Valoración del nivel de conocimientos y su adecuación en materia de RCP en el personal sanitario de los servicios de urgencias hospitalarios de la Comunidad Autónoma de la Región de Murcia

Objective. Cardiopulmonary resuscitation (CPR) is one of the most important hospital care team procedures to be administered by emergency medical services. There is a consensus as to cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations, which are regularly updated every five years. International recommendations advise health professionals to update their knowledge every two years. The objective of this paper is to discover health professionals’ levels of knowledge as regards CPR, whether they are appropriately updated and to confirm whether the training courses on CPR performed improve health personnel’s knowledge levels.Method. A 20-question survey based on American Heart Association (AHA) and Spanish Society of Medicine and Intensive Care (SEMICYUC) recommendations was carried out.Results. Evidence-based results strongly suggest that participants do not follow the international standards as regards training in CPR. Sixty four point seven percent of the participants attend at least one CPR course after 2010, but 10.1% never took a refresher course. Thirty percent of the faculties, 90% of the medical residents and 7% of the nursing staff did not obtain the training required by the AHA in hospital emergency services (one course every two years). Our results show that the higher number of courses received, the higher is the level of knowledge regarding CPR that health staff obtain.Conclusions: There is a need for new approaches as regards the learning methodology used in CPR courses. Our results show that healthcare staff are aware of the need to acquire knowledge on CPR via regular training.Objetivo: La Reanimación Cardiopulmonar (RCP) es uno de los procedimientos de los equipos de asistencia hospitalaria más importantes que se realizan en los servicios de urgencias. Existe un consenso internacional sobre RCP, actualizándose cada 5 años, recomendándose la actualización de conocimientos cada 2 años para los profesionales. El objetivo de este estudio es conocer cuál es el nivel de conocimientos en RCP de los profesionales sanitarios, si estos profesionales están correctamente actualizados y constatar si la realización de cursos en el tiempo recomendado mejora el nivel de conocimientos.Método: Realizamos una encuesta con 20 preguntas basada en los cuestionarios para valoración de conocimientos en RCP de la American Heart Association (AHA) y de la Sociedad Española de Medicina y Cuidados Intensivos (SEMICYUC).Resultados: Obtuvimos como resultado que la totalidad de los encuestados no sigue los estándares internacionales de realización de cursos de actualización de conocimientos. El 64,7 % se actualizó después del 2010 y 10,1% nunca se actualizó. El 30% de los médicos, el 90% de los residentes y el 7% de los enfermeros, no superaban el umbral mínimo de formación establecido por la AHA en servicios de urgencias hospitalarias (un curso cada dos años). Se corrobora que a mayor realización de cursos mejor nivel de conocimientos.Conclusiones: Resulta evidente la necesidad de cambios en la metodología de aprendizaje de los cursos impartidos en materia de RCP para profesionales. Destacamos que el personal sanitario sí esta concienciado de la necesidad de formación en esta materia

Traducción y subtitulación de un episodio de ficción científica

El objetivo principal de este trabajo es la traducción y la subtitulación del inglés al castellano de un producto de ficción (serie televisiva) de una duración aproximada de una hora. A partir de una reflexión sobre el proceso de subtitulación y las restricciones del mismo, traduciremos el diálogo y subtitularemos el episodio. Además, añadiremos dos tablas de análisis de los problemas encontrados durante estos procesosL'objectiu principal d'aquest treball és la traducció i la subtitulació de l'anglès a l'espanyol d'un producte de ficció (sèrie de televisió) d'una durada aproximada d'una hora. A partir d'una reflexió sobre el procés de subtitulació i les seves restriccions, traduirem el diàleg i subtitularem l'episodi. A més, afegirem dues taules d'anàlisi dels problemes que hem trobat durant aquests processosThe main objective of this project is the translation and subtitling from English to Spanish of a television series, which has a duration of an hour approximately. To translate the dialogue and subtitle the episode, we will first have a few considerations about the subtitling process and its restrictions. We will also add two tables to analyse the problems we found during the processes of translating and subtitlin

