[Impact of the COVID-19 pandemic above a universal electronic consultation program (e-consultation) between general practitioners and cardiologists]. / Impacto de la pandemia por COVID-19 sobre un programa de consulta electrónica universal (e-consulta) entre médicos de Atención Primaria y cardiólogos.

Blackground and objective: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are not data of models between clinicians. Our objective is to analyse the impact of the COVID-19 pandemic on the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our area. Methods: Patients with at least one e-consultation between 2018 and 2021 were selected. We analysed the impact of the COVID-19 pandemic on activity and waiting time for care, hospitalizations and mortality, taking as a reference the consultations carried out during 2018. Results: We analysed 25,121 patients. Through logistic regression analysis, it was observed that a shorter delay in care and resolution of the e-consultation without the need for face-to-face care were associated with a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated with worse health outcomes compared to 2018. Conclusions: The results of our study show a significant reduction in e-consult referrals during the first year of the COVID-19 pandemic with a subsequent recovery in the demand for care without the pandemic periods being associated with worse outcomes. The reduction in the time elapsed for solving the e-consult and no need for in-person visit were associated with better outcomes.

Accompaniment Methodology of Open Innovation in Local Universities After COVID-19

Innovation has never been as important as it is now to solve the problems caused by COVID-19 and the socioeconomic crisis. In this context, and within the framework of an economy based on knowledge and change, economic and social agents need open innovation to generate competitiveness and development. For their part, universities need to increase technological production as a source of innovation. In the literature there are models of innovation, but they do not present a method to move from basic to technological research. Aim of this work was to fill, in part, this gap. Under the qualitative approach, the Open Innovation model, the Technological Maturity Levels method and the Pedagogical Accompaniment model were selected to develop a post-COVID-19 route to intensify innovation. The article contributes to knowledge with a methodology that allows expanding the performance of researchers and raising the technological level of universities towards competitiveness. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

Adaptation of midline and mini-midline catheters for patients with COVID-19

Objective: to analyse the time of permanence andmain causes for removal of midline (20 cm) and mini-midline (10 cm) catheters in hospitalized patients, and to study the differences in patients with COVID-19. Method: a descriptive, cross-sectional, retrospective study conducted with data from clinical records in the Hospital Universitario Vall d´Hebron (Barcelona, Spain). The study includedcatheters insertedby the Infusion andVascular Access Nursing (IVAN) Team in patients hospitalized during 2020. Results: the study included 357 catheters in 305 patients (28.9% with COVID-19). The latter presented a higher rate of obesity (21.6% vs. 9.2%;p= 0.003). The median duration of catheters inserted was 11-12 days, without any difference by type of catheter or having COVID-19 (p= 0.88). The main cause for removal in both groups was the end of the treatment, and it was higher in patients without COVID-19 (65.7% vs. 53.1%;p= 0.031), followedby exitus in patients withCOVID-19 (22.9% vs. 8.9%;p= 0.001), and catheter occlusion in the rest (17.3% vs. 8.33%;p= 0.035). There were n= 4 cases of catheter infection and n= 31 suspected cases, without difference by diagnosis or type of catheter. There was no variation in the cause for removal according to the venous access selected. Conclusions: there are no differences in terms of duration of catheters according to their length, vein of insertion or COVID-19 diagnosis. Ultrasound-guided venipuncture, sterile technique and selection of type of catheter by a member of the IVAN team seem to reduce the complications associated. © 2022 DAE Editorial, Grupo Paradigma. All rights reserved.

Trauma: a stress during pandemic?

