Patient preferences and treatment safety for uncomplicated vulvovaginal candidiasis in primary health care

<p>Abstract</p> <p>Background</p> <p>Vaginitis is a common complaint in primary care. In uncomplicated candidal vaginitis, there are no differences in effectiveness between oral or vaginal treatment. Some studies describe that the preferred treatment is the oral one, but a Cochrane's review points out inconsistencies associated with the report of the preferred way that limit the use of such data. Risk factors associated with recurrent vulvovaginal candidiasis still remain controversial.</p> <p>Methods/Design</p> <p>This work describes a protocol of a multicentric prospective observational study with one year follow up, to describe the women's reasons and preferences to choose the way of administration (oral vs topical) in the treatment of not complicated candidal vaginitis. The number of women required is 765, they are chosen by consecutive sampling. All of whom are aged 16 and over with vaginal discharge and/or vaginal pruritus, diagnosed with not complicated vulvovaginitis in Primary Care in Madrid.</p> <p>The main outcome variable is the preferences of the patients in treatment choice; secondary outcome variables are time to symptoms relief and adverse reactions and the frequency of recurrent vulvovaginitis and the risk factors. In the statistical analysis, for the main objective will be descriptive for each of the variables, bivariant analysis and multivariate analysis (logistic regression).. The dependent variable being the type of treatment chosen (oral or topical) and the independent, the variables that after bivariant analysis, have been associated to the treatment preference.</p> <p>Discussion</p> <p>Clinical decisions, recommendations, and practice guidelines must not only attend to the best available evidence, but also to the values and preferences of the informed patient.</p

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Diseño y desarrollo de una aplicación para la formación de neurofisiólogos en la identificación de señales MER en cirugía de estimulación cerebral profunda

La estimulación cerebral profunda (ECP) es una técnica quirúrgica por la que se palían los síntomas de enfermedades neurológicas tales como la Enfermedad de Parkinson (EP). En la ECP, se lleva a cabo una inserción de microelectrodos (MER) cerebrales que registran la actividad neuronal, así como emiten pequeñas descargas para mejorar los síntomas del paciente. Uno de los retos formativos para los neurofisiólogos consiste en la identificación de la zona cerebral en la que se está implantando el electrodo. Dicha formación se suele llevar a cabo en el quirófano, con pacientes reales. En este trabajo se ha desarrollado una aplicación que permite entrenar la identificación de señales MER de forma offline a partir de registros pregrabados. El usuario debe reconocer las zonas cerebrales involucradas en función de la información visual y/o auditiva de la señal. La aplicación se validará con especialistas neurofisiólogos del Hospital Universitario La Paz (Madrid). Gracias a la aplicación especialistas médicos podrán comprobar si son capaces o no de reconocer las distintas áreas cerebrales involucradas para finalizar con éxito futuras intervenciones

Using clinical research networks to assess severity of an emerging influenza pandemic

BACKGROUND: Early clinical severity assessments during the 2009 influenza A H1N1 pandemic (pH1N1) overestimated clinical severity due to selection bias and other factors. We retrospectively investigated how to use data from the International Network for Strategic Initiatives in Global HIV Trials, a global clinical influenza research network, to make more accurate case fatality ratio (CFR) estimates early in a future pandemic, an essential part of pandemic response. METHODS: We estimated the CFR of medically attended influenza (CFRMA) as the product of probability of hospitalization given confirmed outpatient influenza and the probability of death given hospitalization with confirmed influenza for the pandemic (2009-2011) and post-pandemic (2012-2015) periods. We used literature survey results on health-seeking behavior to convert that estimate to CFR among all infected persons (CFRAR). RESULTS: During the pandemic period, 5.0% (3.1%-6.9%) of 561 pH1N1-positive outpatients were hospitalized. Of 282 pH1N1-positive inpatients, 8.5% (5.7%-12.6%) died. CFRMA for pH1N1 was 0.4% (0.2%-0.6%) in the pandemic period 2009-2011 but declined 5-fold in young adults during the post-pandemic period compared to the level of seasonal influenza in the post-pandemic period 2012-2015. CFR for influenza-negative patients did not change over time. We estimated the 2009 pandemic CFRAR to be 0.025%, 16-fold lower than CFRMA. CONCLUSIONS: Data from a clinical research network yielded accurate pandemic severity estimates, including increased severity among younger people. Going forward, clinical research networks with a global presence and standardized protocols would substantially aid rapid assessment of clinical severity

