Pediatricians need to be knowledgeable to adequately carry out their role in the support of breastfeeding, so assessing their knowledge of breastfeeding is vitally important. There are not English ...language validated questionnaires for pediatricians in the literature; however, in Spanish and Portuguese, there is the Breastfeeding Knowledge Survey (ECoLa, derived from
). Our goal is to translate the ECoLa into English. The original survey consisted of true/false questions, including one with an image of a breastfeeding baby, multiple-choice questions featuring clinical cases, and two open-ended short questions. We used a translation approach that incorporated both forward and backward translations and a multidisciplinary committee to evaluate the translation process. During translation, four Spanish versions and seven English versions were considered prior to consensus approval of the final survey. The intraclass correlation coefficient between the English questionnaire and the original Spanish version was 0.85 (95% CI 0.60, 0.95). A sample of 51 participants completed the survey, resulting in a Cronbach's alpha of 0.78 for the English version (95% CI 0.70, 0.86). The Breastfeeding Knowledge Survey is now accessible under a Creative Commons license, permitting its free re-use.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows:
Primary objective
To assess the effects of lower or standard blood pressure targets for hypertensive patients ...with CKD on mortality and morbidity outcomes.
'Lower targets' are defined as blood pressure targets ≤ 130/80 mmHg. 'Standard targets' are defined as blood pressure targets ≤ 140 to 160 mmHg systolic and/or blood pressure targets ≤ 90 to 100 mmHg diastolic.
Our definition of CKD for this review is as follows: albuminuria (urine albumin excretion rate ≥ 30 mg per 24 hours, approximately equivalent to urine albumin:creatinine ratio ≥ 30 mg/g or ≥ 3 mg/mmol) as a marker of kidney damage and/or decreased GFR (GFR categories G3a to G5: GFR < 60 mL/min/1.73 m
2
). Kidney abnormalities defined in the studies as CKD will also be considered to fulfill our inclusion criteria, even though its presence during at least three months cannot be confirmed.
Secondary objectives
To determine if there is a difference in mean achieved systolic and diastolic blood pressure associated with 'lower targets' as compared with 'standard targets' in people with CKD with elevated blood pressure.
To determine if there is a difference in frequency of withdrawals due to adverse effects with 'lower targets' as compared with 'standard targets' in people with CKD with elevated blood pressure.
To determine if there is a difference in the frequency of/rate of doubling of serum creatinine level or 50% reduction in GFR with 'lower targets' as compared with 'standard targets' in people with CKD with elevated blood pressure.
To determine if there is a difference in the proportion of participants reaching target levels of blood pressure between both approaches.
To determine if there is a difference in mean number of antihypertensive drugs used in the 'lower targets' as compared with 'standard targets' in people with CKD with elevated blood pressure.
The randomized clinical trial (RCT) is the ideal and mandatory type of study to verify the effect and safety of a drug. Our aim is to examine the fundamental characteristics of interventional ...clinical trials on influenza and respiratory syncytial virus (RSV). This is a cross-sectional study of RCTs on influenza and RSV in humans between 2014 and 2021 registered in ClinicalTrials.gov. A total of 516 studies were identified: 94 for RSV, 423 for influenza, and 1 for both viruses. There were 51 RCTs of RSV vaccines (54.3%) and 344 (81.3%) for influenza virus vaccines (
< 0.001). Twelve (12.8%) RCTs for RSV were conducted only with women, and 6 were conducted only with pregnant women; for RCTs for influenza, 4 (0.9%) and 3, respectively. For RSV, 29 (31%) of the RCTs were exclusive to people under 5 years of age, and 21 (5%) for influenza virus (
< 0.001). For RSV, there are no RCTs exclusively for people older than or equal to 65 years and no phase 4 trials. RCTs on influenza virus and RSV has focused on vaccines. For the influenza virus, research has been consolidated, and for RSV, research is still in the development phase and directed at children and pregnant women.
Erlotinib and gefitinib are both tyrosine kinase inhibitors (TKIs) approved for the treatment of non-small cell lung cancer (NSCLC). Although it is well known that the increase of gastric pH may ...decrease the solubility of TKIs, there is limited evidence about the clinical repercussion of this fact. The purpose of this study was to determine if the use of gastric acid suppressive therapy (As) concomitantly with TKIs has an adverse impact on progression-free survival (PFS) and to determine whether the type of drug used (proton pump inhibitors/PPIs or histamine-2 receptors antagonists (H2RAs) may influence it.
