Plasma infrared fingerprinting with machine learning enables single-measurement multi-phenotype health screening.

Infrared spectroscopy is a powerful technique for probing the molecular profiles of complex biofluids, offering a promising avenue for high-throughput in vitro diagnostics. While several studies showcased its potential in detecting health conditions, a large-scale analysis of a naturally heterogeneous potential patient population has not been attempted. Using a population-based cohort, here we analyze 5,184 blood plasma samples from 3,169 individuals using Fourier transform infrared (FTIR) spectroscopy. Applying a multi-task classification to distinguish between dyslipidemia, hypertension, prediabetes, type 2 diabetes, and healthy states, we find that the approach can accurately single out healthy individuals and characterize chronic multimorbid states. We further identify the capacity to forecast the development of metabolic syndrome years in advance of onset. Dataset-independent testing confirms the robustness of infrared signatures against variations in sample handling, storage time, and measurement regimes. This study provides the framework that establishes infrared molecular fingerprinting as an efficient modality for populational health diagnostics.

Infrared Signatures of Phycobilins within the Phycocyanin 645 Complex.

Aquatic photosynthetic organisms evolved to use a variety of light frequencies to perform photosynthesis. Phycobiliprotein phycocyanin 645 (PC645) is a light-harvesting complex in cryptophyte algae able to transfer the absorbed green solar light to other antennas with over 99% efficiency. The infrared signatures of the phycobilin pigments embedded in PC645 are difficult to access and could provide useful information to understand the mechanism behind the high efficiency of energy transfer in PC645. We use visible-pump IR-probe and two-dimensional electronic vibrational spectroscopy to study the dynamical evolution and assign the fingerprint mid-infrared signatures to each pigment in PC645. Here, we report the pigment-specific vibrational markers that enable us to track the spatial flow of excitation energy between the phycobilin pigment pairs. We speculate that two high-frequency modes (1588 and 1596 cm-1) are involved in the vibronic coupling leading to fast (

Medical students' attitudes towards communication skills training: a longitudinal study with one cohort.

Objectives: To explore medical students' attitudes towards communication skills and the evolution of these attitudes from their first to fourth academic years. Methods: A cohort of 91 medical students completed the Communication Skills Attitudes Scale (CSAS) at the beginning of their medical studies and at the end of their fourth year after having engaged in a training program in communication skills with experiential characteristics (individual encounters with simulated patients, observations in small groups, feedback, and practice). We analyzed students' positive and negative global attitudes and their affective, cognitive, and respect dimensions towards learning communication skills. Results: Medical students' attitudes toward communication skills declined from their first (52.8) to fourth year (49.6) (p=.011). Along with this significant decrease in positive attitudes, a significant increase in negative attitudes toward communication skills was also observed in trained students (32.2 vs. 34.2; p=.023). The decline in students' attitudes mainly involves a decline in their affective (51.4 vs. 47.3, p=.001) but not cognitive (18.3) attitudes. Female students have more positive attitudes towards communication skills than male students. Conclusions: The decline in students' attitudes, mainly in the affective dimension, could be related to their accumulated learning experiences during the learning process and particularly their experiential training in communication skills. Nevertheless, the importance students give to communication skills in the cognitive dimension remains unchanged. Students' gender also seems to influence their attitudes. Further research is needed to assess the role of other factors involved in this decrease in positive and affective attitudes.

Medical resilience and morality: a survey study on the opinions and actions of exemplary family physicians.

