Clinical screening for oropharyngeal dysphagia in a general hospital. Early outcomes

[ES] Introducción y objetivo: La disfagia orofaríngea es una patología de elevada prevalencia, infradiagnosticada e infratratada, que afecta al 15% de los pacientes en hospitalización de agudos, pudiendo llegar hasta el 80% en el caso de la enfermedad cerebrovascular. Los datos disponibles sugieren que prevención de la morbimortalidad asociada al control de las complicaciones de la disfagia (aspiraciones y malnutrición) es una actividad hospitalaria coste-efectiva. El objetivo del presente trabajo es realizar una primera valoración del volumen de actividad y de los resultados iniciales de un nuevo programa de disfagia en un hospital general. Material y método: Tras constituir la Unidad de Disfagia y realizar una campaña informativa en el hospital, se inicia la actividad con cribado por sospecha clínica. La demanda se tramita como interconsulta al servicio de ORL; la primera valoración la realiza la enfermera de disfagia. Se presentan los primeros resultados de actividad a través de la explotación del registro específico de disfagia. Resultados: En los primeros 3 meses (30/01/2014 a 30/04/2014) se ha realizado 135 valoraciones. La media de edad de los pacientes es de 80 años (DE= 12,9). El 50% de las solicitudes proceden de Medicina Interna y otro 30% de neurología. Los motivos más frecuentes de demanda fueron los procesos respiratorios con sospecha de origen aspirativo (33%) y la valoración en el contexto de un accidente cerebrovascular (26%). Dos tercios de los casos se han manejado sólo con valoración a pie de cama (incluido el test de volumen-viscosidad). En 47 casos se ha completado el estudio con una videoendoscopia de deglución, videofluroscopia o ambas. Las recomendaciones dietéticas iniciales han sido muy restrictivas, permitiéndose dieta oral libre sólo en el 15% de los casos. Discusión: El origen de la demanda intrahospitalaria de valoración de disfagia se corresponde con la epidemiología y la etiología reflejadas en la literatura. La protocolización de las valoraciones, adaptada a los recursos del centro, permite que el manejo de la disfagia sea operativo y sostenible. De acuerdo con los resultados iniciales, parece deseable escalar hacia el cribado por grupos de riesgo. Conclusiones: La sospecha y valoración clínicas de la disfagia tiene implicaciones en el cuidado de los pacientes. [EN] Introduction and objective: Oropharyngeal dysphagia is a highly prevalent disease, underdiagnosed and undertreated, which affects 15% of hospitalized patients, although it might rise to 80% in the case of stroke. Available data suggest that prevention of morbidity and mortality associated with the control of the complications of dysphagia (aspiration and malnutrition) is a cost-effective activity. The aim of this paper is to review the burden of activity and the initial results of a new program of dysphagia in a general hospital. Method: After establishing the Dysphagia Unit and conducting an information campaign in the hospital, we started the screening activity based on clinical suspicion. The demand is processed as a request of evaluation to the ENT department; the first assesment is performed by the dysphagia nurse. We present the early results of the program through the exploitation of a specific dysphagia database. Results: In the first 3 months (01/30/2014 to 30/04/2014) we performed 135 examinations. The mean age of patients was 80 years (SD = 12.9). 50% of the requests came from Internal Medicine department and 30% from Neurology. The most frequent reasons were respiratory processes with suspected aspiration origin (33%) and assessment in the context of stroke (26%). Two thirds of the cases were managed only with bedside assessment (including volume-viscosity test). In 47 cases the study was completed with a videoendoscopy of degluttition, videofluroscopy or both. The initial dietary recommendations have been very restrictive, allowing free oral diet only in 15% of cases. Discussion: The origin of the demand for the assesment of dysphagia in the hospital corresponds to the epidemiology and etiology reflected in the literature. The protocolization of the assesment, adapted to center resources, allows the management of dysphagia to be operational and sustainable. According to the initial results, it seems desirable to scale towards screening based on risk groups. Conclusions: Suspicion and clinical assessment of dysphagia has implications for patient care

Comunicación no verbal en la docencia = Non-verbal communication in teaching

Resumen: La comunicación no verbal ha tenido un gran auge en el último siglo, debido a la importancia demostrada en relativa al mensaje emitido. Este artículo efectúa una aproximación acerca del papel que juega la comunicación no verbal en la credibilidad y congruencia de lo que se dice en clase. Los objetivos del presente trabajo van dirigidos a explicar, explicando las partes de las que consta la comunicación no verbal, cuáles pueden verse obstaculizadas en el discurso y cómo minimizar estas posibles barreras, basándose en una revisión bibliográfica. De esta forma se justifica la importancia de la optimización de los recursos no verbales en el ámbito de la docencia universitaria de titulaciones sanitarias inmersa en el inminente espacio europeo. Palabras clave: Comunicación, Docencia, Lenguaje corporal Abstract: Non-verbal communication has boomed in the last century due to the importance that has shown in the interpretation of the message delivered. This article brings us to the role of nonverbal communication on credibility and consistency of what is said in class. The objectives of this study are point towards to explain, explaining the parts of nonverbal communication, which can be hampered in the speech and how to reduce these potential barriers, based on a literature review. Thereby, It is justified the importance of optimizing nonverbal resources in the scope of health university teaching qualifications immersed in imminent European space. Keywords: Communication, Teaching, Body languag

