[Outpatient rehabilitative care for patients with Long-COVID - a guideline-based clinical practice guideline]. / Ambulante rehabilitative Versorgung von Patienten mit Long-COVID ­ eine leitlinienorientierte klinisch-praktische Handlungsempfehlung.

BACKGROUND: Even after weeks and months, persisting and also newly occurring symptoms after SARS-CoV-2 infection are common and lead in many cases to a broad spectrum of impairments and participation restrictions in all areas of daily life. Scientific evidence on therapeutic options still is limited. The aim of this work is therefore to provide pragmatic treatment recommendations analogous to the current therapeutic appliances guideline. METHOD: In addition to a search in six electronic databases, the experiences from the treatment of more than hundred affected persons from the post-COVID outpatient rehabilitation service were used. Additionally, experiences with patients with similar symptoms from other diseases were included. All authors worked together to develop the pragmatic recommendations for the treatment of the main symptoms within the framework of outpatient therapy measures. A list of recommended diagnostics and functional assessments prior to therapy was also developed. RESULTS: For the main symptoms fatigue, dyspnoea and cognitive impairment, the catalog of therapeutic products offers a wide range of therapeutic options under the diagnosis U09.9. The therapy packages should be composed individually and adapted to the patient's performance level that regularly should be (re-)assessed. Informing the patient about possible relapses and deteriorations and how to deal with them should be also part of the treatment regimen. DISCUSSION: Physical modalities and rehabilitation interventions should be used in out-patient rehabilitation setting for the treatment of Long-COVID. In this regard, it is also important to take into account and treat serious complications after the disease, such as post-intensive care syndrome. Due to the rapid evolution of the knowledge a frequent review of scientific papers and recommendations should be conducted. High-quality intervention studies are necessary to achieve greater evidence in this field.

Test of the Rehabilitation Goal Screening (ReGoS) Tool to Support Decision Making and Goal Setting in Physical and Rehabilitation Medicine Practice.

BACKGROUND: It has already been shown that it is feasible to use International Classification of Functioning, Disability and Health (ICF) Sets as self-assessment instruments. We used this idea to design an ICF-based screening tool to assess patients of a broadly based rehabilitation department. It was developed for the purpose of having a screening tool before taking the anamnesis, as well as for rehabilitation planning and follow-up. METHODS AND MATERIALS: The Rehabilitation Goal Screening (ReGoS) instrument is a self-report questionnaire which was developed based on the most relevant domains from the ICF Core Sets for chronic pain and rehabilitation. The ICF categories were translated into plain language and 0-10 Likert scales were used. A retrospective analysis of routine clinical data using the ReGoS tool, Work Ability Index (WAI) and Hospital Anxiety and Depression Scale (HADS) in paper- or tablet-based form was performed. RESULTS: The average age of the N = 1.008 respondents was 53.9 years (SD = 16.2). Of the respondents, 66% (n = 665) were female. At the time of the survey, 48.3% (n = 487) of the patients were employed. ReGoS results demonstrated that the highest restrictions on a scale from 0 to 10 were found in the areas of energy and drive (M = 5.79, SD = 2.575) and activities of daily living (M = 5.54, SD = 2.778). More than a third of the respondents rated their work ability as critical. CONCLUSION: The use of the ReGoS instrument as an ICF-based screening tool based on a self-report questionnaire provides relevant information for clinical diagnosis, participative goal setting and a detailed functional capacity profile.

The Standard Joint Unit.