BACKGROUND: Studies conducted to understand how family doctors develop resilience and deal with the challenges posed by work-related stress, usually have focused on identifying the elements that generate resilience from psychological perspectives and their impact on coping strategies. Few have explored the role that personal qualities and values that traditionally motivate family physicians can play as drivers of well-being and resilience. OBJECTIVES: To explore attributes that exemplary family physicians (EFP) consider important for their work and the elements that, for them, are source of gratification and resources in the face of the adversities they encounter in their practice. METHODS: This is an exploratory study carried out by online survey. Eighty six doctors regarded as exemplary by their colleagues answered 7 close and 4 open-ended questions that explored their job satisfaction, the elements of their work that reward them, the difficulties and problems they usually encounter, the resources they use to cope with those problems, and the personal qualities they consider central to their work. Four researchers conducted a thematic (deductive and inductive) analysis of the free text responses received. Based on the results obtained, and through an iterative discussion process, the researchers proposed an integrated set of qualities at the core of their professionalism. RESULTS: 88.4% (76) of the doctors said they were satisfied with their work. However, they face problems (202 comments), including demanding patients, insensitive managers with unshared interests/care goals, excessive paperwork, work overload, or time pressures. Sources of gratification point to personal identity; clinical, relational, and collaborative efficiency; a holistic and comprehensive practice (centred on individuals); and a continuous search for excellence (149) and the root of their resources (135). These elements, in turn, corresponded to the attributes considered essential for the practice of family medicine (131). CONCLUSIONS: For EFPs, certain professional values give meaning to their clinical practice and are a source of well-being and resources. This central focus on professional values and qualities can help for better understand the burnout nature and expand the type of action that promotes resilience. Further studies using a less structured qualitative research will be needed to confirm/expand these results.

Molecular Origin of Blood-Based Infrared Spectroscopic Fingerprints*.

Infrared spectroscopy of liquid biopsies is a time- and cost-effective approach that may advance biomedical diagnostics. However, the molecular nature of disease-related changes of infrared molecular fingerprints (IMFs) remains poorly understood, impeding the method's applicability. Here we probe 148 human blood sera and reveal the origin of the variations in their IMFs. To that end, we supplemented infrared spectroscopy with biochemical fractionation and proteomic profiling, providing molecular information about serum composition. Using lung cancer as an example of a medical condition, we demonstrate that the disease-related differences in IMFs are dominated by contributions from twelve highly abundant proteins-that, if used as a pattern, may be instrumental for detecting malignancy. Tying proteomic to spectral information and machine learning advances our understanding of the infrared spectra of liquid biopsies, a framework that could be applied to probing of any disease.

Barriers to teaching communication skills in Spanish medical schools: a qualitative study with academic leaders.

BACKGROUND: In recent years, Spanish medical schools (MSs) have incorporated training in communication skills (CS), but how this training is being carried out has not yet been evaluated. OBJECTIVE: To identify the barriers to the introduction and development of CS teaching in Spanish MSs. METHODS: In a previous study, 34 MSs (83% of all MSs in Spain) were invited to participate in a study that explored the factual aspects of teaching CS in these schools. The person responsible for teaching CS at each school was contacted again for this study and asked to respond to a single open-ended question. Two researchers independently conducted a thematic analysis of the responses. RESULTS: We received responses from 30 MSs (85.7% of those contacted and 73% of all MSs in Spain). Five main thematic areas were identified, each with different sub-areas: negative attitudes of teachers and academic leaders; organisation, structure and presence of CS training in the curriculum; negative attitudes of students; a lack of trained teachers; and problems linked to teaching methods and necessary educational logistics. CONCLUSIONS: The identified barriers and problems indicate that there are areas for improvement in teaching CS in most Spanish MSs. There seems to be a vicious circle based on the dynamic relationship and interdependence of all these problems that should be faced with different strategies and that requires a significant cultural shift as well as decisive institutional support at the local and national levels. The incorporation of CS training into MS curricula represents a major challenge that must be addressed for students to learn CS more effectively and avoid negative attitudes towards learning CS.

Promocionando la Promoción de la Salud: percepciones de estudiantes de medicina sobre un programa educativo para cambio de conductas en atención primaria / Promoting Health Promotion: Medical students perceptions about an educational program on behavioral change in primary care

