Effect of a Pulmonary Embolism Diagnostic Strategy on Clinical Outcomes in Patients Hospitalized for COPD Exacerbation. A Randomized Clinical Trial

SLICE Trial Group.[Importance] Active search for pulmonary embolism (PE) may improve outcomes in patients hospitalized for exacerbations of chronic obstructive pulmonary disease (COPD).[Objective] To compare usual care plus an active strategy for diagnosing PE with usual care alone in patients hospitalized for COPD exacerbation.[Design, Setting, and Participants] Randomized clinical trial conducted across 18 hospitals in Spain. A total of 746 patients were randomized from September 2014 to July 2020 (final follow-up was November 2020).[Interventions] Usual care plus an active strategy for diagnosing PE (D-dimer testing and, if positive, computed tomography pulmonary angiogram) (n = 370) vs usual care (n = 367).[Main Outcomes and Measures] The primary outcome was a composite of nonfatal symptomatic venous thromboembolism (VTE), readmission for COPD, or death within 90 days after randomization. There were 4 secondary outcomes, including nonfatal new or recurrent VTE, readmission for COPD, and death from any cause within 90 days. Adverse events were also collected.[Results] Among the 746 patients who were randomized, 737 (98.8%) completed the trial (mean age, 70 years; 195 [26%] women). The primary outcome occurred in 110 patients (29.7%) in the intervention group and 107 patients (29.2%) in the control group (absolute risk difference, 0.5% [95% CI, −6.2% to 7.3%]; relative risk, 1.02 [95% CI, 0.82-1.28]; P = .86). Nonfatal new or recurrent VTE was not significantly different in the 2 groups (0.5% vs 2.5%; risk difference, −2.0% [95% CI, −4.3% to 0.1%]). By day 90, a total of 94 patients (25.4%) in the intervention group and 84 (22.9%) in the control group had been readmitted for exacerbation of COPD (risk difference, 2.5% [95% CI, −3.9% to 8.9%]). Death from any cause occurred in 23 patients (6.2%) in the intervention group and 29 (7.9%) in the control group (risk difference, −1.7% [95% CI, −5.7% to 2.3%]). Major bleeding occurred in 3 patients (0.8%) in the intervention group and 3 patients (0.8%) in the control group (risk difference, 0% [95% CI, −1.9% to 1.8%]; P = .99).[Conclusions and Relevance] Among patients hospitalized for an exacerbation of COPD, the addition of an active strategy for the diagnosis of PE to usual care, compared with usual care alone, did not significantly improve a composite health outcome. The study may not have had adequate power to assess individual components of the composite outcome.[Trial Registration] ClinicalTrials.gov Identifier: NCT02238639.Peer reviewe

Randomised controlled trial of a prognostic assessment and management pathway to reduce the length of hospital stay in normotensive patients with acute pulmonary embolism

[Background] The length of hospital stay (LOS) for acute pulmonary embolism (PE) varies considerably. Whether the upfront use of a PE prognostic assessment and management pathway is effective in reducing the LOS remains unknown.[Methods] We conducted a randomised controlled trial of adults hospitalised for acute PE: patients were assigned either to a prognostic assessment and management pathway involving risk stratification followed by predefined criteria for mobilisation and discharge (intervention group) or to usual care (control group). The primary end-point was LOS. The secondary end-points were the cost of prognostic tests and of hospitalisation, and 30-day clinical outcomes.[Results] Of 500 patients who underwent randomisation, 498 were included in the modified intention-to-treat analysis. The median LOS was 4.0 days (interquartile range (IQR) 3.7–4.2 days) in the intervention group and 6.1 days (IQR 5.7–6.5 days) in the control group (p<0.001). The mean total cost of prognostic tests was EUR 174.76 in the intervention group, compared with EUR 233.12 in the control group (mean difference EUR −58.37, 95% CI EUR −84.34­ to −32.40). The mean total hospitalisation cost per patient was EUR 2085.66 in the intervention group, compared with EUR 3232.97 in the control group (mean difference EUR −1147.31, 95% CI EUR −1414.97­ to −879.65). No significant differences were observed in 30-day readmission (4.0% versus 4.8%), all-cause mortality (2.4% versus 2.0%) or PE-related mortality (0.8% versus 1.2%) rates.[Conclusions] The use of a prognostic assessment and management pathway was effective in reducing the LOS for acute PE.Peer reviewe

Oxygen Therapy in Patients With Intermediate-Risk Acute Pulmonary Embolism: A Randomized Trial

