Post-Intensive Care Unit Multidisciplinary Approach in Patients with Severe Bilateral SARS-CoV-2 Pneumonia.

Background: Short and long-term sequelae after admission to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) are to be expected, which makes multidisciplinary care key in the support of physical and cognitive recovery. Objective: To describe, from a multidisciplinary perspective, the sequelae one month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia. Design: Prospective cohort study. Environment: Multidisciplinary outpatient clinic. Population: Patients with severe COVID-19 pneumonia, post- ICU admission. Methods: A total of 104 patients completed the study in the multidisciplinary outpatient clinic. The tests performed included spirometry, measurement of respiratory muscle pressure, loss of body cell mass (BCM) and BCM index (BCMI), general joint and muscular mobility, the short physical performance battery (SPPB or Guralnik test), grip strength with hand dynamometer, the six-minute walk test (6-MWT), the functional assessment of chronic illness therapy-fatigue scale (FACIT-F), the European quality of life-5 dimensions (EQ-5D), the Barthel index and the Montreal cognitive assessment test (MoCA). While rehabilitation was not necessary for 23 patients, 38 patients attended group rehabilitation sessions and other 43 patients received home rehabilitation. Endpoints: The main sequelae detected in patients were fatigue (75.96%), dyspnoea (64.42%) and oxygen therapy on discharge (37.5%). The MoCA showed a mean score compatible with mild cognitive decline. The main impairment of joint mobility was limited shoulder (11.54%) and shoulder girdle (2.88%) mobility; whereas for muscle mobility, lower limb limitations (16.35%) were the main dysfunction. Distal neuropathy was present in 23.08% of patients, most frequently located in lower limbs (15.38%). Finally, 50% of patients reported moderate limitation in the EQ-5D, with a mean score of 60.62 points (SD 20.15) in perceived quality of life. Conclusions: Our findings support the need for a multidisciplinary and comprehensive evaluation of patients after ICU admission for COVID-19 because of the wide range of sequelae, which also mean that these patients need a long-term follow-up. Impact on clinical rehabilitation: This study provides data supporting the key role of rehabilitation during the follow-up of severe patients, thus facilitating their reintegration in society and a suitable adaptation to daily living.

Physiotherapists' Evidence-Based Practice profiles by HS-EBP questionnaire in Spain: A cross-sectional normative study.

Evidence-Based Practice (EBP) is a cost-effective approach for improving the quality of clinical care and implementing only well-tested evidence. Health professions, especially physiotherapy, must embrace EBP principles. This paper presents normative data from the Spanish physiotherapist population using the Health-Sciences Evidence-Based Practice questionnaire and explores EBP clusters/profiles of professionals in practice. An intentional sample of 419 practicing physiotherapists was recruited from the Spanish Professional Council of Physiotherapy. Participants completed a cross-sectional online survey with 60 Likert items (scale 1-10) measuring 5 dimensions: 1) Beliefs and attitudes, 2) Results from literature, 3) Professional practice, 4) Assessment of results, and 5) Barriers and Facilitators. The protocol also included sociodemographic, training, and practice-related contrast variables. Normative data were estimated and tabulated for each dimension and then a K-means clustering procedure was implemented using the contrast variables. Results for normative data showed, in descending order, the following 50th percentile values for the five EBP factors: Beliefs and attitudes (8.25), Professional practice (8.00), Assessment of results (7.42), Results from literature (6.71), and EBP Barriers and Facilitators (5.17); all expressed on a scale of 1 to 10. Academic degree, EBP training level, and work time shared in healthcare activity, research, or teaching activity were all statistically significant for discriminating EBP dimension scores. Finally, six different clusters showed that when EBP level is low, the scores in all dimensions are equally low, and vice-versa. The EBP dimensions "Beliefs and attitudes", "Professional practice", and "Evaluation of results" obtained better normative scores overall than "Search for bibliographic evidence and its inclusion in practice" and especially "Perception of EBP barriers", which had the worst score. Normative data are useful for comparing individual scores and the reference population, and information about clusters will enable appropriate global EBP intervention programs to be designed and implemented.