Objetivo: Valorar si un programa formativo ofrecido por médicos de familia en el currículum oficial de medicina sobre principios y estrategias para ayudar a los pacientes a cambiar conductas de riesgo (APCCR) produce cambios en sus percepciones, opiniones y actitudes con relación a este tipo de intervenciones. Diseño: Estudio cuasiexperimental antes-después. Emplazamiento: Una facultad de medicina. Participantes: Todos los alumnos de 4.o curso de medicina (n = 110). Intervenciones: Formación experiencial sobre estrategias comunicativas para APCCR. Mediciones: Opiniones y percepciones evaluadas antes y después del curso mediante cuestionario ad hoc. Resultados: Tras el curso, los estudiantes (n = 103) cambiaron sus ideas sobre la motivación como factor «interno» (15, 13%) a "interno-externo" (71, 61%) (p = 0,003), reforzando sus opiniones sobre la capacidad del médico para APCCR (alta: 72, 62%; baja: 10, 12%; p = 0,008). Los alumnos se consideraron más capaces de respetar la autonomía de los pacientes cuando estos toman decisiones o siguen conductas consideradas perjudiciales (fácil: 58, 50%; difícil: 28, 24%; p = 0,001) e incrementaron su percepción sobre su capacidad para afrontar este tipo de entrevistas (83, 72% vs. 1, 1%; p < 0,001). Conclusiones: Esta formación parece contribuir a crear en estudiantes percepciones y actitudes positivas relacionadas con aspectos claves a la hora de afrontar una entrevista para APCCR, lo cual supone un aspecto preliminar clave para implementar este tipo de estrategias

Objective: To evaluate whether a training program offered by family physicians in the official medical curriculum on principles and strategies to help patients change risk behaviours (HPCRB), produces changes in perceptions, opinions, and attitudes regarding this type of intervention. Design: Quasi-experimental before-after study. Setting: A School of Medicine. Participants: All students in their 4th year (n = 110). Interventions: Experiential training course on communicative strategies for HPCRB. Measurements: Opinions and perceptions were evaluated before and after the course using an ad hoc survey. Results: After the course, students (n = 103) changed their ideas about motivation as an "internal" (15, 13%) to ‘internal-external’ factor (71, 61%) (P = .003), reinforcing their opinions about the clinician's ability for HPCRB (high: 72, 62%; low: 10, 12%; P = .008). They considered themselves more capable to respect patient autonomy when they make decisions or follow harmful behaviours (easy: 58, 50%; difficult: 28, 24%; P = .001), and increased their perception of their ability to cope with this type of interview (83, 72% vs. 1, 1%; P < .001). Conclusions: This training course seems to contribute to creating positive perceptions and attitudes in students, as regards key aspects when conducting an interview for HPCRB. This is a key preliminary aspect to implement this type of strategy

Medical students' perceptions towards learning communication skills: a qualitative study following the 2-year training programme.

OBJECTIVES: This study aimed to gain an understanding of the perceptions of 4th-year medical students about a training course in communication skills with 'experiential learning' characteristics, completed over the past two years. METHODS: Twenty 4th-year medical students were invited to participate in a qualitative study with focus groups. These students were selected randomly, stratifying by gender, from all 4th-year medical students (106) at the Francisco de Vitoria University (Madrid). The students had just completed their communication skills training taught in small groups, with simulated patient interviews and feedback. The focus-group facilitator used an open-ended discussion guide to explore the students' perceptions. Thematic analysis was used to identify salient themes from these discussions. RESULTS: Sixteen students participated in two focus groups. The discussions revealed two contrasting perceptions: while this learning is considered useful, it nevertheless brings about a great deal of stress, especially regarding student exposure to peers in small-group sessions when interviewing standardised patients, and summative assessment. This generates a range of negative feelings in students that could affect perspective and attitude towards the importance of doctor-patient relationships. CONCLUSIONS: Experiential learning is effective in improving students' communication skills. However, these results suggest that use of such strategies requires a strong focus on "student-centred" teaching approaches, in order to minimise some sensitive topics that may arise during the learning. Further research is needed to refine these strategies depending on the teaching situation and to identify different ways of implementing these experiential methods.

Medical students' attitudes toward communication skills learning: comparison between two groups with and without training.