[Background] The effect of supplemental oxygen therapy in patients with intermediate-risk pulmonary embolism (PE) who do not have hypoxemia at baseline is uncertain.[Research Question] Does supplemental oxygen improve echocardiographic parameters in nonhypoxemic patients with intermediate-risk PE?[Study Design And Methods] This pilot trial randomly assigned nonhypoxemic patients with stable PE and echocardiographic right ventricle (RV) enlargement to receive anticoagulation plus supplemental oxygen for the first 48 h vs anticoagulation alone. The primary outcome was normal echocardiographic RV size 48 h after randomization. Secondary efficacy outcomes were the numerical change in the RV to left ventricle (LV) diameter ratio measured 48 h and 7 days after randomization with respect to the baseline ratio measured at inclusion.[Results] The study was stopped prematurely because of the COVID-19 pandemic after recruiting 70 patients (mean ± SD age, 67.3 ± 16.1 years; 36 female [51.4%]) with primary outcome data. Forty-eight h after randomization, normalization of the RV size occurred in 14 of the 33 patients (42.4%) assigned to oxygen and in eight of the 37 patients (21.6%) assigned to ambient air (P = .08). In the oxygen group, the mean RV to LV ratio was reduced from 1.28 ± 0.28 at baseline to 1.01 ± 0.16 at 48 h (P < .001); in the ambient air group, mean RV to LV ratios were 1.21 ± 0.18 at baseline and 1.08 ± 0.19 at 48 h (P < .01). At 90 days, one major bleeding event and one death (both in the ambient air group) had occurred.[Interpretation] In analyses limited by a small number of enrollees, compared with ambient air, supplemental oxygen did not significantly increase the proportion of patients with nonhypoxemic intermediate-risk PE whose RV to LV ratio normalized after 48 h of treatment. This pilot trial showed improvement in some ancillary efficacy outcomes and provides support for a definitive clinical outcomes trial.[Trial Registry] ClinicalTrials.gov; No.: NCT04003116; URL: www.clinicaltrials.govPeer reviewe

Proyecto Puentes: conectando la universidad con la salud mental comunitaria

Se presenta la memoria del Proyecto Puentes, cuya finalidad es explorar e implementar vías de participación entre la comunidad universitaria y las personas con problemas de salud mental. Es decir, tender puentes entre lo académico y la realidad de esas personas, con el propósito de conseguir una fuente de aprendizaje significativo para el estudiantado de la UCM, pero también herramientas útiles en los procesos de recuperación e integración de las personas con problemáticas de salud mental.Depto. de Personalidad, Evaluación y Psicología ClínicaFac. de PsicologíaFALSEsubmitte

Comparison of seven prognostic tools to identify low-risk pulmonary embolism in patients aged <50 years

publishersversionPeer reviewe

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

Asientos más seguros para trabajos en altura

The Instituto of Biomecánica, at the request of Comissions Obreres del País Valencià and under the funding of the Fundación para la Prevención de Riesgos Laborales, has carried out a study whose main objective has been to improve the culture of prevention among workers in rope access work.El Instituto de Biomecánica (IBV), a partir de la solicitud de Comissions Obreres del País Valencià (CC. OO.-CV) y con la financiación de la Fundación para la Prevención de Riesgos Laborales (FPRL), ha llevado a cabo un estudio cuyo objetivo ha consistido en mejorar la cultura de la prevención entre los trabajadores del sector de trabajos verticales

Características clínicas y pronóstico de la tromboembolia pulmonar secundaria al síndrome de clase turista

