Acceptability and feasibility of a virtual community of practice to primary care professionals regarding patient empowerment: A qualitative pilot study

Background: Virtual communities of practice (vCoPs) facilitate online learning via the exchange of experiences and knowledge between interested participants. Compared to other communities, vCoPs need to overcome technological structures and specific barriers. Our objective was to pilot the acceptability and feasibility of a vCoP aimed at improving the attitudes of primary care professionals to the empowerment of patients with chronic conditions. Methods: We used a qualitative approach based on 2 focus groups: one composed of 6 general practitioners and the other of 6 practice nurses. Discussion guidelines on the topics to be investigated were provided to the moderator. Sessions were audio-recorded and transcribed verbatim. Thematic analysis was performed using the ATLAS-ti software. Results: The available operating systems and browsers and the lack of suitable spaces and time were reported as the main difficulties with the vCoP. The vCoP was perceived to be a flexible learning mode that provided up-to-date resources applicable to routine practice and offered a space for the exchange of experiences and approaches. Conclusions: The results from this pilot study show that the vCoP was considered useful for learning how to empower patients. However, while vCoPs have the potential to facilitate learning and as shown create professional awareness regarding patient empowerment, attention needs to be paid to technological and access issues and the time demands on professionals. We collected relevant inputs to improve the features, content and educational methods to be included in further vCoP implementation. Trial registration: ClinicalTrials.gov, NCT02757781. Registered on 25 April 2016.This study was financed by Instituto de Salud Carlos III and Cofinanced by Fondo Europeo de Desarrollo Regional (FEDER). Ministerio de Economía y Competitividad. Gobierno de España. (PI15/00164, PI15/00586, PI15/00566

Evolution of the use, effectiveness and safety of bismuth-containing quadruple therapy for Helicobacter pylori infection between 2013 and 2021: results from the European registry on H. pylori management (Hp-EuReg)

background Bismuth quadruple therapies (BQTs) including bismuth, a proton pump inhibitor (PPI) and two antibiotics have been shown to be highly effective for treating Helicobacter pylori infection even in areas of high bacterial antibiotic resistance. Objective To describe the time trends of use, effectiveness and safety of BQT in Europe using the European Registry on Helicobacter pylori Management (Hp-EuReg). Design Patients registered in the Hp-EuReg from 2013 to 2021 who had received BQT were included. The regimens prescribed, the number of eradication attempts, effectiveness, adherence and safety were analysed. The effectiveness was assessed by modified intention to treat (mITT). Time-trend and multivariate analyses were performed to determine variables that predicted treatment success. results Of the 49 690 patients included in the Hp-EuReg, 15 582 (31%) had received BQT. BQT use increased from 8.6% of all treatments in 2013 to 39% in 2021. Single-capsule BQT—containing bismuth, metronidazole and tetracycline—plus a PPI (single-capsule BQT, ScBQT) was the most frequent treatment mode (43%). Schemes that obtained an effectiveness above 90% were the 10-day ScBQT and 14-day BQT using tetracycline plus metronidazole, or amoxicillin plus either clarithromycin or metronidazole. Only ScBQT achieved above 90% cure rates in all the geographical areas studied. Using the ScBQT scheme, adherence, the use of standard or high-dose PPIs, 14-day prescriptions and the use of BQT as first-line treatment were significantly associated with higher mITT effectiveness. Conclusion The use of BQT increased notably in Europe over the study period. A 10-day ScBQT was the scheme that most consistently achieved optimal effectiveness

Anti-Spike antibodies 3 months after SARS-CoV-2 mRNA vaccine booster dose in patients on hemodialysis: the prospective SENCOVAC study

Background: Patients on hemodialysis are at high-risk for complications derived from coronavirus disease 2019 (COVID-19). The present analysis evaluated the impact of a booster vaccine dose and breakthrough severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections on humoral immunity 3 months after the booster dose. Methods: This is a multicentric and prospective study assessing immunoglobulin G anti-Spike antibodies 6 and 9 months after initial SARS-CoV-2 vaccination in patients on hemodialysis that had also received a booster dose before the 6-month assessment (early booster) or between the 6- and 9-month assessments (late booster). The impact of breakthrough infections, type of vaccine, time from the booster and clinical variables were assessed. Results: A total of 711 patients [67% male, median age (range) 67 (20-89) years] were included. Of these, 545 (77%) received an early booster and the rest a late booster. At 6 months, 64 (9%) patients had negative anti-Spike antibody titers (3% of early booster and 29% of late booster patients, P =. 001). At 9 months, 91% of patients with 6-month negative response had seroconverted and there were no differences in residual prevalence of negative humoral response between early and late booster patients (0.9% vs 0.6%, P =. 693). During follow-up, 35 patients (5%) developed breakthrough SARS-CoV-2 infection. Antibody titers at 9 months were independently associated with mRNA-1273 booster (P =. 001), lower time from booster (P =. 043) and past breakthrough SARS-CoV-2 infection (P <. 001). Conclusions: In hemodialysis patients, higher titers of anti-Spike antibodies at 9 months were associated with mRNA-1273 booster, lower time from booster and past breakthrough SARS-CoV-2 infectionThe present project has been supported by Fresenius Medical Care, Diaverum, Vifor Pharma, Vircell, Fundación Renal Iñigo Álvarez de Toledo and ISCIII FEDER funds RICORS2040 (RD21/0005