OBJECTIVE: The value students give to communication skills (CS), acquiring them, or other related matters can influence the effectiveness of educational programs. In this study, we explored first and fourth year medical students' attitudes toward CS and their learning, assessing the possible influence they have on programmed experiential training in a medical school. SUBJECTS AND METHODS: Two hundred and twenty first and fourth year medical students completed the Communication Skills Attitudes Scale, analyzing the positive and negative, and affective and cognitive attitude subscales toward learning. RESULTS: Fourth year students trained in CS showed less positive attitudes toward CS than first year untrained students. Cognitive and affective attitudes displayed different patterns in both groups; while affective attitudes decreased in fourth year students, cognitive attitudes did not vary significantly between groups. Accumulated learning experiences seem to be more influential than sex. CONCLUSION: The findings suggest that students' attitudes toward CS could decline as a result of CS training. Nevertheless, students' attitudes at the cognitive and fundamental level stay fairly unchanged. Learning CS with experiential methods seems to be challenging for students at a personal level; so, educators should personalize these methods as much as possible. However, further studies using longitudinal research designs should be performed for exploring students' attitudes changes over time.

[Promoting Health Promotion: Medical students perceptions about an educational program on behavioral change in primary care]. / Promocionando la Promoción de la Salud: percepciones de estudiantes de medicina sobre un programa educativo para cambio de conductas en atención primaria.

OBJECTIVE: To evaluate whether a training program offered by family physicians in the official medical curriculum on principles and strategies to help patients change risk behaviours (HPCRB), produces changes in perceptions, opinions, and attitudes regarding this type of intervention. DESIGN: Quasi-experimental before-after study. SETTING: A School of Medicine. PARTICIPANTS: All students in their 4th year (n=110). INTERVENTIONS: Experiential training course on communicative strategies for HPCRB. MEASUREMENTS: Opinions and perceptions were evaluated before and after the course using an ad hoc survey. RESULTS: After the course, students (n=103) changed their ideas about motivation as an 'internal' (15, 13%) to 'internal-external' factor (71, 61%) (P=.003), reinforcing their opinions about the clinician's ability for HPCRB (high: 72, 62%; low: 10, 12%; P=.008). They considered themselves more capable to respect patient autonomy when they make decisions or follow harmful behaviours (easy: 58, 50%; difficult: 28, 24%; P=.001), and increased their perception of their ability to cope with this type of interview (83, 72% vs. 1, 1%; P<.001). CONCLUSIONS: This training course seems to contribute to creating positive perceptions and attitudes in students, as regards key aspects when conducting an interview for HPCRB. This is a key preliminary aspect to implement this type of strategy.

Enseñar y aprender habilidades de comunicación clínica en la Facultad de Medicina. La experiencia de la Francisco de Vitoria (Madrid) / Teaching and learning clinical communication skills in Francisco de Vitoria medical school (Madrid)

La comunicación clínica ha sido aceptada como un contenido importante de los planes de estudio de medicina y reconocida como una competencia esencial por los organismos de acreditación y las organizaciones internacionales de educación médica. La formación en habilidades de «comunicación clínica» requiere que el estudiante ensaye con «pacientes simulados» bajo supervisión y observación directa y reciba un feedback específico y personalizado. Ello exige un programa de enseñanza en grupos pequeños, a través de un aprendizaje experiencial, impartido por profesores médicos especializados en la materia, de forma integrada con el resto de habilidades clínicas, esto es, no mediante intervenciones puntuales, sino a lo largo de todo el currículum. Se describen las características generales, organizativas y pedagógicas de un programa transversal dirigido a los estudiantes de medicina para su formación en habilidades de «comunicación clínica» basado en la experiencia desarrollada en la facultad de medicina en la Universidad Francisco de Vitoria durante los últimos 6 años, la cual puede servir de ejemplo en el contexto de los estudios de medicina en España o de otros entornos educativos

Clinical communication has been accepted as an important content of medical curricula and recognized as an essential competence by accreditation bodies and international medical education organizations. "Clinical Communication" skills training requires the student to practice with "standardized patients" under direct supervision and observation and receive specific and personalized feedback. This task requires a small group teaching, through an experiential learning, given by medical teachers specialized in this subject, in an integrated way with other clinical skills, that is, not through aisolate interventions, but throughout the curriculum. We describes the general, managerial, educational features and main educational results of an integrated "Clinical Communication Skills Curriculum" for medical students, implemented at the Universidad Francisco de Vitoria school of medicine during the last six years. Some useful and practical messages for improving teaching and learning these skills in universitary medical education in Spain are extracted

Mechanistic insight into internal conversion process within Q-bands of chlorophyll a.