[Objective] Clinical presentation and short-term prognosis of patients with travel-associated acute pulmonary embolism (PE) (i.e., economy class syndrome [ECS]) is not well understood.[Methods] In this retrospective cohort study of patients with acute PE identified from a single center registry, we assessed the clinical presentation and the association between ECS and the outcomes of all-cause mortality, PE-related mortality, nonfatal venous thromboembolism and nonfatal major bleeding rates through 30 days after initiation of PE treatment.[Results] Of the 2,333 patients with acute symptomatic PE, 124 (5.3%; 95% confidence interval, 4.4-6.3%) had ECS. Patients with ECS were younger and had fewer comorbid diseases (recent bleeding, chronic obstructive pulmonary disease, congestive heart failure), but they presented with more signs of clinical severity (syncope [48% vs. 14%; P < .001], tachycardia [37% vs. 21%; P < .001], right ventricular dysfunction [31% vs. 19%; P < .01] and myocardial injury [57% vs. 28%; P < .001]) compared to those without ECS. Regression analyses showed a significantly lower risk of all-cause mortality for patients with ECS compared to patients without ECS (1.6% vs. 9.6%; P < .01). We did not detect a difference in PE-related mortality at 30 days between those with and those without ECS (0.8% vs. 3.1%; P = .18).[Conclusions] PE patients with ECS are younger and have fewer comorbid diseases compared to those without ECS. Though they present with more signs of clinical severity, their short-term prognosis is excellent.[Objetivo] No se conocen suficientemente las características clínicas y el pronóstico de los pacientes con tromboembolia de pulmón (TEP) aguda sintomática asociada a los viajes prolongados (síndrome de clase turista [SCT]).[Métodos] Se analizaron retrospectivamente las características basales de los pacientes con TEP aguda y se estratificaron según el factor de riesgo desencadenante. Se determinaron la mortalidad por todas las causas, la mortalidad por la propia TEP, las recurrencias trombóticas no fatales y los sangrados mayores no fatales durante los primeros 30 días de seguimiento.[Resultados] De los 2.333 pacientes incluidos, un total de 124 (5,3%; intervalo de confianza del 95%: 4,4-6,3) fueron diagnosticados de TEP secundaria a SCT. Estos pacientes fueron más jóvenes, presentaron menos frecuentemente comorbilidad y más frecuentemente síncope (48% vs. 14%; p < 0,001), taquicardia (37% vs. 21%; p < 0,001), disfunción de ventrículo derecho (VD) (31% vs. 19%; p < 0,01) y daño miocárdico (57% vs. 28%; p < 0,001) que los demás pacientes con TEP. La mortalidad por todas las causas a 30 días fue significativamente menor para los pacientes con TEP secundaria a SCT (1,6% vs. 9,6%; p < 0,01). La mortalidad a 30 días por TEP no fue diferente entre los dos grupos de pacientes (0,8% vs. 3,1%; p = 0,18).[Conclusiones] Los pacientes con TEP y SCT son más jóvenes y tienen menos comorbilidad que los demás pacientes con TEP. Aunque se presentan más frecuentemente con disfunción de VD y daño miocárdico, el pronóstico a corto plazo es excelente.Peer reviewe

Safest seats in rope access work

[EN] The Instituto of Biomecánica, at the request of Comissions Obreres del País Valencià and under the funding of the Fundación para la Prevención de Riesgos Laborales, has carried out a study whose main objective has been to improve the culture of prevention among workers in rope access work.[ES] El Instituto de Biomecánica (IBV), a partir de la solicitud de Comissions Obreres del País Valencià (CC. OO.-CV) y con la financiación de la Fundación para la Prevención de Riesgos Laborales (FPRL), ha llevado a cabo un estudio cuyo objetivo ha consistido en mejorar la cultura de la prevención entre los trabajadores del sector de trabajos verticales.La actuación ha sido financiada por la Fundación para la Prevención de Riesgos Laborales a través de su convocatoria de asignación de recursos para acciones indirectas territoriales correspondientes al ejercicio 2010Palomares Olivares, N.; Cortés Carbonell, GJ.; Navarro Garcia, FJ.; Ferreras Remesal, A.; Oltra Pastor, A.; Ruiz Folgado, R.; Garcia Molina, C.... (2012). Asientos más seguros para trabajos en altura. Revista de biomecánica. (58):55-57. http://hdl.handle.net/10251/38478S55575

Effect of Prognostic Guided Management of Patients With Acute Pulmonary Embolism According to the European Society of Cardiology Risk Stratification Model.

A recent trial showed that management driven by prognostic assessment was effective in reducing the length of stay (LOS) for acute stable pulmonary embolism (PE). The efficacy and safety of this strategy in each subgroup of risk stratification remains unknown. We conducted a post-hoc analysis of the randomized IPEP study to evaluate the effect of a management strategy guided by early use of a prognostic pathway in the low- and intermediate-high risk subgroups defined by the European Society of Cardiology (ESC) model. These subgroups were retrospectively identified in the control arm. The primary outcome was LOS. The secondary outcomes were 30-day clinical outcomes. Of 249 patients assigned to the intervention group, 60 (24%) were classified as low-, and 30 (12%) as intermediate-high risk. Among 249 patients assigned to the control group, 66 (27%) were low-, and 13 (5%) intermediate-high risk. In the low-risk group, the mean LOS was 2.1 (±0.9) days in the intervention group and 5.3 (±2.9) days in the control group (P The use of a prognostic assessment and management pathway was effective in reducing the LOS for acute PE without comprising safety across subgroups of risk stratification. [ClinicalTrials.gov], Identifier [NCT02733198]