Data analysis techniques such as machine learning have been used for assisting in triage and the diagnosis of health problems. Nevertheless, it has not been used yet to assist community pharmacists ...with services such as the Minor Ailment Services These services have been implemented to reduce the burden of primary care consultations in general medical practitioners (GPs) and to allow a better utilization of community pharmacists' skills. However, there is a need to refer high-risk patients to GPs.
To develop a predictive model for high-risk patients that need referral assisting community pharmacists' triage through a minor ailment service.
An ongoing pragmatic type 3 effectiveness-implementation hybrid study was undertaken at a national level in Spanish community pharmacies since October 2020. Pharmacists recruited patients presenting with minor ailments and followed them 10 days after the consultation. The main outcome measured was appropriate medical referral (in accordance with previously co-designed protocols). Nine machine learning models were tested (three statistical, three black box and three tree models) to assist pharmacists in the detection of high-risk individuals in need of referral.
Over 14'000 patients were included in the study. Most patients were female (68.1%). With no previous treatment for the specific minor ailment (68.0%) presented. A percentage of patients had referral criteria (13.8%) however, not all of these patients were referred by the pharmacist to the GP (8.5%). The pharmacists were using their clinical expertise not to refer these patients. The primary prediction model was the radial support vector machine (RSVM) with an accuracy of 0.934 (CI95 = 0.926,0.942), Cohen's kappa of 0.630, recall equal to 0.975 and an area under the curve of 0.897. Twenty variables (out of 61 evaluated) were included in the model. radial support vector machine could predict 95.2% of the true negatives and 74.8% of the true positives. When evaluating the performance for the 25 patient's profiles most frequent in the study, the model was considered appropriate for 56% of them.
A RSVM model was obtained to assist in the differentiation of patients that can be managed in community pharmacy from those who are at risk and should be evaluated by GPs. This tool potentially increases patients' safety by increasing pharmacists' ability to differentiate minor ailments from other medical conditions.
Introducción: la colaboración entre médicos y farmacéuticos es necesaria en el manejo de los síntomas menores, ya que el paciente acude a ambos profesionales sanitarios para su tratamiento. El ...objetivo del estudio fue elaborar protocolos de trabajo consensuados entre farmacéuticos comunitarios y médicos de atención primaria para el Servicio de Indicación Farmacéutica (SIF). Material y método: se utilizaron dos metodologías: revisión bibliográfica y grupo de expertos para el consenso. Estos protocolos se actualizaron y diseñaron a partir de un documento previo de 2008. En el grupo de expertos se incluyeron cuatro farmacéuticos comunitarios de SEFAC (2), MICOF (2) y cuatro médicos de atención primaria de semFYC (2) y SEMERGEN (2). Resultados: se consensuaron protocolos de trabajo para 31 síntomas menores distribuidos en cinco grupos: respiratorios, dolor moderado, digestivos, dermatológicos y otros. Se añadieron cinco síntomas nuevos al documento de partida. Respecto a la estructura de cada síntoma se consideró: concepto, causas más frecuentes, criterios de derivación al médico (edad, síntomas de alarma, duración de los síntomas, otros problemas de salud y/o medicamentos y situaciones especiales), recomendaciones para la prevención y tratamiento (no farmacológico y farmacológico). Conclusión: el documento desarrollado mediante colaboración entre profesionales de la medicina y la farmacia es una herramienta que contribuye a la mejora de la actuación del farmacéutico en el manejo de los síntomas menores desde la farmacia comunitaria, con énfasis en la definición de indicadores que señalan la necesidad de derivar el paciente al médico de atención primaria.
