seguir treballant en el model FET per utilitzar-lo com a diagnosi de factors de transferència i augmentar la probabilitat de nivells més alts de transferència de l'aprenentatge.La evaluación de la transferencia del aprendizaje es un proceso necesario para que los profesionales evalúen la eficacia de la formación y sus resultados en los trabajadores. Este artículo explora una forma alternativa de evaluar la transferencia: a través del estudio de facilitadores y obstáculos de la transferencia. Su objetivo es validar el modelo FET (factores para evaluar la transferencia), en una muestra de empleados españoles con un análisis factorial confirmatorio. Se aplicó la escala FET en español a una muestra de 2.745 trabajadores españoles de la Administración pública y la empresa privada. Los resultados muestran un modelo de siete factores como la mejor opción sobre la base de los índices de ajuste presentados en el artículo. Obtuvimos una versión más reducida del instrumento, con una validación de constructo adecuada, así como una buena fiabilidad y consistencia interna. Este modelo es un paso adelante en la medición de transferencia indirecta y permite seguir trabajando en el modelo FET para usarlo como diagnóstico de factores de transferencia y aumentar la probabilidad de mayores niveles de transferencia del aprendizaje

Low glomerular filtration rate values are associated with higher TSH in an elderly population at high cardiovascular disease risk

BackgroundHypothyroidism is associated with impaired glomerular filtration rate (GFR), a recognized cardiovascular disease (CVD), and mortality risk factor. In older adults, this association remains unexplored. We aimed to determine the relationship of elevated TSH with GFR in an elderly population at high CVD risk.MethodsOlder adults (age>65ys) with high CVD risk defined by two or more CVD risk factors: smoking (S), high blood pressure (HBP), high total cholesterol, low HDL cholesterol, diabetes (DM), metabolic syndrome or previous cardiovascular event, were prospectively included at our ambulatory Endocrine Clinic. Patients under levothyroxine or thyroid disease were excluded. TSH> 6mU/l defined subclinical hypothyroidism (ScH) with normal free T4 levels. Estimated GFR was calculated by the Berlin-Initiative Study (BIS)-1 formula for elderly population. Urinary albumin to creatinine ratio (uACR), IL-6 and TNF-α, and Carotid intima-media thickness (CIMT) were also determined. The U Mann-Whitney test, the Spearman test, and multiple linear regression were used as statistical tests,ResultsFinally 246 patients (68% females) were included and 20 (8%) had ScH. This group, was older (median, Q1-Q3: 77,72-78; 72,68-77 years, p=0.01) and DM was less frequent than in the euthyroid group (35 vs 58%, p=0.039). Lower fasting glucose (-20%,p=0.01), GFR (-14%,p=0.01) and freeT4 (-10%,p<0.001) were found compared to euthyroid patients. A higher prevalence of Kidney failure was found in ScH (80 vs. 46%, p=0.003) vs. euthyroid individuals. Significant correlations with GFR were detected: age (r-0.482,p<0.001), TSH (r-0.172,p=0.004), IL-6 (r-0.150,p=0.047), TNF-α (r-0.274,p<0.001), uACR (r-0.170,p=0.009) and CIMT(r-0.189,p=0.004). By multiple linear regression, in a model adjusted by age, sex, BMI, uACR, S, DM, TNF-α and HBP, TSH (Bst -0.14, p=0.023, R2 = 0.25) was found an independent predictor of GFR.ConclusionIn older adults with high CVD risk, ScH is associated with lower renal function, and this relationship is present regardless of other cardiometabolic risk factors. These results suggest that ScH could contribute to low GFR and excess CVD risk, although this hypothesis should be addressed in longitudinal studies

Comparación de parámetros metabólicos en pacientes adultos y ancianos sometidos a cirugía bariátrica: Una cohorte prospectiva

