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

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

La narrativa en el proceso de investigación y su alcance en el ámbito clínico

The main objective of this paper is to reflect on the possibilities of narratives on the clinical setting, for this, the social research on health allows us to discuss several topics: How do we understand them? How can we approach them? Which role can they take in the clinical setting? The framework for narrative analysis has been raised from the social sciences, though, the discussion is unfinished and endless, so it is necessary to continue the debate for its better understandingEl principal interés de este artículo es reflexionar sobre las posibilidades que tienen las narrativas dentro del ámbito clínico, para ello, la investigación social en salud nos permite discutir ¿Cómo las entendemos? ¿Cómo podemos acercarnos a éstas? y ¿Qué importancia pueden llegar a ocupar en el contexto clínico? Si bien la perspectiva de la narrativa ha sido planteada desde las ciencias sociales, la discusión es inacabada e interminable, por ello es necesario continuar el debate para su comprensión

El dispositivo institucional y el tiempo en la interacción y la comunicación médico-paciente:: programa UNIFILA

Introduction: In the three levels of medical attention, institutional dynamics impact in particular ways the consultation and the types of encounters in particular ways. The conditions in which the clinical act is generated are dependent on both the persons involved in it as well as on the operation procedures of the institution. Objective: To discuss the reason why the institutional device and time are important to the clinical operation and how these influences in the different forms of interaction and communication among healthcare personnel and patients. Material and methods: This are an observational, qualitative study. The ethnographic method was used through participant observation and spontaneous conversations. Results: The clinical encounter in influenced by specific situations and contexts. This undermines the institution’s efforts to reduce the time spent in waiting for consultation through UNIFILA. This strategy decreased the number of patients per healthcare services provider but the time notion, as well as the medical practice and interactions were reelaborated. Conclusion: Public institutions are increasingly influenced by the administrative economic model, thus, time acts as a resource with value. Efficiency is included in clinical practice, in such a way that objective and quantifiable time prevails over subjective time.Introducción: En los tres niveles de atención, cada dinámica institucional conlleva una connotación particular del cómo se organiza la consulta y los tipos de encuentros. Las condiciones en que se genera el acto clínico no dependen únicamente de los sujetos implicados en la atención, sino también de circunstancias ajenas a ellos, como son los procedimientos de operación institucionales. Objetivo: Discutir por qué el dispositivo institucional y el tiempo son relevantes para la clínica y, cómo esto repercute en las distintas formas de interacción y la comunicación médico-paciente. Material y métodos: El estudio es observacional de tipo cualitativo, se utilizó el método etnográfico a partir de la observación participante y conversaciones espontáneas. Resultados: Aunque la institución intenta acotar el tiempo de espera de la consulta para mejorar la atención, esto resulta difícil en tanto el encuentro clínico es situacional, y responde al contexto específico. Si bien, con la ejecución de UNIFILA el número de pacientes por cada médico disminuyó, la noción del tiempo se reconfiguró y con ello la práctica médica y las interacciones. Conclusión: Las instituciones públicas cada vez están más influenciadas por el modelo económico-administrativo, por lo cual, el tiempo actúa como un recurso con valor. La eficiencia está incluida en la práctica clínica, de tal forma que impera el tiempo objetivo y cuantificable por encima del tiempo subjetiv

Biodiversidad 2015. Reporte de Estado y Tendencias de la Biodiversidad Continental de Colombia

El propósito de este documento es fortalecer la capacidad de agentes públicos y privados para la aplicación de la PNGIBSE, que constituye en sí misma una apuesta de interfaz entre ciencia, política y sociedad en la perspectiva de construir sostenibilidad en el desarrollo. Además de ello, representa un insumo para el seguimiento a los compromisos del país frente a convenios e iniciativas internacionales (CDB, IPBES, OCDE), así como un mecanismo pedagógico para generar interés, conciencia y apropiación de las diferentes dimensiones de la biodiversidad del país. En esta oportunidad, el reporte avanza en el desarrollo de nuevas infografías vinculadas con diferentes fuentes de información que garantizan la calidad de los datos con los que se propone y representa el estado de la biodiversidad y de su gestión en Colombia. Incluye como novedad la presentación de material en portal web dedicado (reporte.humboldt.org.co), de manera que todas las personas puedan apropiarse e interactuar con el contenido de manera más efectiva. La perspectiva es construir un modelo en tiempo real del trabajo que se desarrolla en el país para conocer, proteger, utilizar o restaurar su biodiversidad y servicios ecosistémicos, promoviendo la apropiación de todos los ciudadanos e instituciones en la tarea. Biodiversidad 2015, es evidente, aún no está en capacidad de dar cuenta de todos los procesos de gestión de biodiversidad que se dan en Colombia, liderados por múltiples actores y a todas las escalas. Paulatinamente esperamos poder abrir el espacio para incrementar la visibilidad de todas y cada una de las iniciativas que se adelanten, a sabiendas de que la posibilidad de encontrar nuevas respuestas y mejores prácticas no depende del Instituto ni de ninguna instancia en particular, sino de la capacidad colectiva de aprendizaje. Así, esperamos que este nuevo paso en la construcción de un producto colaborativo sea del interés de todos y nos permita avanzar en esa dirección. reporte.humboldt.org.coBogotá, D. C

Biodiversidad 2015. Estado y tendencias de la biodiversidad continental de Colombia

El propósito de este documento es fortalecer la capacidad de agentes públicos y privados para la aplicación de la PNGIBSE, que constituye en sí misma una apuesta de interfaz entre ciencia, política y sociedad en la perspectiva de construir sostenibilidad en el desarrollo. Además de ello, representa un insumo para el seguimiento a los compromisos del país frente a convenios e iniciativas internacionales (CDB, IPBES, OCDE), así como un mecanismo pedagógico para generar interés, conciencia y apropiación de las diferentes dimensiones de la biodiversidad del país.Bogotá, D. C., ColombiaInstituto de Investigación de Recursos Biológicos Alexander von Humboldtreporte.humboldt.org.coreporte.humboldt.org.co/biodiversidad/en

Estudios multidisciplinarios en Ciencias de la Salud

Es una distinción, como miembro de la Comisión del Programa del Doctorado en Ciencias de la Salud de la Universidad Autónoma del Estado de México, presentar el libro titulado Estudios multidisciplinarios en Ciencias de la Salud, en el que distinguidos y reconocidos investigadores, entusiastas y comprometidos alumnos del programa nos dan a conocer los resultados de sus proyectos de investigación, trabajos que forman parte de los requisitos para acceder al grado de doctor. Entre las razones que invitan a la lectura del libro destaca su contenido conformado con la participación de autores en cuatro áreas en el campo de la salud: Odontología, Ciencias Médicas y Nutrición, Ciencias de la Conducta, y Enfermería y Obstetricia, quienes contribuyen a incrementar el acervo del conocimiento en cada área, en favor de la ciencia, la tecnología, y la salud física y mental de la población.Universidad Autónoma del Estado de México