Objetivo: detectar personas en riesgo alto o muy alto de padecer diabetes mellitus tipo 2 (DM2) o alteraciones del metabolismo de los hidratos de carbono, derivación para posible diagnóstico al ...médico y realizar una intervención educativa. Métodos: estudio observacional transversal y longitudinal prospectivo con intervención educativa en farmacias comunitarias situadas en la provincia de Valencia entre junio y noviembre de 2018. Se incluyeron usuarios de las farmacias comunitarias, mayores de 18 años, no diagnosticados de DM2 que aceptaron realizar la encuesta. Muestreo no probabilístico. Variable principal: puntuación en el test Findrisc, determinación capilar (si F≥15), intervención y número de diagnósticos de DM2 y preDM2. Las diferencias entre grupos se calcularon con el test de chi-cuadrado, t de Student o de Wilcoxon. Resultados: el estudio se realizó en 25 farmacias. La muestra incluyó a 752 usuarios. De ellos, 148 (19,7 %) tenían alto o muy alto riesgo de DM2 (F≥15). Se realizaron 118 determinaciones capilares válidas (22 no aceptaron y 8 no la repitieron), 78 (10,4 %) tuvieron resultados superiores a los normales y a 48 (6,4 %) se les derivó al médico. 32 de estos no fueron al médico o no informaron al farmacéutico del resultado. De los 16 que conocemos el resultado, 12 (1,6 %) fueron diagnosticados de diabetes o prediabetes. Conclusiones: los resultados de este estudio piloto dejan entrever la utilidad de la farmacia comunitaria como agente con un papel importante en el cribado de DM2 al detectar el presente trabajo casi un 20 % de usuarios con un riesgo elevado de padecer la enfermedad.
La hipotermia accidental es una alteración de la termorregulación corporal, definida como una temperatura central igual o inferior a 35ºC. Según la intensidad se puede clasificar en ligera ...(35-32,2ºC), moderada (32,2-28ºC) y grave (<28ºC). Las causas más frecuentes son la exposición al frío, el uso de drogas depresoras del sistema nervioso central y la hipoglucemia, aunque existen otras menos frecuentes. Presentamos un caso de hipotermia moderada secundaria a un brote de psoriasis generalizada que precisó ingreso en la Unidad de Cuidados Intensivos del Hospital García Orcoyen. Se revisa la termorregulación, y la patogénesis, fisiopatología, diagnóstico y manejo de la hipotermia accidental.
Abstract
Aims
We investigated the incidence, risk factors, clinical characteristics, and outcomes of pulmonary embolism (PE) in patients with COVID-19 attending emergency departments (EDs), before ...hospitalization.
Methods and Results
We retrospectively reviewed all COVID-19 patients diagnosed with PE in 62 Spanish EDs (20% of Spanish EDs, case group) during the first COVID-19 outbreak. COVID-19 patients without PE and non-COVID-19 patients with PE were included as control groups. Adjusted comparisons for baseline characteristics, acute episode characteristics, and outcomes were made between cases and randomly selected controls (1:1 ratio). We identified 368 PE in 74 814 patients with COVID-19 attending EDs (4.92‰). The standardized incidence of PE in the COVID-19 population resulted in 310 per 100 000 person-years, significantly higher than that observed in the non-COVID-19 population 35 per 100 000 person-years; odds ratio (OR) 8.95 for PE in the COVID-19 population, 95% confidence interval (CI) 8.51–9.41. Several characteristics in COVID-19 patients were independently associated with PE, the strongest being D-dimer >1000 ng/mL, and chest pain (direct association) and chronic heart failure (inverse association). COVID-19 patients with PE differed from non-COVID-19 patients with PE in 16 characteristics, most directly related to COVID-19 infection; remarkably, D-dimer >1000 ng/mL, leg swelling/pain, and PE risk factors were significantly less present. PE in COVID-19 patients affected smaller pulmonary arteries than in non-COVID-19 patients, although right ventricular dysfunction was similar in both groups. In-hospital mortality in cases (16.0%) was similar to COVID-19 patients without PE (16.6%; OR 0.96, 95% CI 0.65–1.42; and 11.4% in a subgroup of COVID-19 patients with PE ruled out by scanner, OR 1.48, 95% CI 0.97–2.27), but higher than in non-COVID-19 patients with PE (6.5%; OR 2.74, 95% CI 1.66–4.51). Adjustment for differences in baseline and acute episode characteristics and sensitivity analysis reported very similar associations.
Conclusions
PE in COVID-19 patients at ED presentation is unusual (about 0.5%), but incidence is approximately ninefold higher than in the general (non-COVID-19) population. Moreover, risk factors and leg symptoms are less frequent, D-dimer increase is lower and emboli involve smaller pulmonary arteries. While PE probably does not increase the mortality of COVID-19 patients, mortality is higher in COVID-19 than in non-COVID-19 patients with PE.