Combining targeted panel-based resequencing and copy-number variation analysis for the diagnosis of inherited syndromic retinopathies and associated ciliopathies

Inherited syndromic retinopathies are a highly heterogeneous group of diseases that involve retinal anomalies and systemic manifestations. They include retinal ciliopathies, other well-defined clinical syndromes presenting with retinal alterations and cases of non-specific multisystemic diseases. The heterogeneity of these conditions makes molecular and clinical characterization of patients challenging in daily clinical practice. We explored the capacity of targeted resequencing and copy-number variation analysis to improve diagnosis of a heterogeneous cohort of 47 patients mainly comprising atypical cases that did not clearly fit a specific clinical diagnosis. Thirty-three likely pathogenic variants were identified in 18 genes (ABCC6, ALMS1, BBS1, BBS2, BBS12, CEP41, CEP290, IFT172, IFT27, MKKS, MYO7A, OTX2, PDZD7, PEX1, RPGRIP1, USH2A, VPS13B, and WDPCP). Molecular findings and additional clinical reassessments made it possible to accurately characterize 14 probands (30% of the total). Notably, clinical refinement of complex phenotypes was achieved in 4 cases, including 2 de novo OTX2-related syndromes, a novel phenotypic association for the ciliary CEP41 gene, and the co-existence of biallelic USH2A variants and a Koolen-de-Vries syndrome–related 17q21.31 microdeletion. We demonstrate that combining next-generation sequencing and CNV analysis is a comprehensive and useful approach to unravel the extensive phenotypic and genotypic complexity of inherited syndromic retinopathiesFEDER (Fondo Europeo de Desarrollo Regional) | Ref. PI016/00425Instituto de Salud Carlos III | Ref. PT13/0010/001

Table_4_CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3.pdf

[Objectives] CARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.[Methods] In total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.[Results] In total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).[Conclusion] This study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3.Peer reviewe

Genetic landscape of 6089 inherited retinal dystrophies affected cases in Spain and their therapeutic and extended epidemiological implications

Inherited retinal diseases (IRDs), defined by dysfunction or progressive loss of photoreceptors, are disorders characterized by elevated heterogeneity, both at the clinical and genetic levels. Our main goal was to address the genetic landscape of IRD in the largest cohort of Spanish patients reported to date. A retrospective hospital-based cross-sectional study was carried out on 6089 IRD affected individuals (from 4403 unrelated families), referred for genetic testing from all the Spanish autonomous communities. Clinical, demographic and familiar data were collected from each patient, including family pedigree, age of appearance of visual symptoms, presence of any systemic findings and geographical origin. Genetic studies were performed to the 3951 families with available DNA using different molecular techniques. Overall, 53.2% (2100/3951) of the studied families were genetically characterized, and 1549 different likely causative variants in 142 genes were identified. The most common phenotype encountered is retinitis pigmentosa (RP) (55.6% of families, 2447/4403). The most recurrently mutated genes were PRPH2, ABCA4 and RS1 in autosomal dominant (AD), autosomal recessive (AR) and X-linked (XL) NON-RP cases, respectively; RHO, USH2A and RPGR in AD, AR and XL for non-syndromic RP; and USH2A and MYO7A in syndromic IRD. Pathogenic variants c.3386G > T (p.Arg1129Leu) in ABCA4 and c.2276G > T (p.Cys759Phe) in USH2A were the most frequent variants identified. Our study provides the general landscape for IRD in Spain, reporting the largest cohort ever presented. Our results have important implications for genetic diagnosis, counselling and new therapeutic strategies to both the Spanish population and other related populations.This work was supported by the Instituto de Salud Carlos III (ISCIII) of the Spanish Ministry of Health (FIS; PI16/00425 and PI19/00321), Centro de Investigación Biomédica en Red Enfermedades Raras (CIBERER, 06/07/0036), IIS-FJD BioBank (PT13/0010/0012), Comunidad de Madrid (CAM, RAREGenomics Project, B2017/BMD-3721), European Regional Development Fund (FEDER), the Organización Nacional de Ciegos Españoles (ONCE), Fundación Ramón Areces, Fundación Conchita Rábago and the University Chair UAM-IIS-FJD of Genomic Medicine. Irene Perea-Romero is supported by a PhD fellowship from the predoctoral Program from ISCIII (FI17/00192). Ionut F. Iancu is supported by a grant from the Comunidad de Madrid (CAM, PEJ-2017-AI/BMD7256). Marta del Pozo-Valero is supported by a PhD grant from the Fundación Conchita Rábago. Berta Almoguera is supported by a Juan Rodes program from ISCIII (JR17/00020). Pablo Minguez is supported by a Miguel Servet program from ISCIII (CP16/00116). Marta Corton is supported by a Miguel Servet program from ISCIII (CPII17/00006). The funders played no role in study design, data collection, data analysis, manuscript preparation and/or publication decisions