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

Contains fulltext : 172380.pdf (publisher's version ) (Open Access

Neurological manifestations of COVID-19 in adults and children

Different neurological manifestations of coronavirus disease 2019 (COVID-19) in adults and children and their impact have not been well characterized. We aimed to determine the prevalence of neurological manifestations and in-hospital complications among hospitalized COVID-19 patients and ascertain differences between adults and children. We conducted a prospective multicentre observational study using the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) cohort across 1507 sites worldwide from 30 January 2020 to 25 May 2021. Analyses of neurological manifestations and neurological complications considered unadjusted prevalence estimates for predefined patient subgroups, and adjusted estimates as a function of patient age and time of hospitalization using generalized linear models. Overall, 161 239 patients (158 267 adults; 2972 children) hospitalized with COVID-19 and assessed for neurological manifestations and complications were included. In adults and children, the most frequent neurological manifestations at admission were fatigue (adults: 37.4%; children: 20.4%), altered consciousness (20.9%; 6.8%), myalgia (16.9%; 7.6%), dysgeusia (7.4%; 1.9%), anosmia (6.0%; 2.2%) and seizure (1.1%; 5.2%). In adults, the most frequent in-hospital neurological complications were stroke (1.5%), seizure (1%) and CNS infection (0.2%). Each occurred more frequently in intensive care unit (ICU) than in non-ICU patients. In children, seizure was the only neurological complication to occur more frequently in ICU versus non-ICU (7.1% versus 2.3%, P &lt; 0.001). Stroke prevalence increased with increasing age, while CNS infection and seizure steadily decreased with age. There was a dramatic decrease in stroke over time during the pandemic. Hypertension, chronic neurological disease and the use of extracorporeal membrane oxygenation were associated with increased risk of stroke. Altered consciousness was associated with CNS infection, seizure and stroke. All in-hospital neurological complications were associated with increased odds of death. The likelihood of death rose with increasing age, especially after 25 years of age. In conclusion, adults and children have different neurological manifestations and in-hospital complications associated with COVID-19. Stroke risk increased with increasing age, while CNS infection and seizure risk decreased with age

Evaluación de un programa de Programa de Intervención Nutricional en pacientes con enfermedad renal crónica avanzada (ERCA)