The non-radiative relaxation of the excitation energy from higher energy states to the lowest energy state in chlorophylls is a crucial preliminary step for the process of photosynthesis. Despite the continuous theoretical and experimental efforts to clarify the ultrafast dynamics of this process, it still represents the object of an intense investigation because the ultrafast timescale and the congestion of the involved states makes its characterization particularly challenging. Here we exploit 2D electronic spectroscopy and recently developed data analysis tools to provide more detailed insights into the mechanism of internal conversion within the Q-bands of chlorophyll a. The measurements confirmed the timescale of the overall internal conversion rate (170 fs) and captured the presence of a previously unidentified ultrafast (40 fs) intermediate step, involving vibronic levels of the lowest excited state.

Teaching medical students to express empathy by exploring patient emotions and experiences in standardized medical encounters.

OBJECTIVES: To increase medical students' ability to detect contextual and emotional cues and to respond empathetically to patients. METHODS: a training course in communication skills and patient-centered care with different teaching activities (didactic, reflective and interactive: workshops and encounters with simulated patients) was delivered to third-year medical students just before their clerkships. The program was evaluated by an external observer (OE) and simulated patients (SP) in 2 or 3 videotaped encounters. RESULTS: Students improved significantly from baseline to 3rd interview in all communicative skills and domains explored both in OE (32.4%) and SP (38.3%) measurement. At the end of the course students detected significantly more clues and made more empathetic expressions. CONCLUSIONS: The course seems to improve the ability of students to explore the illness experience, showing more empathy in a more genuine way. This was carried out in consultations lasting 10min. PRACTICAL IMPLICATIONS: The program is effective and feasible to be applied as a regular formative activity. Further research is needed to assess whether this training program is applicable to students in more advanced educational levels and if it has any additional outcomes.

Sensibilidad de los alumnos admitidos en una facultad de medicina en aspectos relacionales, organizativos y éticos de la práctica clínica / Sensitivity of students admitted in a medical school regarding relational, managerial and ethical aspects of clinical practice

ANTECEDENTES: A pesar de que la sensibilidad humana y ética se considera atributo clave en los médicos, estos no son considerados para la selección de alumnos en las escuelas de medicina. OBJETIVO: Estudio exploratorio para valorar la sensibilidad de los estudiantes que inician sus estudios de medicina en aspectos relacionales, organizativos, personales y éticos que supone el ejercicio de la medicina. METODOLOGÍA: Estudio cualitativo sobre comentarios basados en la observación. En la primera sesión del curso se presentó a los alumnos un vídeo de un encuentro clínico simulado que ponía de manifiesto diferentes conductas y acontecimientos que incidían negativamente en su calidad. Se les pidió a los alumnos que destacaran al menos un par de aspectos/conductas que podrían mejorarse. Dos observadores externos categorizaron estos comentarios. Resultados y CONCLUSIONES: Participaron 105 alumnos (30 varones, 75 mujeres) que realizaron 251 comentarios (media: 2,3). Se identificaron 47 (21%) comentarios de tipo exclusivamente evaluativos o conceptuales y 177 (79%) de tipo descriptivo de los que la mayoría ofrecían algún comentario evaluativo. Los alumnos detectaron conductas comunicativas entre las que destacan contenidos del lenguaje verbal y no verbal del médico que interpretaron como pérdida del interés profesional y de respeto por el paciente, actitudes de prepotencia y de insensibilidad, falta de solidaridad emocional con los pacientes así como falta de privacidad y confidencialidad. Estos resultados son útiles para conocer la sensibilidad del recién ingresado sobre estos temas y para orientar intervenciones educativas al respecto. Su carácter exploratorio exige realizar estudios más exhaustivos sobre este tema