Alcohol-associated liver disease (ALD) accounts for 70% of liver-related deaths in Europe, with no effective approved therapies. Although mitochondrial dysfunction is one of the earliest ...manifestations of alcohol-induced injury, restoring mitochondrial activity remains a problematic strategy due to oxidative stress. Here, we identify methylation-controlled J protein (MCJ) as a mediator for ALD progression and hypothesize that targeting MCJ may help in recovering mitochondrial fitness without collateral oxidative damage.
C57BL/6 mice wild-type (Wt) Mcj knockout and Mcj liver-specific silencing (MCJ-LSS) underwent the NIAAA dietary protocol (Lieber-DeCarli diet containing 5% (vol/vol) ethanol for 10 days, plus a single binge ethanol feeding at day 11). To evaluate the impact of a restored mitochondrial activity in ALD, the liver, gut, and pancreas were characterized, focusing on lipid metabolism, glucose homeostasis, intestinal permeability, and microbiota composition. MCJ, a protein acting as an endogenous negative regulator of mitochondrial respiration, is downregulated in the early stages of ALD and increases with the severity of the disease. Whole-body deficiency of MCJ is detrimental during ALD because it exacerbates the systemic effects of alcohol abuse through altered intestinal permeability, increased endotoxemia, and dysregulation of pancreatic function, which overall worsens liver injury. On the other hand, liver-specific Mcj silencing prevents main ALD hallmarks, that is, mitochondrial dysfunction, steatosis, inflammation, and oxidative stress, as it restores the NAD + /NADH ratio and SIRT1 function, hence preventing de novo lipogenesis and improving lipid oxidation.
Improving mitochondrial respiration by liver-specific Mcj silencing might become a novel therapeutic approach for treating ALD.
Recent empirical literature has highlighted that adolescents show gender differences in academic performance. The present study intends to disentangle the contribution of some less well-known factors ...to that gender difference in the fourth year of secondary education. To this aim, we use recent methodological advances in decomposition techniques. We observe that girls are less likely to get low scores than boys. More interestingly, gender differences in the returns to expectations about the future have been found to explain most of this advantage for girls, while boys rely more on their initial learning skills to pass. Additionally, we found that boys are more prone to misbehaviour than girls, whereas boys’ academic results are more sensitive to changes in their family socio-economic status, which also explains a significant portion of the gender differences in academic achievement.
This paper studies how COVID-19 lockdown restrictions encouraged and allowed people to form habits of increased mobile phone usage in Spain, even after the most restrictive measures were lifted. We ...have used data from the mobile network of a national telecommunications operator to study the influence of 15 different mobility restrictions on citizens' use of mobile phones from 15 March 2020 to 15 April 2021 in a big Spanish city. In order to approach this issue, a quasi-experimental technique (before and after methodology) was implemented. We found that the use of smartphones presented an initial reduction with the first and most drastic mobility restrictions, but showed a growing use after their removal. However, user mobility was negatively influenced by all the mobility restrictions.
There has been an intense focus to uncover the molecular mechanisms by which fasting triggers the adaptive cellular responses in the major organs of the body. Here, we show that in mice, hepatic ...S-adenosylmethionine (SAMe)-the principal methyl donor-acts as a metabolic sensor of nutrition to fine-tune the catabolic-fasting response by modulating phosphatidylethanolamine N-methyltransferase (PEMT) activity, endoplasmic reticulum-mitochondria contacts, β-oxidation, and ATP production in the liver, together with FGF21-mediated lipolysis and thermogenesis in adipose tissues. Notably, we show that glucagon induces the expression of the hepatic SAMe-synthesizing enzyme methionine adenosyltransferase α1 (MAT1A), which translocates to mitochondria-associated membranes. This leads to the production of this metabolite at these sites, which acts as a brake to prevent excessive β-oxidation and mitochondrial ATP synthesis and thereby endoplasmic reticulum stress and liver injury. This work provides important insights into the previously undescribed function of SAMe as a new arm of the metabolic adaptation to fasting.
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