Urgencias tras consumo de cocaína: factores relacionados con el ingreso hospitalario / Emergencies following cocaine use: factors related to hospital admission

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Health Sciences-Evidence Based Practice Questionnaire (HS-EBP): Normative Data and Differential Profiles in Spanish Osteopathic Professionals.

The main goal of this study was to obtain normative data of the scores of the Health-Sciences Evidence Based Practice (HS-EBP) questionnaire, and to analyse evidence-based practice (EBP) among potential clusters of osteopathy professionals in Spain. An online descriptive cross-sectional study has been applied. A total number of 443 Spanish practicing osteopaths answered a survey including the 5 dimensions of the HS-EBP questionnaire and sociodemographic, training, and practice variables using the "LimeSurvey" online platform. Results point out that the median scores for each five HS-EBP questionnaire dimensions were 95.00, 86.00, 78.00, 84.00 and 62.00 considering that the range of possible scores in each of the dimensions was: from 12 to 120 in dimensions 1, 4 and 5; from 14-140 in dimension 2; and from 10-100 in dimension 3. A clustering algorithm extracted 6 different profiles across the five HS-EBP latent dimensions: low scores in all dimensions (cluster 1); low scores in all dimensions but with medium scores in dimension 1 (cluster 2); mixed pattern of scores, low in dimensions 2 and 5 and medium in the rest of the dimensions; medium scores in all dimensions (cluster 4); high scores in all dimensions and low scores in dimension 5 (cluster 5); and high scores in all dimensions (cluster 6). Significant relationship was found among the response patterns in the clusters and: academic degree level, EBP training and training level, and work time invested in healthcare activity, research and teaching activity. These results allow a description of the actual level of EBP and differential profiles of Osteopathy care practice in Spain. Knowledge of normative scores of the HS-EBP questionnaire and identification of different predictors of Spanish osteopaths' EBP, e.g., academic degree, EBP training and training level, work time invested in healthcare activity, research, and teaching activity, and having a working relationship with an accredited educational centre, enable a comprehensive evaluation of the EBP of osteopathic professionals and can also be useful for developing and implementing formative intervention programs for improving EBP practice in osteopathic practice.

Medication overdoses: changes over time. / Evolución temporal de las intoxicaciones medicamentosas.

OBJECTIVES: To review changes occurring over time in cases of medication overdose attended by an emergency department. MATERIAL AND METHODS: Retrospective review of epidemiologic and care variables related to drug poisonings in a university teaching hospital in 2007 and 2017. We used multivariate analysis to compare the 2 years. RESULTS: A total of 750 cases were included; 438 (58.4%) were from 2007. Fewer cases were seen in 2017 even though the total numbers of emergencies and poisonings had risen (P<.001). Fewer cases were suicides or suicide attempts in 2017 (P<.001), and digestive tract decontamination and antidotes were used less often (P<.001 and P=.007, respectively). Admissions (P=.004) and voluntary self-discharges or patient losses were also down in 2017 (P=.03). However, multidrug poisonings increased (P=.001), especially in the context of recreational drug use by men. Benzodiazepine overdoses accounted for most of such cases (65.1%). CONCLUSION: Medication overdoses seem to be decreasing, although the proportion of men overdosing is rising. Suicide attempts, the abuse of specific medications, and admissions also seem to be decreasing.

OBJETIVO: Análisis de la evolución temporal de las intoxicaciones medicamentosas (IM) atendidas en urgencias hospitalarias. METODO: Estudio retrospectivo, con análisis multivariante de variables epidemiológicas y asistenciales de IM, comparando la casuística de los años 2007 con 2017, en un hospital universitario. RESULTADOS: Se incluyeron 750 casos, 58,4% del 2007. En 2017, disminuyeron la causa suicida (p < 0,001), el empleo de descontaminación digestiva (p < 0,001) y antídotos (p = 0,007), y los ingresos (p = 0,004), altas voluntaria o fugas (p = 0,03). Se incrementó por el contrario la intoxicación múltiple (p = 0,001), especialmente en varones y en contexto recreativo. Las benzodiacepinas fueron los fármacos más implicados en las IM (65,1%). CONCLUSIONES: Existe una tendencia al descenso de las IM atendidas, con incremento en varones, menos intencionalidad suicida, menos uso de terapéuticas específicas y menos admisiones hospitalarias.