CARB-ES-19 Multicenter Study of Carbapenemase-Producing Klebsiella pneumoniae and Escherichia coli From All Spanish Provinces Reveals Interregional Spread of High-Risk Clones Such as ST307/OXA-48 and ST512/KPC-3

ObjectivesCARB-ES-19 is a comprehensive, multicenter, nationwide study integrating whole-genome sequencing (WGS) in the surveillance of carbapenemase-producing K. pneumoniae (CP-Kpn) and E. coli (CP-Eco) to determine their incidence, geographical distribution, phylogeny, and resistance mechanisms in Spain.MethodsIn total, 71 hospitals, representing all 50 Spanish provinces, collected the first 10 isolates per hospital (February to May 2019); CPE isolates were first identified according to EUCAST (meropenem MIC > 0.12 mg/L with immunochromatography, colorimetric tests, carbapenem inactivation, or carbapenem hydrolysis with MALDI-TOF). Prevalence and incidence were calculated according to population denominators. Antibiotic susceptibility testing was performed using the microdilution method (EUCAST). All 403 isolates collected were sequenced for high-resolution single-nucleotide polymorphism (SNP) typing, core genome multilocus sequence typing (cgMLST), and resistome analysis.ResultsIn total, 377 (93.5%) CP-Kpn and 26 (6.5%) CP-Eco isolates were collected from 62 (87.3%) hospitals in 46 (92%) provinces. CP-Kpn was more prevalent in the blood (5.8%, 50/853) than in the urine (1.4%, 201/14,464). The cumulative incidence for both CP-Kpn and CP-Eco was 0.05 per 100 admitted patients. The main carbapenemase genes identified in CP-Kpn were blaOXA–48 (263/377), blaKPC–3 (62/377), blaVIM–1 (28/377), and blaNDM–1 (12/377). All isolates were susceptible to at least two antibiotics. Interregional dissemination of eight high-risk CP-Kpn clones was detected, mainly ST307/OXA-48 (16.4%), ST11/OXA-48 (16.4%), and ST512-ST258/KPC (13.8%). ST512/KPC and ST15/OXA-48 were the most frequent bacteremia-causative clones. The average number of acquired resistance genes was higher in CP-Kpn (7.9) than in CP-Eco (5.5).ConclusionThis study serves as a first step toward WGS integration in the surveillance of carbapenemase-producing Enterobacterales in Spain. We detected important epidemiological changes, including increased CP-Kpn and CP-Eco prevalence and incidence compared to previous studies, wide interregional dissemination, and increased dissemination of high-risk clones, such as ST307/OXA-48 and ST512/KPC-3

Assessment of the knowledge level and its relevance in terms of CPR in medical personnel of the hospital emergency medical system of the Autonomous Community of the Region of Murcia.