Introduction: The aim was to evaluate metabolic parameters in a group of patients older than 65 years old compared to younger adults at three and six months after bariatric surgery (BS). Materials and methods: Prospective analytic study of a cohort of 40 patients under BS since 2015 to 2018. Participants were divided into two groups (Group A: ≥65; B: <65 years old). Anthropometrics and metabolic parameters were assessed before and 3 and 6 months after BS. The excess weight loss percentage (EWLP) and the Triglycerides/HDLc ratio, as a marker of insulin resistance, were also evaluated. A p <0.05 was statistically significant. Results: Forty patients were under BS, we included thirty six: 21 patients were at group A (Median age: 59, RIQ: 48-61 years old) and 15 at group B (median age 67, RIQ: 66-69 years old), the prevalence of patients with type 2 diabetes was 53% (n=8) in group B vs 43% (n=9) at group A. After 3 and 6 months of BS, we found no statistical difference between groups in WL and the EWLP and the decrease in fasting blood glucose (FBG), HbAc1 % levels but a significant rise in the levels of HDLc in group B. We observed a statistically decrease in the TAG/HDLc ratio and a positive correlation between HbA1c% and levels of FBG, HDLc and the TAG/HDLc ratio in group B. Moreover, we found a reduction in the use of antidiabetics and lipid lowering drugs in this age group.Conclusion: We found a significant benefit in metabolic effects of BS in the≥65 y/o cohort, especially by decreasing insulin resistance, even in those patients without diagnosis of DM2. We need more studies and a greater sample size to generalize these results.Introducción: El Objetivo fue evaluar los parámetros metabólicos en pacientes adultos ≥ 65 años en comparación con adultos < 65 años sometidos a CB pre y post intervención.Materiales y métodos: Estudio analítico de cohorte prospectiva en 40 pacientes sometidos a CB durante el periodo julio de 2015 y marzo de 2018. Los pacientes fueron divididos en dos grupos (A: ≥65 años; B: < 65 años) y se evaluaron previo a la cirugía (basal), y a los 3 y 6 meses posteriores al acto quirúrgico parámetros antropométricos y parámetros bioquímicos. Se calculó el porcentaje de peso perdido (PEPP) y se evaluó el índice Triglicéridos/HDLc (TAG/HDLc) como marcador de insulinorresistencia.Resultados: De los 40 pacientes sometidos a la CB, se incluyeron 36: 21 pacientes eran del grupo A (mediana de edad: 59, RIQ: 48-61 años) y 15 pacientes del grupo B (mediana de edad: 67, RIQ: 66-69 años), el porcentaje de pacientes con diabetes mellitus tipo 2 era de 53%(n=8) en B vs 43% (n=9) en A. Luego de 3 y 6 meses post CB se observó en el grupo B un descenso en el peso, índice de masa corporal y porcentaje de exceso de peso perdido (PEPP) no significativo, disminución en los niveles de glucemia y HbA1c sumado a un aumento significativo en los niveles de HDLc, además de un descenso significativo del índice TAG/HDLc en el grupo B. Se encontró una correlación positiva entre los niveles de HbA1c y PEPP, HDLc y el índice TAG/HDLc así como el descenso del uso de antidiabéticos e hipolipemiantes en el grupo B. Conclusiones: la CB logró similares resultados antropométricos en el grupo de pacientes ≥ de 65 años presentando una mejoría significativa en los paramétricos metabólicos a los 3 y 6 meses, principalmente en la insulinorresistencia, lo cual apoyaría el beneficio de la CB en este grupo etario

Bariatric surgery in women in reproductive age: recommendations from the “Diabetes and Pregnancy” and “Diabetes and Obesity” working committees from the Argentine Society of Diabetes