In this retrospective observational study included were patients treated for ≥1 week with erlotinib or gefitinib from January 2012 to December 2015. Demographic, diagnostic and therapeutic variables were collected. Patients were divided into two groups (As users and non-As users). For the calculation of the PFS the Kaplan Meier and multivariate Cox regression analysis were used.
163 patients with mean age 70 years were included. 72.397percnt; (n=118) received TKIs and As concomitantly. The mean PFS was 84 days (95% CI, 65-101) and 221 days (95% CI, 125-429; p <0.0001) in As users and non-As users, respectively. Regarding the type of As used, no significant differences were observed.
Concomitant use of As and TKIs adversely impacted the PFS outcomes in NSCLC patients regardless of the type of As used. Further studies are needed to determine the clinical impact of interactions between antiacids and antineoplastics.
Background: Primary Care (PC) must attend and follow
COVID-19 patients with mild and moderate symptoms,
and identify severe cases. The aim of this study was to describe
the characteristics of ...patients attended in PC with suspicious
COVID-19 and health care provision by PC.
Methods: Retrospective longitudinal observational
study of electronic health records (EHR) and agendas.
Probabilistic sampling of suspicious COVID-19 patients’
pathway in 5 health centers in Madrid between March 16
and 20, 2020. The variables used were sociodemographic,
symptoms, examination, radiography, characteristics of
schedules and professional sick leaves. Descriptive analysis
and time to event (pneumonia).
Results: 240 EHR were reviewed. Average age 48
years, 60% women. Most frequent symptoms: cough
(80%) and elevation of temperature (63%). Pneumonia
appeared in 23%. 73% were bilateral. Age and male gender
were related to pneumonia. 20% required admission.
7 patients died (2.9%). 19,027 COVID-19 appointments
were scheduled in PC. 60% of patients were attended in
PC without performing chest X-ray or assistance by other
care level. 22.4% of GPs working days were absent because
of sick leaves. Differences were found amongst facilities
in chest X-ray requesting (max. 62%, min. 2%).
The PC center with the fewest X-rays requested was the
one with the major number of sick leaves.
Conclusions: Age and male gender were related to
pneumonia onset in PC. Health care activity was intense,
and variability was found amongst facilities. Professional
sick leaves could affect the quality of care.
Fundamentos: La Atención Primaria (AP) debe
atender y hacer un seguimiento a pacientes COVID-19
con cuadros leves y moderados, e identificar casos graves.
El objetivo del estudio fue describir las características de
los pacientes atendidos en AP con sospecha de COVID-19
y la provisión de atención sanitaria en AP.
Métodos: Estudio observacional longitudinal retrospectivo
de historias clínicas y agendas. Muestreo probabilístico
de pacientes atendidos en el circuito de sospecha
de COVID-19 en 5 centros de salud en Madrid entre el 16
y 20 de marzo 2020. Las variables utilizadas fueron sociodemográficas,
síntomas, exploración, radiografía, características
de las agendas y de las ausencias de profesionales.
Análisis descriptivo y de tiempo hasta evento (neumonía).
Resultados: Se revisaron 240 historias. Edad media
48 años, 60% mujeres. Síntomas más frecuentes: tos
(80%) y elevación de temperatura (63%). Apareció neumonía
en el 23%. El 73% fueron bilaterales. La edad y el
sexo masculino se relacionaron con la aparición de neumonía.
Precisó ingreso el 20%. Fallecieron 7 pacientes
(2,9%). Se atendieron 19.027 citas. El 60% de pacientes
fue atendido en AP sin radiografía ni valoración por otro
nivel asistencial. Fueron baja laboral el 22,4% de las jornadas
de Medicina. Hubo diferencias entre centros en la
realización de radiografías (máximo 62%, mínimo 2%), el
centro con menos radiografías solicitadas fue el que más
bajas laborales presentó (41,3%).
