Results of the implementation of a double-check protocol with point-of-care ultrasound for acute heart failure in the emergency department.

OBJECTIVE: To determine the effectiveness of a double-check protocol using Point-of-Care Ultrasound in the management of patients diagnosed with Acute Heart Failure in an Emergency Department. METHOD: Prospective analytical cross-sectional observational study with patients diagnosed with Acute Heart Failure by the outgoing medical team, who undergo multi-organ ultrasound evaluation including cardiac, pulmonary, and inferior vena cava ultrasound. RESULTS: 96 patients were included. An alternative diagnosis was found in 33% of them. Among the 77% where AHF diagnosis was confirmed, 73.4% had an underlying cause or condition not previously known (Left Ventricular Ejection Fraction less than 40% or moderate-severe valvulopathy). The introduction of the protocol had a clinically relevant impact on 47% of all included patients. CONCLUSIONS: The implementation of a double-check protocol using POCUS, including cardiac, pulmonary, and inferior vena cava assessment in patients diagnosed with Acute Heart Failure, demonstrates a high utility in ensuring accurate diagnosis and proper classification of these patients.

General infection prevention, mitigation, and control procedures implemented in the university education during the COVID-19 pandemic to achieve classroom attendance: a successful community case study.

Introduction: The COVID-19 pandemic entailed confinement and elimination of face-to-face university classes in Spain. The Francisco de Vitoria University in Madrid (UFV by its Spanish acronym) implemented risk management systems to enable on-campus university activity to avoid a negative impact on students, teachers, and faculties. Methods: A tracking/registry system was implemented to collect data, identify COVID-19-related cases, implement containment measures, and do follow-up in the UFV community (administration/services personnel [ASP], teaching/research personnel [TRP], and students), from September 2020 to April 2022. In addition, a prevention plan was implemented on campus to avoid COVID-19 spreading. Satisfaction with these measures was assessed through an online questionnaire. Results: A total of 7,165 suspected COVID-19 cases (84.7% students, 7.7% ASP, 6.5% TRP) were tracked (62.5% female cases, mean age (±SD) 24.8 years (±9.2 years)), and 45% of them confirmed (82% symptomatic/16% asymptomatic), being the student group that with the highest percentage (38.3% total tracked cases). The source of infection was identified in 50.6% of the confirmed cases (90.2% located off-campus). Nineteen COVID-19 outbreaks were registered (inside-10/outside-9). COVID-19 incidence rates were similar or lower than those reported in the Community of Madrid, except in the last wave, corresponding to Omicron variant. The degree of satisfaction (scale 1-6) with the implemented measures was high (scores 4.48-5.44). Conclusion: During the COVID-19 pandemic, UFV control measures, periodic monitoring, and the effectiveness of the tracking system have contributed to maintaining classroom teaching, guaranteeing health and safety. UFV has adapted to a new reality as an example of good practice for future pandemics or emergency situations.

A survey of deep learning models in medical therapeutic areas.

Artificial intelligence is a broad field that comprises a wide range of techniques, where deep learning is presently the one with the most impact. Moreover, the medical field is an area where data both complex and massive and the importance of the decisions made by doctors make it one of the fields in which deep learning techniques can have the greatest impact. A systematic review following the Cochrane recommendations with a multidisciplinary team comprised of physicians, research methodologists and computer scientists has been conducted. This survey aims to identify the main therapeutic areas and the deep learning models used for diagnosis and treatment tasks. The most relevant databases included were MedLine, Embase, Cochrane Central, Astrophysics Data System, Europe PubMed Central, Web of Science and Science Direct. An inclusion and exclusion criteria were defined and applied in the first and second peer review screening. A set of quality criteria was developed to select the papers obtained after the second screening. Finally, 126 studies from the initial 3493 papers were selected and 64 were described. Results show that the number of publications on deep learning in medicine is increasing every year. Also, convolutional neural networks are the most widely used models and the most developed area is oncology where they are used mainly for image analysis.

Patient Perspective on the Management of Cancer Pain in Spain.