Introduction: Coronavirus disease 2019 pandemic significantly impacted on trauma systems, since emergency departments (ED) suddenly were overwhelmed by patients requiring intensive care unit (ICU) admission. Once, trauma volume was supposed to decrease due to lockdown policies, we aimed to describe ICU trauma admissions during this period. Method(s): Retrospective observational study of all trauma patients admitted to the ICU of a Portuguese Trauma Center between January 2020 and December 2021. Data were collected from clinical hospital records. Result(s): 437 trauma patients (15% of all admissions), mostly male (71%), with a median age of 59 years-old (42-74) were included. At least one comorbidity was present in 71% of the patients. Median severity scores were: SAPS II 26 (19-38), SOFA 3 (1-6), ISS 13 (9-22), RTS 8 (6-8) and TRISS 96,75 (81.1-98.6). The most frequent mechanisms of injury were falls (59%) and road traffic accidents (25%). The majority consisted of blunt trauma (88%), 65% of brain trauma and 35% of musculoeskeletal trauma. Trauma Team assessment was started in < 3 min in all cases and median length of stay (LOS) in the ED was 261 min (154-418). Surgical intervention was performed in < 4 h in 56% of surgical brain trauma injuries, in < 6 h in 67% of extremity open fractures and in < 1 h in 6% of a penetrating trauma. Shock, mainly hemorrhagic, was present in 8% of the patients on hospital admission. 38% were submitted to invasive mechanical ventilation and 34% to vasopressors. The most common complication was nosocomial infection (18%). The median LOS in the UCI was 12 days (5-24). Only 8% of the patients died in the ICU and 11% in the hospital. Conclusion(s): During pandemic, trauma persisted a major health problem with a significant consumption of time and critical care resources. The high influx of patients may have influenced the LOS in the ED before ICU admission and the time until the surgical intervention. Despite it, mortality remained low.

Impact of the COVID-19 pandemic upon a universal electronic consultation program (e-consultation) between general practitioners and cardiologists Impacto de la pandemia por COVID-19 sobre un programa de consulta electrónica universal (e-consulta) entre médicos de atención primaria y cardiólogos

Background and objective Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. Methods Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. Results A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019–2020 and 2020–2021) were not associated to poorer health outcomes compared to 2018. Conclusions The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.

Impact of the COVID-19 pandemic upon a universal electronic consultation program (e-consultation) between general practitioners and cardiologists.

BACKGROUND AND OBJECTIVE: Virtual healthcare models, usually between healthcare professionals and patients, have developed strongly during the coronavirus disease 2019 (COVID-19) pandemic, but there are no data corresponding to models between clinicians. An analysis was made of the impact of the COVID-19 pandemic upon the activity and health outcomes of the universal e-consultation program for patient referrals between primary care physicians and the Cardiology Department in our healthcare area. METHODS: Patients with at least one e-consultation between 2018 and 2021 were selected. We analyzed the impact of the COVID-19 pandemic upon activity and waiting time for care, hospitalizations and mortality, taking as reference the consultations carried out during 2018. RESULTS: A total of 25,121 patients were analyzed. Logistic regression analysis showed a shorter delay in care and resolution of the e-consultation without the need for face-to-face care to be associated to a better prognosis. The COVID-19 pandemic periods (2019-2020 and 2020-2021) were not associated to poorer health outcomes compared to 2018. CONCLUSIONS: The results of our study show a significant reduction in e-consultation referrals during the first year of the COVID-19 pandemic, with a subsequent recovery in the demand for care, and without the pandemic periods being associated to poorer outcomes. The reduction in time elapsed for resolving the e-consultations and no need for face-to-face visits were associated to improved outcomes.

Lessons from COVID-19 for future disasters: an opinion paper.

A "Pandemic/Disaster Law" is needed to condense and organize the current dispersed and multiple legislation. The State must exercise a single power and command appropriate to each situation, with national validity. The production of plans for the use of land and real estate as potential centers for health care, shelter or refuge is recommended. There should be specific disaster plans at least for Primary Health Care, Hospitals and Socio-sanitary Centers. The guarantee of the maintenance of communication and supply routes is essential, as well as the guarantee of the autochthonous production of basic goods. The pandemic has highlighted the need to redefine the training plans for physicians who, in their different specialties, have to undertake reforms that allow a more versatile and transversal training. National research must have plans to be able to respond quickly to questions posed by the various crises, using all the nation's resources and in particular, all the data and capabilities of the health sector. Contingency plans must consider ethical aspects, and meet the needs of patients and families with a humanized approach. In circumstances of catastrophe, conflicts increase and require a bioethical response that allows the best decisions to be made, with the utmost respect for people's values. Rapid, efficient and truthful communication systems must be contained in a special project for this sector in critic circumstances. Finally, we believe that the creation of National Coordination Centers for major disasters and Public Health can contribute to better face the crises of the future.