Objetivo: La Reanimación Cardiopulmonar (RCP) es uno de los procedimientos de los equipos de asistencia hospitalaria más importantes que se realizan en los servicios de urgencias. Existe un consenso internacional sobre RCP, actualizándose cada 5 años, recomendándose la actualización de conocimientos cada 2 años para los profesionales. El objetivo de este estudio es conocer cuál es el nivel de conocimientos en RCP de los profesionales sanitarios, si estos profesionales están correctamente actualizados y constatar si la realización de cursos en el tiempo recomendado mejora el nivel de conocimientos. Método: Realizamos una encuesta con 20 preguntas basada en los cuestionarios para valoración de conocimientos en RCP de la American Heart Association (AHA) y de la Sociedad Española de Medicina y Cuidados Intensivos (SEMICYUC). Resultados: Obtuvimos como resultado que la totalidad de los encuestados no sigue los estándares internacionales de realización de cursos de actualización de conocimientos. El 64,7 % se actualizó después del 2010 y 10,1% nunca se actualizó. El 30% de los médicos, el 90% de los residentes y el 7% de los enfermeros, no superaban el umbral mínimo de formación establecido por la AHA en servicios de urgencias hospitalarias (un curso cada dos años). Se corrobora que a mayor realización de cursos mejor nivel de conocimientos. Conclusiones: Resulta evidente la necesidad de cambios en la metodología de aprendizaje de los cursos impartidos en materia de RCP para profesionales. Destacamos que el personal sanitario sí esta concienciado de la necesidad de formación en esta materia.ABSTRACT: Objective. Cardiopulmonary resuscitation (CPR) is one of the most important hospital care team procedures to be administered by emergency medical services. There is a consensus as to cardiopulmonary resuscitation and emergency cardiovascular care science with treatment recommendations, which are regularly updated every five years. International recommendations advise health professionals to update their knowledge every two years. The objective of this paper is to discover health professionals’ levels of knowledge as regards CPR, whether they are appropriately updated and to confirm whether the training courses on CPR performed improve health personnel’s knowledge levels. Method. A 20-question survey based on American Heart Association (AHA) and Spanish Society of Medicine and Intensive Care (SEMICYUC) recommendations was carried out. Results. Evidence-based results strongly suggest that participants do not follow the international standards as regards training in CPR. Sixty four point seven percent of the participants attend at least one CPR course after 2010, but 10.1% never took a refresher course. Thirty percent of the faculties, 90% of the medical residents and 7% of the nursing staff did not obtain the training required by the AHA in hospital emergency services (one course every two years). Our results show that the higher number of courses received, the higher is the level of knowledge regarding CPR that health staff obtain. Conclusions: There is a need for new approaches as regards the learning methodology used in CPR courses. Our results show that healthcare staff are aware of the need to acquire knowledge on CPR via regular training

Mindfulness-Based Program for Anxiety and Depression Treatment in Healthcare Professionals: A Pilot Randomized Controlled Trial

In primary health care, the work environment can cause high levels of anxiety and depression, triggering relevant expert and individual change. Mindfulness-Based Stress Reduction (MBSR) programs reduce signs of anxiety and depression. The purpose of this sub-analysis of the total project, was to equate the effectiveness of the standard MBSR curriculum with the abbreviated version in minimizing anxiety and depression. This randomized controlled clinical trial enrolled 112 mentors and resident specialists from Family and Community Medicine and Nurses (FCMN), distributed across six teaching units (TU) of the Spanish National Health System (SNHS). Experimental group participants received a MBRS training (abbreviated/standard). Depression and anxiety levels were measured with the Goldberg Anxiety and Depression Scale (GADS) at three different time periods during the analysis: before (pre-test) and after (post-test) participation, as well as 3 months after the completion of intervention. Taking into account the pre-test scores as the covariate, an adjusted analysis of covariance (ANCOVA) showed significant depletion in anxiety and depression in general (F (2.91) = 4.488; p = 0.014; η2 = 0.090) and depression in particular (F (2, 91) = 6.653; p = 0.002; η2 = 0.128 at the post-test visit, maintaining their effects for 3 months (F (2.79) = 3.031; p = 0.050; η2 = 0.071—F (2.79) = 2.874; p = 0.049; η2 = 0.068, respectively), which is associated with the use of a standard training program. The abbreviated training program did not have a significant effect on the level of anxiety and depression. The standard MBSR training program had a positive effect on anxiety and depression and promotes long-lasting effects in tutors and resident practitioners. New research is needed to demonstrate the effectiveness of abbreviated versions of training programs