Pain in cancer is often underdiagnosed and undertreated. Breakthrough pain, in particular, severely impacts the quality of life of patients. In this study, we evaluated management and care of pain in Spain from the patient perspective by assessing the experience of 275 patients who had suffered breakthrough pain. Although most patients had suffered moderate-to-severe pain in the last 24 hours, pain relief was achieved in the majority of cases. The body areas with a higher pain intensity was felt varied based on primary cancer. Adherence to treatment was subpar, and patients were moderately concerned about addiction to treatment and adverse events. Doctors did not assess pain in every visit and there is room for improvement in its classification. Education strategies directed toward patients and health care personnel are needed to improve pain assessment, follow-up, and compliance. These could guide shared decision-making and improve communication about cancer pain to improve its care.

Searching for the erosion of empathy in medical undergraduate students: a longitudinal study.

OBJECTIVE: To analyse the trajectory of empathy throughout the degree programme of medicine in a Spanish school of medicine. DESIGN: Longitudinal, prospective 5-year study, between October 2014 and June 2019. SETTING: Students from a Spanish university of medicine. PARTICIPANTS: Two voluntary cohorts of undergraduate medical students from two different school years were invited to participate (n=135 (cohort 1, C1) and 106 (cohort 2, C2) per school year). Finally, a total number of 174 students (102 (C1, 71.6% women) and 72 (C2, 70.8% women) students, respectively) were monitored for 5 years. Each cohort was divided in two subcohorts of paired and unpaired students that were analysed to check possible social desirability bias. PRIMARY OUTCOME MEASURE: The Jefferson Scale of Empathy (JSE). RESULTS: The cohort of 102 students (C1) monitored between their first and fifth years of study (71.6% women) showed an improvement among paired women of 2.15 points in total JSE score (p=0.01) and 2.39 points in cognitive empathy (p=0.01); in the unpaired female cohort the increase was of 2.32 points (cognitive empathy) (p=0.02). The cohort of 72 students (C2) monitored between their second and sixth years of study (70.8% women) displayed a cognitive empathy increase of 2.32 points (p=0.04) in the paired group of women. There were no significant differences between paired and unpaired results for either cohort. Empathy scores among men did not decrease. CONCLUSIONS: The empathy of medical students at our school did not decline along grade years. In fact, it improved slightly, particularly cognitive empathy, among women. This paper contributes to enlarge data from Europe, where longitudinal studies are scarce. It supports the idea that there may be global geo-sociocultural differences; however, more studies comparing different school settings are needed.

Validation of the Jefferson Scale of Physician Empathy in Spanish medical students who participated in an Early Clerkship Immersion programme.

BACKGROUND: The Jefferson Scale of Physician Empathy is the most widely used instrument to measure empathy in the doctor-patient relationship. This work pursued cultural adaptation and validation of the original scale, in its health professions version (JSE-HP), for medical students who participate in an Early Clerkship Immersion Programme of a Spanish university. METHODS: The questionnaire was replied by 506 1st, 2nd, 3rd and 5th year medical students from Universidad Francisco de Vitoria, Madrid, in 2014 and 2016. Internal consistency was analysed by means of Cronbach's alpha, and reliability by means of test-retest using the intraclass correlation coefficient and the Bland-Altman method. The construct validity was checked by means of confirmatory factor analysis and association with other empathy-related variables. Criterion validity was compared using Davis' Interpersonal Reactivity Index. RESULTS: Cronbach's alpha was 0.82 (range 0.80-0.85). Item-total score correlations were positive and significant (median 0.45, p <  0.01). The test-retest intraclass correlation coefficient was 0.68 (0.42-0.82). The factor analysis confirmed the three original factors: "perspective taking", "compassionate care" and "standing in the patient's shoes". Women and students who preferred specialities focused on persons obtained the best scores. The JSE-HP scores were positively correlated with Interpersonal Reactivity Index, personality traits were associated with empathy, clinical interview skills and Objective Structured Clinical Examinations. CONCLUSION: The results support the validity and reliability of JSE-HP applied to Spanish medical students.