Using rhetoric images to record story(ies): discourses on Covid-19-related deaths in Brazil

This article reflects on the role of images in rhetorical techniques. The theme will be Covid-19-related deaths in Brazil. To this end, two covers from Brazilian newspapers namely, O Globo, from Rio de Janeiro, and Folha de S. Paulo, from São Paulo, compose the corpus. More specifically, the covers were published in the editions issued after the country registered over 100,000 and 200,000 Covid-19-related deaths. The objective is to show the argumentative role of metonymy and repetition in the corpus texts. The images presented in the study were relevant to the two cover compositions. O Globo used photos of several people who died from the disease. Folha de S. Paulo reproduced shoes that had been worn by some of the victims. The analysis is based on theoretical assumptions about rhetorical images by rhetoric and new rhetoric scholars. © This content is licensed under a Creative Commons Attribution License, which permits unrestricted use and distribution, provided the original author and source are credited.

Insights for COVID-19 in 2023.

Predictions for a near end of the pandemic by the World Health Organization should be interpreted with caution. Current evidence indicates that the efficacy of a fourth dose of classical mRNA vaccines (BT162b2 or mRNA-1273) is low and short-lived in preventing SARS-CoV-2 infection in its predominant variant (Omicron). However, its efficacy is high against severe symptomatic infection, hospitalization and death. The new vaccines being introduced are bivalent and active against the Omicron variants. Potential new vaccines to be introduced in the coming year include a vaccine based on a recombinant protein that emulates the receptor binding domain of the Spike protein under development by the Spanish company Hipra, as well as vaccines for nasal or oral administration. Available information suggests that vaccines against COVID-19 can be administered in association with influenza vaccination without particular complications. New drugs against COVID-19, both antiviral and anti-inflammatory, are under investigation, but this does not seem to be the case with monoclonal antibodies. The indication to use masks in some circumstances will be maintained next year in view of the accumulation of scientific data on their efficacy. Finally, the long COVID or Post-COVID syndrome may continue to affect a very high proportion of patients who have had the disease, requiring combined diagnostic and therapeutic resources.

COVID in Pediatric Age: an opinion paper.

The incidence of COVID in pediatrics was underestimated during the first months of the pandemic due to the oligosymptomatic nature of the infection in many children and the scarcity of diagnostic tests applied to this population. It is now accepted that children are infected and transmit the disease in the same way as adults. On the contrary, children have less severe and less lethal COVID, probably due to a lower maturity of the child's immune system, a lower number of ACE2 receptors and the lower presence of comorbidities in this population group. The development of a multisystemic inflammatory syndrome after SARS-CoV-2 infection in children, despite its rarity, is a very serious condition that frequently requires intensive care. Other less severe post-COVID manifestations have been described in children but are not yet well defined. COVID has had and continues to have a significant psychological impact on the children themselves, on their caregivers and on the exacerbation of pre-existing psychiatric conditions. We apply adult therapeutic principles to children but with very low levels of evidence. Information on the tolerability of the available medications in this population group is still scarce. The mortality of COVID in children is very low and generally affects children with significant comorbidities. There are, at present, three vaccines licensed for pediatric use which are compatible with all other vaccines applicable to children. In these circumstances, there has been much speculation about the indication for vaccination in the pediatric age group, but given its good tolerance, there are clinical and ethical reasons that, in our opinion, justify it.

COVID-19: Some unresolved issues.

Two years after the COVID-19 pandemic, many uncertainties persist about the causal agent, the disease and its future. This document contains the reflection of the COVID-19 working group of the Official College of Physicians of Madrid (ICOMEM) in relation to some questions that remain unresolved. The document includes considerations on the origin of the virus, the current indication for diagnostic tests, the value of severity scores in the onset of the disease and the added risk posed by hypertension or dementia. We also discuss the possibility of deducing viral behavior from the examination of the structure of the complete viral genome, the future of some drug associations and the current role of therapeutic resources such as corticosteroids or extracorporeal oxygenation (ECMO). We review the scarce existing information on the reality of COVID 19 in Africa, the uncertainties about the future of the pandemic and the status of vaccines, and the data and uncertainties about the long-term pulmonary sequelae of those who suffered severe pneumonia.

Pharmacological treatment of COVID-19: an opinion paper.