Clinical, biological, and prognostic implications of SF3B1 co-occurrence mutations in very low/low- and intermediate-risk MDS patients

SF3B1 is a highly mutated gene in myelodysplastic syndrome (MDS) patients, related to a specific subtype and parameters of good prognosis in MDS without excess blasts. More than 40% of MDS patients carry at least two myeloid-related gene mutations but little is known about the impact of concurrent mutations on the outcome of MDS patients. In applying next-generation sequencing (NGS) with a 117 myeloid gene custom panel, we analyzed the co-occurrence of SF3B1 with other mutations to reveal their clinical, biological, and prognostic implications in very low/low- and intermediate-risk MDS patients. Mutations in addition to those of SF3B1 were present in 80.4% of patients (median of 2 additional mutations/patient, range 0–5). The most frequently mutated genes were as follows: TET2 (39.2%), DNMT3A (25.5%), SRSF2 (10.8%), CDH23 (5.9%), and ASXL1, CUX1, and KMT2D (4.9% each). The presence of at least two mutations concomitant with that of SF3B1 had an adverse impact on survival compared with those with the SF3B1 mutation and fewer than two additional mutations (median of 54 vs. 87 months, respectively: p = 0.007). The co-occurrence of SF3B1 mutations with specific genes is also linked to a dismal prognosis: SRSF2 mutations were associated with shorter overall survival (OS) than SRSF2wt (median, 27 vs. 75 months, respectively; p = 0.001), concomitant IDH2 mutations (median OS, 11 [mut] vs. 75 [wt] months; p = 0.001), BCOR mutations (median OS, 11 [mut] vs. 71 [wt] months; p = 0.036), and NUP98 and STAG2 mutations (median OS, 27 and 11 vs. 71 months, respectively; p = 0.008 and p = 0.002). Mutations in CHIP genes (TET2, DNMT3A) did not significantly affect the clinical features or outcome. Our results suggest that a more comprehensive NGS study in low-risk MDS SF3B1mut patients is essential for a better prognostic evaluation.This work was supported by grants from the following: Contrato Rio Hortega, CM17/00171; Gerencia Regional de Salud (Castilla y León) para proyectos de investigación año 2018, 1850/A/18; Spanish Fondo de Investigaciones Sanitarias, PI15/01471, PI18/01500; Instituto de Salud Carlos III (ISCIII); European Regional Development Fund (ERDF) “Una manera de hacer Europa”; Consejería de Educación, Junta de Castilla y León (SA271P18); Proyectos de Investigación del SACYL, Spain, GRS1847/A/18, GRS1653/A17; SYNtherapy, Synthetic Lethality for Personalized Therapy-based Stratification In Acute Leukemia (ERAPERMED2018–275); ISCIII (AC18/00093), co-funded by ERDF/ESF, “Investing in your future”, by grants from Red Temática de Investigación Cooperativa en Cáncer (RTICC) (RD12/0036/0069) and Centro de Investigación Biomédica en Red de Cáncer (CIBERONC CB16/12/00233). JMHS is supported by a research grant from Fundación Española de Hematología y Hemoterapia. MM is currently supported by an Ayuda predoctoral de la Junta de Castilla y León from the Fondo Social Europeo (JCYL- EDU/556/2019 PhD scholarship)

Impact of Heart Failure on In-Hospital Outcomes after Surgical Femoral Neck Fracture Treatment

Background: Femoral neck fracture (FNF) is a common condition with a rising incidence, partly due to aging of the population. It is recommended that FNF should be treated at the earliest opportunity, during daytime hours, including weekends. However, early surgery shortens the available time for preoperative medical examination. Cardiac evaluation is critical for good surgical outcomes as most of these patients are older and frail with other comorbid conditions, such as heart failure. The aim of this study was to determine the impact of heart failure on in-hospital outcomes after surgical femoral neck fracture treatment. Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2007–2015. We included patients older than 64 years treated for reduction and internal fixation of FNF. Demographic characteristics of patients, as well as administrative variables, related to patient’s diseases and procedures performed during the episode were evaluated. Results: A total of 234,159 episodes with FNF reduction and internal fixation were identified from Spanish National Health System hospitals during the study period; 986 (0.42%) episodes were excluded, resulting in a final study population of 233,173 episodes. Mean age was 83.7 (±7) years and 179,949 (77.2%) were women (p < 0.001). In the sample, 13,417 (5.8%) episodes had a main or secondary diagnosis of heart failure (HF) (p < 0.001). HF patients had a mean age of 86.1 (±6.3) years, significantly older than the rest (p < 0.001). All the major complications studied showed a higher incidence in patients with HF (p < 0.001). Unadjusted in-hospital mortality was 4.1%, which was significantly higher in patients with HF (18.2%) compared to those without HF (3.3%) (p < 0.001). The average length of stay (LOS) was 11.9 (±9.1) and was also significantly higher in the group with HF (16.5 ± 13.1 vs. 11.6 ± 8.7; p < 0.001). Conclusions: Patients with HF undergoing FNF surgery have longer length of stay and higher rates of both major complications and mortality than those without HF. Although their average length of stay has decreased in the last few years, their mortality rate has remained unchanged