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

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

Acerca de las implicaciones de las facultades de medicina en la medicina de familia / About the implications of medical schools in family medicine

No disponible

Efecto de la infección por Clostridium difficile sobre la estancia hospitalaria. Estudio de cohortes / The effect of Clostridium difficile infection on length of hospital stay. A cohort study

Introducción: Clostridium difficile es responsable de un espectro de enfermedades denominado «infección por Clostridium difficile» (ICD). Actualmente es la primera causa de diarrea de origen hospitalario en los países desarrollados. Esta infección se ha visto asociada tanto a un aumento de la estancia hospitalaria y de la mortalidad, como a una mayor probabilidad de reingreso. En nuestro país estos efectos indeseables no han sido aún caracterizados. Nuestro objetivo fue cuantificar el exceso de estancia hospitalaria atribuible a la infección por C. difficile. Métodos Estudio retrospectivo de cohortes emparejadas, por edad, sexo y fecha de ingreso, realizado en un hospital universitario de tercer nivel, en el contexto de un brote de transmisión hospitalaria de ICD. Resultados La cohorte de infectados incluyó a 38 pacientes y la de no infectados, a 76. Los pacientes que sufrieron ICD presentaron mayor desnutrición al ingreso (OR = 10,3; 3,6-29,6), estuvieron expuestos a una mayor variedad de antibióticos (diferencia de medias = 1,5; 0,7-2,2), presentaron una mayor mortalidad (31,6% frente a 6,6% de los controles; p < 0,001) y una mayor estancia hospitalaria (31,5 días de mediana frente a 5,5 días de los controles; p < 0,001). Una vez ajustado el análisis, la infección por C. difficile se asoció a un exceso de estancia de 4 días (p < 0,001).Conclusiones La infección por C. difficile tiene importantes consecuencias sobre el alargamiento de la estancia hospitalaria y, por tanto, sobre los costes sanitarios (AU)

Introduction: Clostridium difficile is responsible for a spectrum of diseases known as “Clostridium difficile infection” (CDI). It is currently the leading cause of nosocomial diarrhea in developed countries. This infection has been associated with both increased hospital stay and mortality, and to a greater likelihood of readmission. In our country these undesirable effects have not yet been characterized. Our objective was to quantify the increase in hospital stay attributable to infection by C. difficile. Methods: A retrospective cohort study matched by age, sex and admission date, was conducted in atertiary care university hospital during an outbreak of nosocomial transmission of CDI. Results: The cohort study included 38 infected, and 76 non-infected patients. Patients who developed CDI showed a higher proportion of malnutrition at admission (OR = 10.3; 3.6 to 29.6), were exposed to a wider range of antibiotics (mean difference = 1.5; 0.7-2.2), had a higher mortality (31.6% vs. 6.6% of controls, P < .001), and a longer hospital stay (median 31.5 days versus 5.5 days for controls, P < .001). After adjustment, infection by C. difficile was associated with an increase in hospital stay of 4 days (P < .001).Conclusions: C. difficile infection has important consequences on the length of hospital stay, and therefore on health costs (AU)

[The effect of Clostridium difficile infection on length of hospital stay. A cohort study]. / Efecto de la infección por Clostridium difficile sobre la estancia hospitalaria. Estudio de cohortes.

INTRODUCTION: Clostridium difficile is responsible for a spectrum of diseases known as "Clostridium difficile infection" (CDI). It is currently the leading cause of nosocomial diarrhea in developed countries. This infection has been associated with both increased hospital stay and mortality, and to a greater likelihood of readmission. In our country these undesirable effects have not yet been characterized. Our objective was to quantify the increase in hospital stay attributable to infection by C.difficile. METHODS: A retrospective cohort study matched by age, sex and admission date, was conducted in a tertiary care university hospital during an outbreak of nosocomial transmission of CDI. RESULTS: The cohort study included 38 infected, and 76 non-infected patients. Patients who developed CDI showed a higher proportion of malnutrition at admission (OR=10.3; 3.6 to 29.6), were exposed to a wider range of antibiotics (mean difference=1.5; 0.7-2.2), had a higher mortality (31.6% vs. 6.6% of controls, P<.001), and a longer hospital stay (median 31.5 days versus 5.5 days for controls, P<.001). After adjustment, infection by C.difficile was associated with an increase in hospital stay of 4 days (P<.001). CONCLUSIONS: C.difficile infection has important consequences on the length of hospital stay, and therefore on health costs.