The precocity and efficacy of the vaccines developed so far against COVID-19 has been the most significant and saving advance against the pandemic. The development of vaccines has not prevented, during the whole period of the pandemic, the constant search for therapeutic medicines, both among existing drugs with different indications and in the development of new drugs. The Scientific Committee of the COVID-19 of the Illustrious College of Physicians of Madrid wanted to offer an early, simplified and critical approach to these new drugs, to new developments in immunotherapy and to what has been learned from the immune response modulators already known and which have proven effective against the virus, in order to help understand the current situation.

Emotion Analysis of Writers and Readers of Japanese Tweets on Vaccinations

Public opinion in social media is increasingly becoming a critical factor in pandemic control. Understanding the emotions of a population towards vaccinations and COVID-19 may be valuable in convincing members to become vaccinated. We investigated the emotions of Japanese Twitter users towards Tweets related to COVID-19 vaccination. Using the WRIME dataset, which provides emotion ratings for Japanese Tweets sourced from writers (Tweet posters) and readers, we fine-tuned a BERT model to predict levels of emotional intensity. This model achieved a training accuracy of MSE = 0.356. A separate dataset of 20,254 Japanese Tweets containing COVID-19 vaccine-related keywords was also collected, on which the fine-tuned BERT was used to perform emotion analysis. Afterwards, a correlation analysis between the extracted emotions and a set of vaccination measures in Japan was conducted. The results revealed that surprise and fear were the most intense emotions predicted by the model for writers and readers, respectively, on the vaccine-related Tweet dataset. The correlation analysis also showed that vaccinations were weakly positively correlated with predicted levels of writer joy, writer/reader anticipation, and writer/reader trust.

Effectiveness of COVID -19 vaccine on cancer patients in one Latin American country: A follow-up of ACHOC-C19 study

Background: In our experience during the first year of development of ACHOC-C19 study, we observed 26% mortality in patients with cancer and COVID 19 infection. The impact of vaccination was not evaluated prior to the implementation of this strategy worldwide in this kind of population. It was proposed to evaluate the effectiveness of immunization during the second phase of our investigation. Methods: Cohort study derived from the National Registry of Patients with Cancer and COVID-19 (ACHOCC-19). Data were collected from June 2021 since vaccine was available. Patients were: older than 18 years, diagnosed with cancer (solid tumors), treated and/or under follow-up, and with COVID-19 infection. The comparative analysis of the vaccinated and non-vaccinated cohort is presented. Outcomes included: all-cause mortality within 30 days of infection diagnosis, hospitalization, and mechanical ventilation. Effect estimation was performed through relative risk (RR) and multivariate analysis for each event, using generalized linear models of the binomial family. Results: 896 patients were included, 470 were older than 60 years (52.4%) and 59% women (n = 530). 172 patients were recruited in the vaccinated cohort and 724 in the non-vaccinated cohort (ratio: 1 to 4.2). The cumulative incidence of hospitalization among the unvaccinated was 42.4% (n = 307), and among the vaccinated, 29% (n = 50);invasive mechanical ventilation requirement was 8.4% (n = 61) in unvaccinated, and 4.6% (n = 8) in vaccinated. The cumulative incidence of mortality from all causes in the unvaccinated was 17% (n = 123) and in the vaccinated 4.65% (n = 8). Table summarizes the multivariate analysis. The adjusted RR for mortality for the unvaccinated is 3.4 (95% CI: 1.7-6.8), for hospitalization 1.36 (95% CI: 1.08-1.72), and for mechanical ventilation 2.1 (95% CI: 1.02-4.2). Conclusions: The incidence of complications and death in patients with cancer and COVID-19 infection is significantly higher in those who have not received a vaccination schedule compared to those who have been vaccinated. Immunization should be promoted and intensified in this population group.