OBJECTIVE: Reliable data on cannabis quantities is required to improve assessment of cannabis consumption for epidemiological analysis and clinical assessment, consequently a Standard Joint Unit (SJU) based on quantity of 9-Tetrahydrocannabinol (9-THC) has been established. METHODOLOGY: Naturalistic study of a convenience sample recruited from February 2015-June 2016 in universities, leisure spaces, mental health services and cannabis clubs in Barcelona. Adults, reporting cannabis use in the last 60 days, without cognitive impairment or language barriers, answered a questionnaire on cannabis use and were asked to donate a joint to further determine their 9-THC and Cannabidiol (CBD) content. RESULTS: 492 participants donated 315 valid joints. Donators were on average 29 years old, mostly men (77%), single (75%), with at least secondary studies (73%) and in active employment (63%). Marijuana joints (N=232) contained a median of 6.56mg of 9-THC (Interquartile range-IQR=10,22) and 0.02mg of CBD (IQR=0.02); hashish joints (N=83) a median of 7.94mg of 9-THC (IQR=10,61) and 3.24mg of CBD (IQR=3.21). Participants rolled 4 joints per gram of cannabis and paid 5€ per gram (median values). CONCLUSION: Consistent 9-THC-content in joints lead to a SJU of 7mg of 9-THC, the integer number closest to the median values shared by both cannabis types. Independently if marijuana or hashish, 1 SJU = 1 joint = 0.25 g of cannabis = 7 mg of 9-THC. For CBD, only hashish SJU contained relevant levels. Similarly to the Standard Drink Unit for alcohol, the SJU is useful for clinical, epidemiological and research purposes.

Working on a Standard Joint Unit: A pilot test. / Estableciendo la unidad de porro estándar: estudio piloto.

INTRODUCTION: Assessing cannabis consumption remains complex due to no reliable registration systems. We tested the likelihood of establishing a Standard Joint Unit (SJU) which considers the main cannabinoids with implication on health through a naturalistic approach.  Methodology. Pilot study with current cannabis users of four areas of Barcelona: universities, nightclubs, out-patient mental health service, and cannabis associations. We designed and administered a questionnaire on cannabis use-patterns and determined the willingness to donate a joint for analysis. Descriptive statistics were used to analyze the data. RESULTS: Forty volunteers answered the questionnaire (response rate 95%); most of them were men (72.5%) and young adults (median age 24.5 years; IQR 8.75 years) who consume daily or nearly daily (70%). Most participants consume marihuana (85%) and roll their joints with a median of 0.25 gr of marihuana. Two out of three (67.5%) stated they were willing to donate a joint. CONCLUSION: Obtaining an SJU with the planned methodology has proved to be feasible. Pre-testing resulted in an improvement of the questionnaire and retribution to incentivize donations. Establishing an SJU is essential to improve our knowledge on cannabis-related outcomes.

Introducción. Explorar el consumo de cánnabis sigue siendo complejo debido a la falta de sistemas de registro. Se evaluó la factibilidad de obtener una Unidad de Porro Estándar (UPE) que considere los principales cannabinoides con implicación clínica mediante un estudio naturalístico. Metodología. Estudio piloto con consumidores actuales de cánnabis de cuatro áreas (universidades, ocio nocturno, servicio ambulatorio de salud mental y asociaciones cannábicas) en Barcelona. Se diseñó y administró un cuestionario sobre patrones de consumo y se determinó la predisposición a donar un porro para análisis. Se utilizaron estadísticos descriptivos para analizar los datos. Resultados. Cuarenta consumidores de cannabis respondieron a la encuesta (tasa de respuesta 95%), siendo la mayoría hombres (72,5%) y jóvenes adultos (mediana de edad 24,5 años; RIQ 8,75 años) que consumen a diario o casi diariamente (70%). La marihuana es el derivado más consumido (85%), habiendo de mediana 0,25 gr de marihuana por porro. Un 67,5% de los participantes se mostraron predispuestos a donar un porro para análisis. Conclusión. La obtención de la UPE con la metodología prevista es factible. Tras el piloto el cuestionario ha sido adaptado y se ha introducido un incentivo para estimular la donación de muestras. Establecer la UPE permitirá avanzar en el conocimiento de las consecuencias del consumo de cannabis.