Epidemiología de la infección por Clostridium difficile en España / Epidemiology of Clostidium difficile infection in Spain

Las infecciones por Clostridum difficile (ICD) han despertado un gran interés debido a su asociación con los cuidados sanitarios y a su impacto en la morbilidad y mortalidad en los ancianos. En los últimos años ha habido un creciente incremento en el número de estudios publicados sobre la incidencia, los cambios en la presentación clínica y la epidemiología con la descripción de nuevos factores de riesgo. La frecuencia de la ICD en España no está suficientemente caracterizada, pero los datos disponibles indican que la incidencia está dentro del rango de los países de nuestro entorno, aunque en aumento. Además, la elevada y creciente utilización de los antibióticos de amplio espectro, tanto en nuestros hospitales como en la comunidad, son factores que favorecen el crecimiento de esta enfermedad. El ribotipo hipervirulento 027 no se ha extendido en nuestros hospitales. Necesitamos conocer con mayor validez y precisión la incidencia de ICD comunitaria y asociada a los cuidados sanitarios, mejorar la información sobre brotes, la afectación de determinados grupos de población, la caracterización de los tipos circulantes, y los efectos que produce sobre la mortalidad y el coste sanitario. Es necesaria la puesta en marcha de programas de mejora en el uso de los antibióticos. Asimismo, es necesario elevar el conocimiento y la realización de las precauciones estándar, especialmente de la higiene de las manos, y de las medidas específicas para limitar la diseminación de C. difficile en las instituciones sanitarias (AU)

There has been increasing interest in Clostridium difficile infection (CDI) due its association with healthcare and its impact on morbidity and mortality in the elderly. During the last few years there has been a growing increase in the number of published studies on the incidence, changes on the clinical presentation and on the epidemiology, with the description of new risk factors. The frequency of CDI in Spain is not sufficiently characterised. The available data indicates that incidence is within the range of that of surrounding countries but increasing. Furthermore, the high and growing use of broad spectrum (..) (AU)

[Epidemiology of Clostridium difficile infection in Spain]. / Epidemiología de la infección por Clostridium difficile en España.

There has been increasing interest in Clostridium difficile infection (CDI) due its association with healthcare and its impact on morbidity and mortality in the elderly. During the last few years there has been a growing increase in the number of published studies on the incidence, changes on the clinical presentation and on the epidemiology, with the description of new risk factors. The frequency of CDI in Spain is not sufficiently characterised. The available data indicates that incidence is within the range of that of surrounding countries but increasing. Furthermore, the high and growing use of broad spectrum antibiotics, both in our hospitals and in the community setting, are factors that favour the increase of the disease. The hyper-virulent ribotype 027 has not spread in our hospitals. We need to know with enhanced validity and accuracy the incidence of CDI, both community and healthcare-associated, the information on outbreaks, the incidence on certain population groups, the characterisation of circulating ribotypes and the impact of the disease in terms of mortality and health costs. We need to implement programs for the improvement of antibiotic therapy in the hospital, as well as in the community. Furthermore, the knowledge and the performance of standard precautions need to be improved, particularly hand hygiene, and the specific measures to limit the transmission of C. difficile among the healthcare institutions.

[Risk factors for Clostridium difficile infections in hospitalized patients]. / Factores de riesgo de infección por Clostridium difficile en pacientes hospitalizados.

BACKGROUND AND OBJECTIVES: To identify risk factors, and to estimate the crude effects attributable to hospital acquired Clostridium difficile infection (CDI). PATIENTS AND METHODS: Case-control study matched by age, gender, and admission date. Patient and healthcare risk factors were evaluated. Hospital stays and mortality were compared. RESULTS: Thirty-eight cases and 76 controls were included (mean age 73 years). Cases presented worse Charlson index (P .02), higher pre-infection stay (median 10 vs. 5.5 days) and had received antibiotic treatment more frequently (89.5 vs. 40.7%) than their control counterparts. Albuminemia < 3.5 gr/dL (OR 7.1; 1.4-37), having received cephalosporins (OR 10.1; 1.8-55.1), quinolones (OR 9.4; 1.1-41.1), or proton pump inhibitors (OR 6.6; 1.1-41.1) were associated with an independent higher risk of CDI. Total hospital stay (31 vs. 5.5 days), as well as crude mortality, was higher for cases than for control patients (31.6 vs. 6.6%). CONCLUSIONS: Receiving cephalosporins, quinolones and proton pump inhibitors, as well as hyponutrition, increase the risk of CDI. CDI is associated with relevant crude effects on mortality and excess of stay.