Evolución temporal de las intoxicaciones medicamentosas / Medication overdoses: changes over time

Objetivo: Análisis de la evolución temporal de las intoxicaciones medicamentosas (IM) atendidas en urgencias hospitalarias. Método: Estudio retrospectivo, con análisis multivariante de variables epidemiológicas y asistenciales de IM, comparando la casuística de los años 2007 con 2017, en un hospital universitario. Resultados: Se incluyeron 750 casos, 58,4% del 2007. En 2017, disminuyeron la causa suicida (p < 0,001), el empleo de descontaminación digestiva (p < 0,001) y antídotos (p = 0,007), y los ingresos (p = 0,004), altas voluntaria o fugas (p = 0,03). Se incrementó por el contrario la intoxicación múltiple (p = 0,001), especialmente en varones y en contexto recreativo. Las benzodiacepinas fueron los fármacos más implicados en las IM (65,1%). Conclusiones: Existe una tendencia al descenso de las IM atendidas, con incremento en varones, menos intencionalidad suicida, menos uso de terapéuticas específicas y menos admisiones hospitalarias

Objective: To review changes occurring over time in cases of medication overdose attended by an emergency department. Methods: Retrospective review of epidemiologic and care variables related to drug poisonings in a university teaching hospital in 2007 and 2017. We used multivariate analysis to compare the 2 years. Results: A total of 750 cases were included; 438 (58.4%) were from 2007. Fewer cases were seen in 2017 even though the total numbers of emergencies and poisonings had risen (P<.001). Fewer cases were suicides or suicide attempts in 2017 (P<.001), and digestive tract decontamination and antidotes were used less often (P<.001 and P=.007, respectively). Admissions (P=.004) and voluntary self-discharges or patient losses were also down in 2017 (P=.03). However, multidrug poisonings increased (P=.001), especially in the context of recreational drug use by men. Benzodiazepine overdoses accounted for most of such cases (65.1%). Conclusions: Medication overdoses seem to be decreasing, although the proportion of men overdosing is rising. Suicide attempts, the abuse of specific medications, and admissions also seem to be decreasing

Estudio de los factores asociados al uso de sustancias en la adolescencia mediante Reglas de Asociación / Study of the factors associated with substance use in adolescence using Association Rules

El objetivo del presente estudio es analizar los factores relacionados con el uso de sustancias adictivas en la adolescencia mediante reglas de asociación, herramientas descriptivas incluidas en Data Mining. Para ello se cuenta con una base de datos referidos al consumo de sustancias adictivas en la adolescencia y se utiliza el paquete arules, integrado en el programa de libre distribución R (versión 2.10.1). La muestra está formada por 9.300 estudiantes de edades comprendidas entre los 14 y los 18 años (47,1% chicos y 52,9% chicas) con una edad media de 15,6 años (SE=1,2). Los adolescentes contestaron un cuestionario anónimo que incluía preguntas sobre factores de riesgo personales, familiares y ambientales para el consumo desustancias. Las mejores reglas obtenidas en relación al consumo de sustancias relacionan el consumo de alcohol con la educación paterna percibida y el consumo de los amigos (confianza= 0.8528), el consumo de tabaco, cannabis y cocaína con la actuación paterna percibida y la realización de conductas ilegales (confianzas de 0.8032, 0.8718 y 1.0000, respectivamente)y el uso de éxtasis con el consumo de los iguales (confianza = 1.0000).En general, las reglas de asociación muestran de forma sencilla la relación existente entre ciertas pautas de actuación paterna percibida, la emisión de conductas desviadas de las normas de comportamiento social, el consumo por parte del grupo de iguales y el abuso de drogas, legales e ilegales, en la adolescencia. Se describen las implicaciones de los resultados obtenidos así como la utilidad de esta nueva metodología de análisis (AU)