Estableciendo la unidad de porro estándar: estudio piloto / Working on a Standard Joint Unit: A Pilot Test

Introducción. Explorar el consumo de cánnabis sigue siendo complejo debido a la falta de sistemas de registro. Se evaluó la factibilidad de obtener una Unidad de Porro Estándar (UPE) que considere los principales cannabinoides con implicación clínica mediante un estudio naturalístico. Metodología. Estudio piloto con consumidores actuales de cánnabis de cuatro áreas (universidades, ocio nocturno, servicio ambulatorio de salud mental y asociaciones cannábicas) en Barcelona. Se diseñó y administró un cuestionario sobre patrones de consumo y se determinó la predisposición a donar un porro para análisis. Se utilizaron estadísticos descriptivos para analizar los datos. Resultados. Cuarenta consumidores de cannabis respondieron a la encuesta (tasa de respuesta 95%), siendo la mayoría hombres (72,5%) y jóvenes adultos (mediana de edad 24,5 años; RIQ 8,75 años) que consumen a diario o casi diariamente (70%). La marihuana es el derivado más consumido (85%), habiendo de mediana 0,25 gr de marihuana por porro. Un 67,5% de los participantes se mostraron predispuestos a donar un porro para análisis. Conclusión. La obtención de la UPE con la metodología prevista es factible. Tras el piloto el cuestionario ha sido adaptado y se ha introducido un incentivo para estimular la donación de muestras. Establecer la UPE permitirá avanzar en el conocimiento de las consecuencias del consumo de cannabis

Introduction. Assessing cannabis consumption remains complex due to no reliable registration systems. We tested the likelihood of establishing a Standard Joint Unit (SJU) which considers the main cannabinoids with implication on health through a naturalistic approach. Methodology. Pilot study with current cannabis users of four areas of Barcelona: universities, nightclubs, out-patient mental health service, and cannabis associations. We designed and administered a questionnaire on cannabis use-patterns and determined the willingness to donate a joint for analysis. Descriptive statistics were used to analyze the data. Results. Forty volunteers answered the questionnaire (response rate 95%); most of them were men (72.5%) and young adults (median age 24.5 years; IQR 8.75 years) who consume daily or nearly daily (70%). Most participants consume marihuana (85%) and roll their joints with a median of 0.25 gr of marihuana. Two out of three (67.5%) stated they were willing to donate a joint. Conclusion. Obtaining an SJU with the planned methodology has proved to be feasible. Pre-testing resulted in an improvement of the questionnaire and retribution to incentivize donations. Establishing an SJU is essential to improve our knowledge on cannabis-related outcomes

A randomised controlled non-inferiority trial of primary care-based facilitated access to an alcohol reduction website (EFAR Spain): the study protocol.

INTRODUCTION: Early identification (EI) and brief interventions (BIs) for risky drinkers are effective tools in primary care. Lack of time in daily practice has been identified as one of the main barriers to implementation of BI. There is growing evidence that facilitated access by primary healthcare professionals (PHCPs) to a web-based BI can be a time-saving alternative to standard face-to-face BIs, but there is as yet no evidence about the effectiveness of this approach relative to conventional BI. The main aim of this study is to test non-inferiority of facilitation to a web-based BI for risky drinkers delivered by PHCP against face-to-face BI. METHOD AND ANALYSIS: A randomised controlled non-inferiority trial comparing both interventions will be performed in primary care health centres in Catalonia, Spain. Unselected adult patients attending participating centres will be given a leaflet inviting them to log on to a website to complete the Alcohol Use Disorders Identification Test (AUDIT-C) alcohol screening questionnaire. Participants with positive results will be requested online to complete a trial module including consent, baseline assessment and randomisation to either face-to-face BI by the practitioner or BI via the alcohol reduction website. Follow-up assessment of risky drinking will be undertaken online at 3 months and 1 year using the full AUDIT and D5-EQD5 scale. Proportions of risky drinkers in each group will be calculated and non-inferiority assessed against a specified margin of 10%. Assuming reduction of 30% of risky drinkers receiving standard intervention, 1000 patients will be required to give 90% power to reject the null hypothesis. ETHICS AND DISSEMINATION: The protocol was approved by the Ethics Commmittee of IDIAP Jordi Gol i Gurina P14/028. The findings of the trial will be disseminated through peer-reviewed journals, national and international conference presentations. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT02082990.