El incremento de la obesidad en el mundo, a edades más tempranas, ha tenido un impacto negativo especialmente en las mujeres en edad reproductiva. Se ven afectadas tanto la fertilidad como la tasa de embarazos de riesgo, de niños con bajo peso al nacer, pretérmino e índice de cesáreas. La cirugía bariátrica como alternativa de tratamiento de la obesidad ha mejorado la fertilidad, pero el trastorno malabsortivo que provoca modifica la absorción de nutrientes en la madre y en el feto. El diagnóstico de diabetes gestacional se dificulta dado que la prueba de tolerancia oral a la glucosa estaría contraindicada en estos casos. El objetivo de estas recomendaciones es proveer herramientas para el control y seguimiento de mujeres en edad reproductiva sometidas a cirugía bariátrica.Worldwide increased obesity prevalence at early ages particularly affects women of reproductive ages. Both fertility and risk pregnancy rates are affected, of low birth weight infants, prematures and cesarean section rates have been modified considerably. Bariatric surgery is a validated tool to improve fertility but nutrient malabsorption as a consequence of surgery could affect mother and fetus nutrition and development. Gestational diabetes diagnosis turns difficult in this group of obese patients after bariatric surgery since oral glucose tolerance testing would be contraindicated in these cases. The aim of these recommendations was to offer tools for a good control and follow up of women at reproductive age.Fil: Gutt, Susana. Hospital Italiano de Buenos Aires; ArgentinaFil: Rovira, Gabriela. Universidad de Buenos Aires. Facultad de Medicina. Sede Hospital Britanico Bs.as; ArgentinaFil: Jawerbaum, Alicia Sandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Centro de Estudios Farmacológicos y Botánicos; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Espinoza, Frank. Instituto Cardiovascular Lezica; ArgentinaFil: Mociulsky, Juliana. Clínica de Nutrición y Salud Dr. Cormillot; ArgentinaFil: Sucani, Stella. Provincia de Misiones. Hospital Escuela de Agudos Dr. Ramon Madariaga; ArgentinaFil: Kojdamanian, Verónica. Centro de Educación, Prevención y Asistencia al paciente diabético; ArgentinaFil: Aguirre Ackermann, Marianela. Centro Integral de Endocrinología y Nutrición; ArgentinaFil: Álvarez, María Graciela. Centro de Estudio y Tratamiento de la Obesidad Severa; ArgentinaFil: Camaño, Alejandro. Centro Médico de Especialidades y Diagnósticos Privado para la Salud; ArgentinaFil: Glatstein, Liliana. Centro Médico San Andrés; ArgentinaFil: Lifszyc, Paula. Hospital Carlos G. Durand; ArgentinaFil: Gómez Martin, Carolina. Centro Integral de Endocrinología y Diabetes; ArgentinaFil: Mendes, Patricio. Maternidad San Lucas; ArgentinaFil: Menéndez, Estrella. Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno; ArgentinaFil: Yuma, María. Hospital Italiano de Buenos Aires; ArgentinaFil: Bertona, Celina. Universidad Nacional de Cuyo; ArgentinaFil: Cafaro, Lilia. Obesidad y Cirugía Mini Invasiva; ArgentinaFil: Fuentes, Susana. Provincia de Buenos Aires. Ministerio de Salud. Hospital Alta Complejidad En Red El Cruce Dr. Nestor Carlos Kirchner Samic; ArgentinaFil: Salzberg, Susana. Instituto Centenario; ArgentinaFil: Basualdo, Natalia. Hospital Materno Infantil Ramón Sardá; ArgentinaFil: González, Sandra . Cínica IMA; ArgentinaFil: Villarroel Parra, Beatriz. Hospital de Agudos Dalmacio Vélez Sarsfield; Argentina. Sanatorio Santa Isabel; ArgentinaFil: Musso, Carla. Fundacion Favaloro; Argentin

Real-world Outcomes of Relapsed/Refractory Diffuse Large B-cell Lymphoma Treated With Polatuzumab Vedotin-based Therapy

: After FDA and EMA approval of the regimen containing polatuzumab vedotin plus rituximab and bendamustine (PolaBR), eligible relapsed/refractory diffuse large B-cell lymphoma (DLBCL) patients in Italy were granted early access through a Named Patient Program. A multicentric observational retrospective study was conducted focusing on the effectiveness and safety of PolaBR in everyday clinical practice. Fifty-five patients were enrolled. There were 26 females (47.3%), 32 patients were primary refractory and 45 (81.8%) resulted refractory to their last therapy. The decision to add or not bendamustine was at physician's discretion. Thirty-six patients underwent PolaBR, and 19 PolaR. The 2 groups did not differ in most of baseline characteristics. The final overall response rate was 32.7% (18.2% complete response rate), with a best response rate of 49.1%. Median disease-free survival was reached at 12 months, median progression-free survival at 4.9 months and median overall survival at 9 months, respectively. Overall, 88 adverse events (AEs) were registered during treatment in 31 patients, 22 of grade ≥3. Eight cases of neuropathy occurred, all of grades 1-2 and all related to polatuzumab. The two groups of treatment did not differ for effectiveness endpoints but presented statistically significant difference in AEs occurrence, especially in hematological AEs, in AEs of grade equal or greater than 3 and in incidence of neuropathy. Our data add useful information on the effectiveness of Pola(B)R in the setting of heavily pretreated DLBCL and may also suggest a better tolerability in absence of bendamustine without compromise of efficacy