Conclusiones: La edad y sexo masculino se correlacionaron
con la aparición de neumonía en AP. La actividad
asistencial fue intensa y se identificó variabilidad
entre centros. Las bajas profesionales pudieron afectar a
la calidad de la atención.
It has often been suggested that cardiovascular mortality and their geographical heterogeneity are associated with nutrients intake patterns and also lipid profile. The large Spanish study Dieta y ...Riesgo de Enfermedades Cardiovasculares en España (DRECE) investigated this theory from 1991 to 2010. Out of the 4,783 Spanish individuals making up the DRECE cohort, 220 subjects (148 men and 72 women) died (4.62%) during the course of the study. The mean age of patients who died from cardiovascular causes (32 in all) was 61.08 years 95% CI (57.47-64.69) and 70.91% of them were males. The consumption of nutrients and the lipid profile by geographical area, studied by geospatial models, showed that the east and southern area of the country had the highest fat intake coupled to a high rate of unhealthy lipid profile. It was concluded that the spatial geographical analysis showed a relationship between high fat intake, unhealthy lipid profile and cardiovascular mortality in the different geographical areas, with a high variability within the country.
Mediterranean Diet (MedDiet) is broadly aknowledged as healthy. Different scoring systems of adherence to MedDiet have been developed. These indexes share components, but also disagree and don’t ...correlate as expected. So, methodological issues arise when comparing studies using different MedDiet adherence scores. Furthermore, scoring calculus is time consuming and prone to error. We develop this package as a reproducible and easy-to-use way of calculating different scores of adherence to MedDiet and provide a methodological improvement to nutriepidemiological studies using adherence scores. Each function in MedDietCalc package computes a single score according to its authors published scoring schema. Implementation: R package. Main feature is a group of calculators of 14 literature available MedDiet scores, with several implementations to ease their use. It also includes a sample dataset from DRECE 6 study and FRESCO cardiovascular risk score calculator. Available from the Comprehensive R Archive Network
CRAN.R-project.org
under the name “MedDietCalc”, licensed with General Public License 3. We provide the first software to compute and compare different MedDiet scores, which can also be used with datasets. Different scores to measure adherence to MedDiet exist, with no gold standard. In the provided sample just 3 score pairs were highly correlated, and most of them were moderately or poorly correlated. This disagreement limits our understanding of the effects of MedDiet on health status. Comparability of studies could be improved if adherence to MedDiet were reported with more than a single score.
Heart failure (HF) is a chronic, frequent and disabling condition but with a modifiable course and a large potential for improving. The aim of this study was to validate the two available clinical ...prediction rules for mortality at one year in patients with primo-hospitalization for decompensated HF: PREDICE and AHEAD. The secondary aim was to evaluate in our setting the changes in the clinical pattern of HF in the last decade in patients hospitalized for a first episode of the disease.
A prospective multicenter cohort study, which included 180 patients hospitalized with "de novo" HF was conducted to validate the PREDICE score. Calibration and discrimination measurements were calculated for the PREDICE model and the PREDICE score (using the validation cohort of the PREDICE) and the AHEAD score (using both the development and the validation cohort of the PREDICE).
For the PREDICE models, the area under the curve (AUC) was 0.68 (95% confidence interval CI: 0.57-0.79) and the calibration slope 0.65 (95% CI: 0.21-1.20). For the PREDICE score AUC was 0.59 (95% CI: 0.47-0.71) and slope 0.42 (95% CI: -0.20-1.17). For the AHEAD score the AUC was 0.68 (95% CI: 0.62-0.73) and slope 1.38 (95% CI: 0.62-0.73) when used the development cohort of PREDICE and the AUC was 0.58 (95% CI: 0.49-0.67), and slope 0.68 (95% CI: -0.06 to 1.47) when used its validation cohort.
The present study shows that the two risk scores available for patients with primo-hospitalization for decompensated HF (PREDICE and AHEAD) are not currently valid for predicting mortality at one-year. In our setting the clinical spectrum of hospitalized patients with new-onset HF has been modified over time. The study underscores the need to validate the prognostic models before clinical implementation.