BACKGROUND: Although human sensitivity and ethics is considered a key attribute doctors, usually these are not considered in candidates to be admitted in medical schools. AIM: An exploratory study to assess the sensitivity of students admitted in medical school in relational, organizational, personal and ethical issues involved in clinical practice. METHODOLOGY: A qualitative study on comments based on the observation of a clinical situation. In the first session of the course students watched a video of a clinical encounter who highlighted different behaviors and events that contributed negatively on its quality. Students were asked to stand out at least a couple of aspects/behaviors that could be improved. Two external observers categorized these comments. Results and CONCLUSIONS: A total of 105 students (30 men and 75 women) made 251 comments (average: 2.3). Exclusively evaluative or conceptual comments: 47 (21%); descriptive comments (most with evaluative remarks also): 177 (79%). Students detected a wide range of communicative behaviors: physician verbal and nonverbal behaviours that were interpreted as loss of professional interest and respect for the patient, attitudes of arrogance and insensitivity, lack of emotional solidarity with the patients as well as lack of privacy and confidentiality. These results are useful to know the sensitivity of the students admitted to medical school on these issues and to guide and planing educational INTERVENTIONS: Further studies on this topic will be needed

Comunicación clínica: por qué, cómo, cuándo y qué (núcleo curricular) enseñar / Clinical communication: why, how, when and what ("Curricular nucleus") to teach

La comunicación clínica (CC) es hoy en día reconocida como una competencia fundamental que debe poseer el médico, y no solamente por ser la más utilizada por el clínico, sino porque en su contexto se despliegan el resto de competencias clínicas. Además, las evidencias científicas muestran que una CC de calidad se relaciona con importantes resultados en la asistencia y hoy en día supone un fin en sí misma. La CC no es algo que se adquiera por la simple experiencia, sino que debe y puede enseñarse. Para ello los métodos docentes que se han mostrado más eficaces son los denominados experienciales, que incorporan el feedback, la repetición y la reflexión tras encuentros con pacientes reales o simulados, con profesores preparados y de manera continuada a lo largo de todo el currículum. El consenso LAPS_CCC sobre un "núcleo curricular de habilidades comunicativas" recientemente alcanzado por 46 expertos de Iberoamérica, España y Portugal representa una propuesta sobre los contenidos a enseñar en los estudios de Medicina para estos países y es útil para orientar la incorporación de la CC en sus facultades de medicina de una forma homogénea y realista

Clinical Communication (CC) is nowadays recognized as a key competence that every physician should have and not only because it is the most used by the clinician but because other clinical skills are practiced through it. We also have enough evidence showing that a communication of quality is related to important outcomes of care and, at present, the western society considers good communication an end by itself. The CC is not something that is acquired only by experience but should and can be taught. Teaching methods that have proven to be most effective are those "experientials", i. e. , incorporating feedback, rehearsal and reflection after encounters with actual or simulated patients, with trained teachers and throughout the entire curriculum. The LAPS_CCC consensus on a "core curriculum of communication skills" recently reached among 46 experts from Latin America, Spain and Portugal, represents a proposal on contents to be taught in medical studies in the context of these countries and it is useful to guide the incorporation of the CC in their medical schools in a homogeneous and realistic way

A Latin American, Portuguese and Spanish consensus on a core communication curriculum for undergraduate medical education.

BACKGROUND: To present learning outcomes in clinical communication for a Core Curriculum for medical undergraduate students in Latin America, Portugal and Spain (LAPS-CCC) and to establish an expert network to support a transnational implementation. METHODS: Through an iterative process, an international group of 15 experts developed an initial set of learning outcomes following a review and discussion of relevant international and local literature. A two-round Delphi survey involving 46 experts from 8 countries was performed. Quantative and qualitative analisis permited the definition of the final consensus. RESULTS: The initial proposal included 157 learning outcomes. The Delphi process generated 734 comments and involved the modification, deletion and addition of some outcomes. At the end of the process, a consensus was reached on 136 learning outcomes grouped under 6 competency domains with a high overall acceptance (95.1 %). CONCLUSIONS: The learning outcomes of this proposal provide a guide to introduce, support and develop communication curriculae for undergraduate medical studies in the countries involved or in other Spanish- or Portuguese-speaking countries.