Introducción y Objetivos: La Enfermedad Renal Crónica Avanzada (ERCA) se asocia a una elevada prevalencia de malnutrición. La práctica habitual en estos pacientes va dirigida a reducir la ingesta proteica, recomendación que podría favorecer esta situación. Por ello, el objetivo de este estudio fue evaluar el efecto de un programa de intervención nutricional (PIN) sobre la función renal y el estado nutricional en pacientes con ERCA. Pacientes y Métodos: Se diseñó un estudio longitudinal y prospectivo con 93 pacientes (53,7% hombres, 66 ± 17años) que participaron en un PIN durante 6 meses con visitas mensuales. Al inicio y al final de la intervención se evaluaron: estado nutricional en función de los criterios de Chang, datos antropométricos, dietéticos y bioquímicos (albúmina, prealbúmina, aclaramiento de creatinina, fósforo y potasio séricos, Colesterol-total, LDL, HDL, triglicéridos y PCR). Resultados: Tras el PIN la ingesta calórica disminuyó en los normonutridos (1833 ± 318 vs 1571 ± 219 kcal p < 0,001) y se mantuvo en los malnutridos. Se redujo significativamente la ingesta proteica (69,9 ± 16,6 vs 54,9 ± 11 g p < 0,001), potasio (2938 ± 949 vs 2377 ± 743 mg, p < 0,0001) y fósforo (1180 ± 304 vs 946,6 ± 211 mg, p < 0,0001). Un 16,5% requirió suplementación. El porcentaje de pacientes que presentaba malnutrición según criterios de Chan disminuyó tras el PIN (41,7 % (27,8% leve, 10,10% moderada y 3,8% grave) vs 16,8% (8% leve, 5% moderada y 3,8% grave)). Tras el PIN incrementó significativamente el aclaramiento de creatinina (17,8 ± 5,2 vs 19,4 ± 6,9 ml/min, p < 0,01), albúmina (3,3 ± 0,5 g/dL vs 3,5 ± 0,4 g/dL, p < 0,05) y disminuyó el potasio sérico (4,8 ± 0,6 vs 4,5 ± 0,5 mmol/L, p < 0,05), Colesterol Total (179,8 ± 44,3 vs 170,0 ± 15,1 mg/dL, p < 0,05), LDL colesterol (113,2 ± 37,0 vs 108,3 ± 27,3 mg/dL, p < 0.01) y triglicéridos (141,9 ± 60,8 vs 129,9 ± 52,7 mg/dL, p < 0,05 Introducción y Objetivos: La Enfermedad Renal Crónica Avanzada (ERCA) se asocia a una elevada prevalencia de malnutrición. La práctica habitual en estos pacientes va dirigida a reducir la ingesta proteica, recomendación que podría favorecer esta situación. Por ello, el objetivo de este estudio fue evaluar el efecto de un programa de intervención nutricional (PIN) sobre la función renal y el estado nutricional en pacientes con ERCA. Pacientes y Métodos: Se diseñó un estudio longitudinal y prospectivo con 93 pacientes (53,7% hombres, 66 ± 17años) que participaron en un PIN durante 6 meses con visitas mensuales. Al inicio y al final de la intervención se evaluaron: estado nutricional en función de los criterios de Chang, datos antropométricos, dietéticos y bioquímicos (albúmina, prealbúmina, aclaramiento de creatinina, fósforo y potasio séricos, Colesterol-total, LDL, HDL, triglicéridos y PCR). Resultados: Tras el PIN la ingesta calórica disminuyó en los normonutridos (1833 ± 318 vs 1571 ± 219 kcal p < 0,001) y se mantuvo en los malnutridos. Se redujo significativamente la ingesta proteica (69,9 ± 16,6 vs 54,9 ± 11 g p < 0,001), potasio (2938 ± 949 vs 2377 ± 743 mg, p < 0,0001) y fósforo (1180 ± 304 vs 946,6 ± 211 mg, p < 0,0001). Un 16,5% requirió suplementación. El porcentaje de pacientes que presentaba malnutrición según criterios de Chan disminuyó tras el PIN (41,7 % (27,8% leve, 10,10% moderada y 3,8% grave) vs 16,8% (8% leve, 5% moderada y 3,8% grave)). Tras el PIN incrementó significativamente el aclaramiento de creatinina (17,8 ± 5,2 vs 19,4 ± 6,9 ml/min, p < 0,01), albúmina (3,3 ± 0,5 g/dL vs 3,5 ± 0,4 g/dL, p < 0,05) y disminuyó el potasio sérico (4,8 ± 0,6 vs 4,5 ± 0,5 mmol/L, p < 0,05), Colesterol Total (179,8 ± 44,3 vs 170,0 ± 15,1 mg/dL, p < 0,05), LDL colesterol (113,2 ± 37,0 vs 108,3 ± 27,3 mg/dL, p < 0.01) y triglicéridos (141,9 ± 60,8 vs 129,9 ± 52,7 mg/dL, p < 0,05Introduction and Objectives: Advanced Chronic Kidney Disease (ACKD) is associated with high prevalence of malnutrition. The habitual continuous dietary restrictions used in clinical practice. increased the malnutrition risk. The aim of this study was to evaluate the effects of a Nutritional intervention Program (NIP) on renal function and nutritional status in patients with ACKD. Patients and Methods: 93 patients, (53.7% men, 66 ± 17 years) were included in a prospective longitudinal study. The patients recived a NIP during 6 months with mensual visits. At baseline and six months the outcome assessed were: nutritional status by Chang criteria, anthropometric, dietetic and biochemical parameters (albumin, prealbumin, creatinine clearance, serum phosphorus, potassium, total-Cholesterol, LDL, HDL, triglycerides, and PCR). Results: After intervention, caloric intake decreased in nourished patients (1833 ± 318 vs 1571 ± 219 kcal p = .001). and it was constant in malnourished patients. The intake of protein (69,9 ± 16,6 vs 54,9 ± 11 g p < 0.001), potassium (2938 ± 949 vs 2377 ± 743 mg p < 0.001) and phosphorus (1180 ± 304 vs 946,6 ± 211 mg p < 0.001) significantly decreased. 16.5% patients required supplementation. A total of 41.7% of patients were malnourished at baseline (27.8% mild, 10.10% moderate and 3.8% severe), and 16.8% at the end (8% mild, 5% moderate and 3.8% severe) by Chang criteria. At the end of NIP, patients significantly increased creatinine clearance (17,8 ± 5,2 vs 19,4 ± 6,9 ml/min, p < 0,01), albumin (3,3 ± 0,5 vs. 3,5 ± 0,4 g/dL, p < 0,05), and decreased serum potassium (4,8 ± 0,6 vs 4,5 ± 0,5 mmol/L, p < 0,05), total cholesterol (179,8 ± 44,3 vs 170,0 ± 15,1 mg/dL, p < 0,05), LDL (113,2 ± 37,0 vs 108,3 ± 27,3 mg/dL, p < 0.01) and tryglicerides (141.9 ± 60.8 vs 129.9 ± 52.7 mg/dL, p < 0.05). Conclusions: The study reflected a NIP usefulness in the nutritional status and renal function improvements within an interdisciplinary framework during ACKD consultation