DEGRADED BEAUTY: CONTEXTUAL ART AND LANDSCAPE EDUCATION THROUGH A PROJECT IN SECONDARY SCHOOL

Today educational settings face the challenge of connecting the curriculum that is taught in school with the students' reality outside the classroom. In that sense, art education can be especially relevant, allowing students to stablish affective and emotional links with this reality through a creative process. The project described in this paper promoted a creative and critical work about the degradation of the landscape in the vicinity of our secondary school. In order to internalize and to solve this problem students enrolled in music and visual arts classes worked through the paradigms of contextual art and critical pedagogy. The present text is structured around the art-based research model (Frayling, 1993;de Laiglesia, 2009), describing and conceptualizing the project and focusing in the concept of degraded beauty through four parts: context, concept, actions and publicity. After considering the teacher as a public intellectual, the object of the project was to generate a critical thinking in students from a theory-grounded perspective.

Confined community health: reflections and experiences from the local public health

This paper aims to share the reflections related to the community actions in which the Agencia de Salut Publica de Barcelona has been involved during the emergency of COVID-19. The tasks carried out can be arranged in three stages, frequently overlapping: detection of needs and problems;contact with key stakeholders to assess what to do and how to do it;adaptation of the interventions to the "new normal" and generation of new responses. The emerging problems included: not being able to do the confinement (due to homelessness, material conditions, living in a situation of violence);digital gap (lack of knowledge, devices, access to Wifi);greater exposure to COVID-19 in the essential but precarious, feminized and racialized jobs (care, cleaning, food shops) that are the most frequent in the neighborhoods in where we work;language and cultural barriers that preclude to follow recommendations;to lose employment;insufficient income to cover basic needs;social isolation;and the deterioration of emotional health caused by the situation. During the process, some interventions were adapted to be delivered on-line. Solidarity networks and local resources were key to meet basic needs, but also other needs related to lack of digital knowledge or device. Community action in health, from a critical, intersectional and local perspective, and with intersectoral work and community participation, can contribute to: facilitate a contextualized response in the event of a health crisis;mitigate the effects derived from its economic and social crisis.

Collaborative tools web 3.0 in the teaching of mathematics in times of Covid 19 pandemic

The limited use of collaborative tools in the teaching of Mathematics with students of Middle Basic General Education has allowed us to think about the three essential axes that this work entails: collaborative tools, Didactics of Mathematics, and learning and knowledge technologies (LKT). This research aimed to analyze the use of web 3.0 collaborative tools in the teaching of Mathematics. The methodology applied with a mixed experimental-exploratory approach, through a structured questionnaire of 24 questions on a Likert scale which was validated by Cronbach's alpha statistic with a result of 0.846, the TAM model was applied to measure the acceptance of digital resources developed through collaborative web3.0 tools in virtual learning during the global pandemic covid-19, the ADDIE methodology was applied in the execution and application of collaborative tools for students in the eighth year of General Basic education. The contrast of the hypothesis was carried out using the Kolmogorov-Smirnov statistical test for a sample where a value less than 0.000 was obtained, stating that the development of web 3.0 resources by the teacher improves collaborative work focused on learning mathematics and, in this way, a paradigm shift is manifested in its conceptualization and modifications in its didactic development. The results show that the role of technology and the Internet in the learning of mathematics can generate some motivation, they represent for students and teachers a significant factor of high impact in the learning of mathematics in the long term, not because of their use or access to them, but for the competence to apply them in their learning. © 2022 IEEE.

Characterization of tofacitinib use as COVID-19 therapy

Objective: The main purpose of this study is to characterize and compare the population that received tofacitinib with those that were not treated with the drug for COVID-19 at the Clínica Unión Médica del Norte, in 2020. Methods: An observational, retrospective, cross-sectional, exploratory, and secondary source study was conducted. A comparison was made between clinical and sociodemographic characteristics, laboratory results and their treatment option. Results: Five hundred and seven patients admitted to the COVID-19 unit of the Clínica Unión Médica del Norte were included. It was determined that lower death rates were registered in the group that received tofacitinib (6.45%) compared to the group that did not use the drug. Likewise, those receiving this therapy required less mechanical ventilation, however, a higher proportion of these patients were admitted to the Intensive Care Unit. In addition, a greater reduction in glycaemia was identified in the patients receiving tofacitinib, but they had higher levels of ferritin and D-dimer. Conclusions: Tofacitinib may be beneficial in terms of mortality rates and reduction in the use of mechanical ventilation. Furthermore, it is promising with respect to positive patient progression. However, our research is not conclusive. Future confirmatory research is needed on the efficacy of tofacitinib therapy for COVID-19 patients.