Objective: To compare the effects of intensive vs standard blood pressure (BP) targets on the mortality of hypertensive patients with chronic renal disease. Design and method: A bibliographic search ...of all relevant databases was carried out without restriction by language, year of publication or publication status. We considered randomized controlled clinical trials on patients older than 18 years, diagnosed with hypertension and chronic renal disease who were allocated to either “intensive’’ BP target (less than or equal to 130/80 mmHg) or “standard’’ BP target (less than or equal to 140–160/90–100 mmHg). Additionally, trials should include more than 50 participants per group followed during at least one year. Trials were not limited by any concomitant disease or baseline cardiovascular risk. We contacted trials’ authors to obtain Individual Patient Data and, if necessary, extracted information from chronic renal patients. COVIDENCE software was used for screening, the Cochrane Review Manager (RevMan web) for data synthesis and analysis, and the Cochrane Risk of Bias Tool (ROB2) to assess the risk of bias for each trial. Results: A total of 2298 records were identified by the bibliographic search. We obtained the full text of 29 publications from the pre-selected studies. Of these, six studies met the inclusion criteria and we obtained Individual Patient Data for all of them (AASK, SPRINT, HOT, ACCORD BP, MDRD, SPS3). There was no statistically significant difference in total mortality between the intensive and standard blood pressure target groups (RR 0.92, 95%CI 0.75–1.13, p = 0.42, 6 studies, 7,348 participants). In absolute terms, there were 5 additional deaths per 1000 participants in the standard target group (95% CI: 6 fewer to 16 more deaths per 1000 participants). Overall deaths were 227/3352 (6.8%) in the intensive target group vs 285/3996 (7.9%) in the standard target group (Figure). The quality of evidence was moderate according to the GRADE assessment. Conclusions: Intensive blood pressure lowering targets in patients with arterial hypertension and chronic renal disease do not result in lower mortality compared to standard blood pressure lowering.
Possible cases of SARS-CoV-2 infection were diagnosed in primary care in Madrid, some of these cases had pneumonia. Most of the SARS-CoV-2 pneumonia published data came from hospitalised patients. ...This study set out to describe clinical characteristics of patients with SARS-CoV-2 pneumonia diagnosed in primary care across age groups and type of pneumonia.
Observational retrospective study obtaining clinical data from the electronic health records of patients who were followed-up by SARS-CoV-2 possible infection in a primary care practice in Madrid. All the cases were collected by in-person or remote consultation during the 10th March to the 7th of April.
Diagnosis of SARS-CoV-2 pneumonia by chest X-ray ordered by the GP. Main outcomes and measures: Symptoms of SARS-CoV-2 pneumonia, physical examination and diagnostic tests as a blood test, nasopharyngeal swab results for RT-PCR (Reverse transcriptase-polymerase chain reaction) and chest X-ray results.
The overall SARS-CoV-2 pneumonias collected were 172 (female 87 50.6%, mean age 60.5 years standard deviation SD 17.0). Comorbidities were body mass index ≥ 25 kg/m
(90 52.3%), hypertension (83 48.3%), dyslipidaemia (68 39.5%) and diabetes (33 19.2%). The sample was stratified by age groups (< 50 years, 50-75 years and ≥ 75 years). Clinical manifestations at onset were fever (144 83.7%), cough (140 81.4%), dyspnoea (103 59.9%) and gastrointestinal disturbances (72 41.9%). Day 7.8 (SD:4.1) from clinical onset was the mean day of pneumonia diagnosis. Bilateral pneumonia was more prevalent than unilateral (126 73.3% and 46 26.7%). Patients with unilateral pneumonia were prone to higher pulse oximetry (96% vs 94%, p < 0.001). We found differences between unilateral and bilateral cases in C-reactive protein (29.6 vs 81.5 mg/L, p < 0.001), and lymphocytes (1400.0 vs 1000.0E3/ml, p < 0.001). Complications were registered: 42 (100%) of patients ≥ 75 years were admitted into hospital; pulmonary embolism was only present at bilateral pneumonia (7 patients 5.6%) and death occurred in 1 patient with unilateral pneumonia (2.2%) vs 10 patients (7.9%) with bilateral pneumonia ( p 0.170).
Clinical manifestations of SARS-CoV-2 pneumonia were fever, cough and dyspnoea; this was especially clear in the elderly. We described different characteristics between unilateral and bilateral pneumonia.
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