The aim of this study is to analyse the factors related to the use of addictive substances in adolescence using association rules, descriptive tools included in Data Mining. Thus, we have a database referring to the consumption of addictive substances in adolescence, and use the free distribution program in the R arules package (version 2.10.0). The sample was made up of 9,300 students between the ages of 14 and 18 (47.1% boys and 52.9% girls) with an average age of 15.6 (SE=1.2). The adolescents answered an anonymous questionnaire on personal, family and environmental risk factors related to substance use. The best rules obtained with regard to substance use relate the consumption of alcohol to perceived parenting style and peer consumption (confidence = 0.8528), the use of tobacco (smoking), cannabis and cocaine to perceived parental action and illegal behaviour (confidence= 0.8032, 0.8718 and 1.0000, respectively), and the use of ecstasy to peer consumption (confidence = 1.0000). In general, the association rules show in a simple manner the relationship between certain patterns of perceived parental action, behaviours that deviate from social behavioural norms, peer consumption and the use of different legal and illegal drugs of abuse in adolescence. The implications of the results obtained are described, together with the usefulness of this new methodology of analysis (AU)

The methodology of Data Mining. An application to alcohol consumption in teenagers.

This paper is aimed mainly at making researchers in the field of drug addictions aware of a methodology of data analysis aimed at knowledge discovery in databases (KDD). KDD is a process consisting of a series of phases, the most characteristic of which is called data mining (DM), whereby different modelling techniques are applied in order to detect patterns and relationships among the data. Common and differentiating factors between the most widely used DM techniques are analysed, mainly from a methodological viewpoint, and their use is exemplified using data related to alcohol consumption in teenagers and its possible relationship with personality variables (N=7030). Although the overall accuracy obtained (% correct predictions) is very similar in the three models analyzed, the Artificial Neural Network (ANN) technique generates the most accurate model (64.1%), followed by Decision Trees (DT) (62.3%) and Naïve Bayes (NB) (59.9%).

La metodología del Data Mining. Una aplicación al consumo de alcohol en adolescentes / The methodology of Data Mining. An application to alcohol consumption in teenagers

El presente trabajo pretende principalmente acercar a los investigadores del campo de las drogodependencias una metodología de análisis de datos orientada al descubrimiento de conocimiento en bases de datos (KDD). El KDD es un proceso que consta de una serie de fases, la más característica de las cuales se denomina Data Mining (DM), en la que se aplican diferentes técnicas de modelado para detectar patrones y relaciones en los datos. Se analizan los factores comunes y diferenciadores de las técnicas DM más ampliamente utilizadas, desde una visión principalmente metodológica, y ejemplificando su uso con datos provenientes del consumo de alcohol en adolescentes y su posible relación con variables de personalidad (N=7030). Aunque la precisión global obtenida (% de predicciones correctas) es muy similar en los tres modelos analizados, las redes neuronales generan el modelo más preciso (64.1%), seguidas de los árboles de decisión (62.3%) y Naive Bayes (59.9%) (AU)

This paper is aimed mainly at making researchers in the field of drug addictions aware of a methodology of data analysis aimed at knowledge discovery in databases (KDD). KDD is a process consisting of a series of phases, the most characteristic of which is called data mining (DM), where by different model ling techniques are applied in order to detect patterns and relationships among the data. Common and differentiating factors between the most widely used DM techniques are analysed, mainly from a methodological viewpoint, and their use is exemplified using data related to alcohol consumption in teenagers and its possible relationship with personality variables (N=7030). Although the overall accuracy obtained (% correct predictions) is very similar in the three models analyzed, the Artificial Neural Network (ANN) technique generates the most accurate model (64.1%), followed by Decision Trees (DT) (62.3%) and Naïve Bayes (NB) (59.9%) (AU)