Evaluación formativa entre pares. Experiencias en todos los niveles universitarios

[ES] El objetivo de este trabajo es describir tres tipos de experiencia de evaluación entre pares diseñados con el fin de mejorar no solo el aprendizaje de las materias, sino también las competencias profesionales tanto de evaluados como de evaluadores. Otro de los fines fue estimular la reflexión de los docentes implicados para que, tras un debate sobre las ventajas e inconvenientes del proceso, generasen protocolos y repertorios de buenas prácticas transferibles entre asignaturas y campos de conocimiento. El primer tipo de experiencia, llevada a cabo entre estudiantes en grupos pequeños o medianos en once asignaturas de grado y máster, consistió en la evaluación de trabajos en grupo escritos y/o de sus exposiciones orales. La segunda, realizada entre pares de alumnos en gran grupo, se centró en pruebas “clásicas” escritas utilizadas como parte de la evaluación formativa de una asignatura. Por último, en la tercera experiencia profesores expertos evaluaron la actuación docente de sus pares noveles. Tras concluir las fases de preparación, evaluación y recogida de resultados de las mismas, y a falta del análisis final de los datos de las encuestas de satisfacción y el rendimiento académico, podemos decir que los resultados parecen prometedores: se ha producido un aumento de la motivación y la familiarización con instrumentos de evaluación como las escalas de valoración. Los participantes parecen haber mejorado también sus competencias comunicativas, su capacidad reflexiva y “habilidades blandas” (soft skills) como la capacidad crítica y la colaboración, además de avanzar en su autonomía personal y profesional. Como conclusión, podemos decir que este es un paso adelante en la búsqueda de experiencias de evaluación eficaces desde el punto de vista formativo, sostenibles para el sistema universitario, el docente y la asignatura, y transferibles entre asignaturas de todos los niveles educativos

Heart Failure Is a Poor Prognosis Risk Factor in Patients Undergoing Cholecystectomy: Results from a Spanish Data-Based Analysis

Background: The incidence of cholecystectomy is increasing as the result of the aging worldwide. Our aim was to determine the influence of heart failure on in-hospital outcomes in patients undergoing cholecystectomy in the Spanish National Health System (SNHS). Methods: We conducted a retrospective study using the Spanish National Hospital Discharge Database. Patients older than 17 years undergoing cholecystectomy in the period 2007–2015 were included. Demographic and administrative variables related to patients’ diseases as well as procedures were collected. Results: 478,111 episodes of cholecystectomy were identified according to the data from SNHS hospitals in the period evaluated. From all the episodes, 3357 (0.7%) were excluded, as the result the sample was represented by 474,754 episodes. Mean age was 58.3 (+16.5) years, and 287,734 (60.5%) were women (p < 0.001). A primary or secondary diagnosis of HF was identified in 4244 (0.89%) (p < 0.001) and mean age was 76.5 (+9.6) years. A higher incidence of all main complications studied was observed in the HF group (p < 0.001), except stroke (p = 0.753). Unadjusted in-hospital mortality was 1.1%, 12.9% in the group with HF versus 1% in the non HF group (p < 0.001). Average length of hospital stay was 5.4 (+8.9) days, and was higher in patients with HF (16.2 + 17.7 vs. 5.3 + 8.8; p < 0.001). Risk-adjusted in-hospital mortality models’ discrimination was high in both cases, with AUROC values = 0.963 (0.960–0.965) in the APRG-DRG model and AUROC = 0.965 (0.962–0.968) in the CMS adapted model. Median odds ratio (MOR) was high (1.538 and 1.533, respectively), stating an important variability of risk-adjusted outcomes among hospitals. Conclusions: The presence of HF during admission increases in hospital mortality and lengthens the hospital stay in patients undergoing cholecystectomy. However, mortality and hospital stay have significantly decreased during the study period in both groups (HF and non HF patients)

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Ahora / Ara

La cinquena edició del microrelatari per l’eradicació de la violència contra les dones de l’Institut Universitari d’Estudis Feministes i de Gènere «Purificación Escribano» de la Universitat Jaume I vol ser una declaració d’esperança. Aquest és el moment en el qual les dones (i els homes) hem de fer un pas endavant i eliminar la violència sistèmica contra les dones. Ara és el moment de denunciar el masclisme i els micromasclismes començant a construir una societat més igualitària. Cadascun dels relats del llibre és una denúncia i una declaració que ens encamina cap a un món millor