Interinstitutional variation of caesarean delivery rates according to indications in selected obstetric populations: a prospective multicenter study.

The aim of the study was to identify which groups of women contribute to interinstitutional variation of caesarean delivery (CD) rates and which are the reasons for this variation. In this regard, 15,726 deliveries from 11 regional centers were evaluated using the 10-group classification system. Standardized indications for CD in each group were used. Spearman's correlation coefficient was used to calculate (1) relationship between institutional CD rates and relative sizes/CD rates in each of the ten groups/centers; (2) correlation between institutional CD rates and indications for CD in each of the ten groups/centers. Overall CD rates correlated with both CD rates in spontaneous and induced labouring nulliparous women with a single cephalic pregnancy at term (P = 0.005). Variation of CD rates was also dependent on relative size and CD rates in multiparous women with previous CD, single cephalic pregnancy at term (P < 0.001). As for the indications, "cardiotocographic anomalies" and "failure to progress" in the group of nulliparous women in spontaneous labour and "one previous CD" in multiparous women previous CD correlated significantly with institutional CD rates (P = 0.021, P = 0.005, and P < 0.001, resp.). These results supported the conclusion that only selected indications in specific obstetric groups accounted for interinstitutional variation of CD rates.

The application of the Ten Group classification system (TGCS) in caesarean delivery case mix adjustment. A multicenter prospective study.

BACKGROUND: Caesarean delivery (CD) rates are commonly used as an indicator of quality in obstetric care and risk adjustment evaluation is recommended to assess inter-institutional variations. The aim of this study was to evaluate whether the Ten Group classification system (TGCS) can be used in case-mix adjustment. METHODS: Standardized data on 15,255 deliveries from 11 different regional centers were prospectively collected. Crude Risk Ratios of CDs were calculated for each center. Two multiple logistic regression models were herein considered by using: Model 1- maternal (age, Body Mass Index), obstetric variables (gestational age, fetal presentation, single or multiple, previous scar, parity, neonatal birth weight) and presence of risk factors; Model 2- TGCS either with or without maternal characteristics and presence of risk factors. Receiver Operating Characteristic (ROC) curves of the multivariate logistic regression analyses were used to assess the diagnostic accuracy of each model. The null hypothesis that Areas under ROC Curve (AUC) were not different from each other was verified with a Chi Square test and post hoc pairwise comparisons by using a Bonferroni correction. RESULTS: Crude evaluation of CD rates showed all centers had significantly higher Risk Ratios than the referent. Both multiple logistic regression models reduced these variations. However the two methods ranked institutions differently: model 1 and model 2 (adjusted for TGCS) identified respectively nine and eight centers with significantly higher CD rates than the referent with slightly different AUCs (0.8758 and 0.8929 respectively). In the adjusted model for TGCS and maternal characteristics/presence of risk factors, three centers had CD rates similar to the referent with the best AUC (0.9024). CONCLUSIONS: The TGCS might be considered as a reliable variable to adjust CD rates. The addition of maternal characteristics and risk factors to TGCS substantially increase the predictive discrimination of the risk adjusted model.

Frequency of factor V, prothrombin and methylenetetrahydrofolate reductase gene variants in preeclampsia.

BACKGROUND: The association between thrombophilic variants (Leiden mutation of the factor V gene, G20210A mutation of the prothrombin gene and C677T polymorphism of the methylenetetrahydrofolate reductase (MTHFR) gene) with preeclampsia was investigated in a north-eastern Italian population. METHODS: Fifty-eight preeclamptic (PE) women and 74 normal pregnancies were evaluated. Genotypes were determined by polymerase chain reaction. RESULTS: The frequency of heterozygous carriers of the factor V Leiden was similar between PE women (5.2%) compared to the control subjects (4.1%; p 0.76). Also the frequencies of G20210A and C677T mutations were similar between PE and control subjects. CONCLUSIONS: In this population, we found no difference in the prevalence of genetic risk factors for thrombosis in women with preeclampsia compared with control subjects.