Guidelines for the treatment of the diabetes mellitus type 2. Argentine Society of Diabetes

Objetivos: 1) actualizar la Guía de Tratamiento de la Diabetes Mellitus tipo 2 de la Sociedad Argentina de Diabetes publicada en el año 2010; 2) proveer al equipo de salud una herramienta actualizada para el manejo terapéutico de las personas con esta patología. Materiales y métodos: se convocó a un grupo de expertos, miembros titulares de la Sociedad Argentina de Diabetes, para analizar los trabajos disponibles en distintas fuentes, clasificándolos de acuerdo a su nivel de evidencia (Tabla 2), éste podrá observarse en negrita al final del párrafo correspondiente; sobre esta base se modificó la guía 2010 actualizando sus contenidos. Se designó un comité de redacción responsable de la compaginación final del documento. Conclusiones: los cambios en el estilo de vida continúan siendo la primera opción terapéutica, la metformina es la droga de primera línea, si no existen contraindicaciones para su uso o intolerancia, cualquiera de las otras familias de fármacos antidiabéticos, la insulina y sus análogos pueden usarse como monoterapia o asociadas entre sí teniendo en cuenta sus contraindicaciones, siempre y cuando no se utilicen juntas aquellas con mecanismos de acción similar. Los algoritmos 1 y 2 pueden considerarse la síntesis de la propuesta actual, elaborada para orientar la toma de decisiones respecto del tratamiento de la DMT2.Objectives: 1) update the Guidelines for the Treatment of the Diabetes Mellitus Type 2 of the Argentine Society of Diabetes, published in 2010; 2) provide to the health team updated guidance for the therapeutic management of people with this disease. Material and methods: a group of experts, full members of the Argentine Society of Diabetes, was convened to analyze the papers available from different sources, classifying them according to their level of evidence (Table 2), written in bold at the end of the paragraph; on this basis the 2010 guideline was modified to update contents. A drafting committee responsible for the final layout of the document was appointed. Conclusions: changes in lifestyle remain the first therapeutic option, metformin is the drug of first line, if there are no contraindications for use or intolerance, any of the other families of antidiabetic drugs, insulin and insulin analogs, can be used as monotherapy or associated, taking into account their contraindications and not using together those with similar action mechanisms. Algorithms 1 and 2 can be considered the synthesis of the current proposal.Facultad de Ciencias MédicasCentro de Endocrinología Experimental y Aplicad

Therapeutic Hemoglobin Levels after Gene Transfer in β-Thalassemia Mice and in Hematopoietic Cells of β-Thalassemia and Sickle Cells Disease Patients

Preclinical and clinical studies demonstrate the feasibility of treating β-thalassemia and Sickle Cell Disease (SCD) by lentiviral-mediated transfer of the human β-globin gene. However, previous studies have not addressed whether the ability of lentiviral vectors to increase hemoglobin synthesis might vary in different patients

Multiple Myeloma Treatment in Real-world Clinical Practice : Results of a Prospective, Multinational, Noninterventional Study