Jornadas Nacionales de Robótica y Bioingeniería 2023: Libro de actas

Las Jornadas de Robótica y Bioingeniería de 2023 tienen lugar en la Escuela Técnica Superior de Ingeniería Industrial de la Universidad Politécnica de IVIadrid, entre los días 14 y 16 de junio de 2023. En este evento propiciado por el Comité Español de Automática (CEA) tiene lugar la celebración conjunta de las XII Jornadas Nacionales de Robótica y el XIV Simposio CEA de Bioingeniería. Las Jornadas Nacionales de Robótica es un evento promovido por el Grupo Temático de Robótica (GTRob) de CEA para dar visibilidad y mostrar las actividades desarrolladas en el ámbito de la investigación y transferencia tecnológica en robótica. Asimismo, el propósito de Simposio de Bioingeniería, que cumple ahora su decimocuarta dicción, es el de proporcionar un espacio de encuentro entre investigadores, desabolladores, personal clínico, alumnos, industriales, profesionales en general e incluso usuarios que realicen su actividad en el ámbito de la bioingeniería. Estos eventos se han celebrado de forma conjunta en la anualidad 2023. Esto ha permitido aunar y congregar un elevado número de participantes tanto de la temática robótica como de bioingeniería (investigadores, profesores, desabolladores y profesionales en general), que ha posibilitado establecer puntos de encuentro, sinergias y colaboraciones entre ambos. El programa de las jornadas aúna comunicaciones científicas de los últimos resultados de investigación obtenidos, por los grupos a nivel español más representativos dentro de la temática de robótica y bioingeniería, así como mesas redondas y conferencias en las que se debatirán los temas de mayor interés en la actualidad. En relación con las comunicaciones científicas presentadas al evento, se ha recibido un total de 46 ponencias, lo que sin duda alguna refleja el alto interés de la comunidad científica en las Jornadas de Robótica y Bioingeniería. Estos trabajos serán expuestos y presentados a lo largo de un total de 10 sesiones, distribuidas durante los diferentes días de las Jornadas. Las temáticas de los trabajos cubren los principales retos científicos relacionados con la robótica y la bioingeniería: robótica aérea, submarina, terrestre, percepción del entorno, manipulación, robótica social, robótica médica, teleoperación, procesamiento de señales biológicos, neurorehabilitación etc. Confiamos, y estamos seguros de ello, que el desarrollo de las jornadas sea completamente productivo no solo para los participantes en las Jornadas que podrán establecer nuevos lazos y relaciones fructíferas entre los diferentes grupos, sino también aquellos investigadores que no hayan podido asistir. Este documento que integra y recoge todas las comunicaciones científicas permitirá un análisis más detallado de cada una de las mismas

The management of acute venous thromboembolism in clinical practice - study rationale and protocol of the European PREFER in VTE Registry

Background: Venous thromboembolism (VTE) is a major health problem, with over one million events every year in Europe. However, there is a paucity of data on the current management in real life, including factors influencing treatment pathways, patient satisfaction, quality of life (QoL), and utilization of health care resources and the corresponding costs. The PREFER in VTE registry has been designed to address this and to understand medical care and needs as well as potential gaps for improvement. Methods/design: The PREFER in VTE registry was a prospective, observational, multicenter study conducted in seven European countries including Austria, France Germany, Italy, Spain, Switzerland, and the UK to assess the characteristics and the management of patients with VTE, the use of health care resources, and to provide data to estimate the costs for 12 months treatment following a first-time and/or recurrent VTE diagnosed in hospitals or specialized or primary care centers. In addition, existing anticoagulant treatment patterns, patient pathways, clinical outcomes, treatment satisfaction, and health related QoL were documented. The centers were chosen to reflect the care environment in which patients with VTE are managed in each of the participating countries. Patients were eligible to be enrolled into the registry if they were at least 18 years old, had a symptomatic, objectively confirmed first time or recurrent acute VTE defined as either distal or proximal deep vein thrombosis, pulmonary embolism or both. After the baseline visit at the time of the acute VTE event, further follow-up documentations occurred at 1, 3, 6 and 12 months. Follow-up data was collected by either routinely scheduled visits or by telephone calls. Results: Overall, 381 centers participated, which enrolled 3,545 patients during an observational period of 1 year. Conclusion: The PREFER in VTE registry will provide valuable insights into the characteristics of patients with VTE and their acute and mid-term management, as well as into drug utilization and the use of health care resources in acute first-time and/or recurrent VTE across Europe in clinical practice. Trial registration: Registered in DRKS register, ID number: DRKS0000479