Combining targeted panel-based resequencing and copy-number variation analysis for the diagnosis of inherited syndromic retinopathies and associated ciliopathies

Abstract Inherited syndromic retinopathies are a highly heterogeneous group of diseases that involve retinal anomalies and systemic manifestations. They include retinal ciliopathies, other well-defined clinical syndromes presenting with retinal alterations and cases of non-specific multisystemic diseases. The heterogeneity of these conditions makes molecular and clinical characterization of patients challenging in daily clinical practice. We explored the capacity of targeted resequencing and copy-number variation analysis to improve diagnosis of a heterogeneous cohort of 47 patients mainly comprising atypical cases that did not clearly fit a specific clinical diagnosis. Thirty-three likely pathogenic variants were identified in 18 genes (ABCC6, ALMS1, BBS1, BBS2, BBS12, CEP41, CEP290, IFT172, IFT27, MKKS, MYO7A, OTX2, PDZD7, PEX1, RPGRIP1, USH2A, VPS13B, and WDPCP). Molecular findings and additional clinical reassessments made it possible to accurately characterize 14 probands (30% of the total). Notably, clinical refinement of complex phenotypes was achieved in 4 cases, including 2 de novo OTX2-related syndromes, a novel phenotypic association for the ciliary CEP41 gene, and the co-existence of biallelic USH2A variants and a Koolen-de-Vries syndrome–related 17q21.31 microdeletion. We demonstrate that combining next-generation sequencing and CNV analysis is a comprehensive and useful approach to unravel the extensive phenotypic and genotypic complexity of inherited syndromic retinopathies

Smartphone-based Ecological Momentary Intervention for secondary prevention of suicidal thoughts and behaviour: protocol for the SmartCrisis V.2.0 randomised clinical trial

Auteurs : MEmind Study GroupInternational audienceSuicide is one of the leading public health issues worldwide. Mobile health can help us to combat suicide through monitoring and treatment. The SmartCrisis V.2.0 randomised clinical trial aims to evaluate the effectiveness of a smartphone-based Ecological Momentary Intervention to prevent suicidal thoughts and behaviour. Methods and analysis: the SmartCrisis V.2.0 study is a randomised clinical trial with two parallel groups, conducted among patients with a history of suicidal behaviour treated at five sites in France and Spain. The intervention group will be monitored using Ecological Momentary Assessment (EMA) and will receive an Ecological Momentary Intervention called ‘SmartSafe’ in addition to their treatment as usual (TAU). TAU will consist of mental health follow-up of the patient (scheduled appointments with a psychiatrist) in an outpatient Suicide Prevention programme, with predetermined clinical appointments according to the Brief Intervention Contact recommendations (1, 2, 4, 7 and 11 weeks and 4, 6, 9 and 12 months). The control group would receive TAU and be monitored using EMA. Ethics and dissemination: this study has been approved by the Ethics Committee of the University Hospital Fundación Jiménez Díaz. It is expected that, in the near future, our mobile health intervention and monitoring system can be implemented in routine clinical practice. Results will be disseminated through peer-reviewed journals and psychiatric congresses. Reference number EC005-21_FJD. Participants gave informed consent to participate in the study before taking part. Trial registration number NCT04775160