Funding Information: The authors would like to thank all patients and their families and all the EMMOS investigators for their valuable contributions to the study. The authors would like to acknowledge Robert Olie for his significant contribution to the EMMOS study. Writing support during the development of our report was provided by Laura Mulcahy and Catherine Crookes of FireKite, an Ashfield company, a part of UDG Healthcare plc, which was funded by Millennium Pharmaceuticals, Inc, and Janssen Global Services, LLC. The EMMOS study was supported by research funding from Janssen Pharmaceutical NV and Millennium Pharmaceuticals, Inc. Funding Information: The authors would like to thank all patients and their families and all the EMMOS investigators for their valuable contributions to the study. The authors would like to acknowledge Robert Olie for his significant contribution to the EMMOS study. Writing support during the development of our report was provided by Laura Mulcahy and Catherine Crookes of FireKite, an Ashfield company, a part of UDG Healthcare plc, which was funded by Millennium Pharmaceuticals, Inc, and Janssen Global Services, LLC. The EMMOS study was supported by research funding from Janssen Pharmaceutical NV and Millennium Pharmaceuticals, Inc. Funding Information: M.M. has received personal fees from Janssen, Celgene, Amgen, Bristol-Myers Squibb, Sanofi, Novartis, and Takeda and grants from Janssen and Sanofi during the conduct of the study. E.T. has received grants from Janssen and personal fees from Janssen and Takeda during the conduct of the study, and grants from Amgen, Celgene/Genesis, personal fees from Amgen, Celgene/Genesis, Bristol-Myers Squibb, Novartis, and Glaxo-Smith Kline outside the submitted work. M.V.M. has received personal fees from Janssen, Celgene, Amgen, and Takeda outside the submitted work. M.C. reports honoraria from Janssen, outside the submitted work. M. B. reports grants from Janssen Cilag during the conduct of the study. M.D. has received honoraria for participation on advisory boards for Janssen, Celgene, Takeda, Amgen, and Novartis. H.S. has received honoraria from Janssen-Cilag, Celgene, Amgen, Bristol-Myers Squibb, Novartis, and Takeda outside the submitted work. V.P. reports personal fees from Janssen during the conduct of the study and grants, personal fees, and nonfinancial support from Amgen, grants and personal fees from Sanofi, and personal fees from Takeda outside the submitted work. W.W. has received personal fees and grants from Amgen, Celgene, Novartis, Roche, Takeda, Gilead, and Janssen and nonfinancial support from Roche outside the submitted work. J.S. reports grants and nonfinancial support from Janssen Pharmaceutical during the conduct of the study. V.L. reports funding from Janssen Global Services LLC during the conduct of the study and study support from Janssen-Cilag and Pharmion outside the submitted work. A.P. reports employment and shareholding of Janssen (Johnson & Johnson) during the conduct of the study. C.C. reports employment at Janssen-Cilag during the conduct of the study. C.F. reports employment at Janssen Research and Development during the conduct of the study. F.T.B. reports employment at Janssen-Cilag during the conduct of the study. The remaining authors have stated that they have no conflicts of interest. Publisher Copyright: © 2018 The AuthorsMultiple myeloma (MM) remains an incurable disease, with little information available on its management in real-world clinical practice. The results of the present prospective, noninterventional observational study revealed great diversity in the treatment regimens used to treat MM. Our results also provide data to inform health economic, pharmacoepidemiologic, and outcomes research, providing a framework for the design of protocols to improve the outcomes of patients with MM. Background: The present prospective, multinational, noninterventional study aimed to document and describe real-world treatment regimens and disease progression in multiple myeloma (MM) patients. Patients and Methods: Adult patients initiating any new MM therapy from October 2010 to October 2012 were eligible. A multistage patient/site recruitment model was applied to minimize the selection bias; enrollment was stratified by country, region, and practice type. The patient medical and disease features, treatment history, and remission status were recorded at baseline, and prospective data on treatment, efficacy, and safety were collected electronically every 3 months. Results: A total of 2358 patients were enrolled. Of these patients, 775 and 1583 did and did not undergo stem cell transplantation (SCT) at any time during treatment, respectively. Of the patients in the SCT and non-SCT groups, 49%, 21%, 14%, and 15% and 57%, 20%, 12% and 10% were enrolled at treatment line 1, 2, 3, and ≥ 4, respectively. In the SCT and non-SCT groups, 45% and 54% of the patients had received bortezomib-based therapy without thalidomide/lenalidomide, 12% and 18% had received thalidomide/lenalidomide-based therapy without bortezomib, and 30% and 4% had received bortezomib plus thalidomide/lenalidomide-based therapy as frontline treatment, respectively. The corresponding proportions of SCT and non-SCT patients in lines 2, 3, and ≥ 4 were 45% and 37%, 30% and 37%, and 12% and 3%, 33% and 27%, 35% and 32%, and 8% and 2%, and 27% and 27%, 27% and 23%, and 6% and 4%, respectively. In the SCT and non-SCT patients, the overall response rate was 86% to 97% and 64% to 85% in line 1, 74% to 78% and 59% to 68% in line 2, 55% to 83% and 48% to 60% in line 3, and 49% to 65% and 36% and 45% in line 4, respectively, for regimens that included bortezomib and/or thalidomide/lenalidomide. Conclusion: The results of our prospective study have revealed great diversity in the treatment regimens used to manage MM in real-life practice. This diversity was linked to factors such as novel agent accessibility and evolving treatment recommendations. Our results provide insight into associated clinical benefits.publishersversionPeer reviewe