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Bruchanski L, Torre AC, Bibiloni N, Sommer J, Boietti B, Grande Ratti MF, Rapisarda R, Luna D, Mazzuoccolo L, Plazzotta F. Effect of the COVID-19 Lockdown on Patients Valuation of Usability of Telemedicine. Stud Health Technol Inform 2024; 310:394-398. [PMID: 38269832 DOI: 10.3233/shti230994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
The aim of this paper was to report patient valuation of usability with our telemedicine system and to explore the effect of pandemic in its behavior. We conducted a cross-sectional study based on the prospective recollection of the results of the Spanish abbreviated version of the Telehealth Usability Questionnaire (TUQ), from October 2019 to July 2020. We observed an inflection point of growth of answers during the pandemic era and a trend of decrease in usability valuations coinciding with the massive and forced implementation of the system after lockdown. This effect was transitory, evidencing an improvement over time. These results might be explained with a sociotechnical approach that includes considering the learning curve and suggest the importance of a telemedicine usability tool to guide decision-making. In conclusion, tools to assess telemedicine services may identify facilitators and barriers to its use in a highly changing social and technological context.
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Affiliation(s)
- Lucila Bruchanski
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Argentina
| | - Ana Clara Torre
- Department of Dermatology, Hospital Italiano de Buenos Aires, Argentina
| | - Nuria Bibiloni
- Department of Dermatology, Hospital Italiano de Buenos Aires, Argentina
| | - Janine Sommer
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Argentina
| | - Bruno Boietti
- University of Hospital Italiano de Buenos Aires, Argentina
| | | | - Romina Rapisarda
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Argentina
| | - Daniel Luna
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Argentina
| | - Luis Mazzuoccolo
- Department of Dermatology, Hospital Italiano de Buenos Aires, Argentina
| | - Fernando Plazzotta
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Argentina
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Mirofsky M, Boietti B, Cirelli D, Rodriguez C, Bibolini J, Young P, Cámera L, Pollan JA, Sanchez Thomas D, Valdez P, Huespe IA. Vaccination impact: mortality and time shift to COVID-19 maximum severity in hospitalized patients. An Argentine multicenter registry. Medicina (B Aires) 2024; 84:19-28. [PMID: 38271929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024] Open
Abstract
INTRODUCTION The COVID-19 vaccine became an effective instrument to prevent severe SARS-CoV-2 infections. However, 5% of vaccinated patients will have moderate or severe disease. OBJECTIVE to compare mortality and days between the symptom onset to the peak disease severity, in vaccinated vs. unvaccinated COVID-19 hospitalized patients. METHODS Retrospective observational study in 36 hospitals in Argentina. COVID-19 adults admitted to general wards between January 1, 2021, and May 31, 2022 were included. Days between symptoms onset to peak of severity were compared between vaccinated vs. unvaccinated patients with Cox regression, adjusted by Propensity Score Matching (PSM). Results in patients with one and two doses were also compared. RESULTS A total of 3663 patients were included (3001 [81.9%] unvaccinated and 662 [18%] vaccinated). Time from symptom onset to peak severity was 7 days (IQR 4-12) vs. 7 days (IQR 4-11) in unvaccinated and vaccinated. In crude Cox regression analysis and matched population, no significant differences were observed. Regarding mortality, a Risk Ratio (RR) of 1.51 (IC95% 1.29-1.77) was observed in vaccinated patients, but in the PSM cohort, the RR was 0.73 (IC95% 0.60-0.88). RR in patients with one COVID-19 vaccine dose in PSM adjusted population was 0.7 (IC95% 0.45-1.03), and with two doses 0.6 (IC95% 0.46-0.79). DISCUSSION The time elapsed between the onset of COVID-19 symptoms to the highest severity was similar in vaccinated and unvaccinated patients. However, hospitalized vaccinated patients had a lower risk of mortality than unvaccinated patients.
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Affiliation(s)
- Matias Mirofsky
- Hospital Municipal de Agudos Dr. Leonidas Lucero, Bahía Blanca, Buenos Aires, Argentina. E-mail:
| | | | | | | | - Julian Bibolini
- Hospital Alta Complejidad Pte. Juan D. Perón, Formosa, Argentina
| | - Pablo Young
- Hospital Británico de Buenos Aires, Buenos Aires, Argentina
| | - Luis Cámera
- Hospital Italiano de Buenos Aires, CABA, Argentina
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Warley F, Kalmus M, Cristaldo N, Otero V, Ismael IL, Boietti B, Smietniansky M. Determination and Management of Risks for Practices and Procedures in the Elderly (DRIPP): the impact of a comprehensive geriatric evaluation in elderly with diffuse large B-cell lymphoma. Hematol Transfus Cell Ther 2023:S2531-1379(23)02587-7. [PMID: 38307825 DOI: 10.1016/j.htct.2023.09.2367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/20/2023] [Accepted: 09/05/2023] [Indexed: 02/04/2024] Open
Abstract
INTRODUCTION Diffuse large B-cell lymphoma (DLBCL) treatment in older patients is challenging. The Determination and Management of Risks for Practices and Procedures in the Elderly (DRIPP) is a multidimensional evaluation program that involves patients undergoing oncological treatments. OBJECTIVE We aimed to evaluate the overall survival and progression-free survival (PFS) of patients evaluated and those not evaluated by the DRIPP. MATERIALS AND METHODS Retrospective cohort study, patients > 65 years with DLBCL were included. They were divided into 3 groups: patients with a diagnosis prior to the DRIPP implementation (pre-DRIPP), patients with the DRIPP (DRIPP) and patients with a diagnosis after the DRIPP implementation, but who did not undergo the evaluation (non-DRIPP). RESULTS A total of 125 patients were analyzed. Fourteen (11%) patients in the pre-DRIPP group, 74 (59%) in the DRIPP group, and 37 (30%) in the non-DRIPP group. In 43 (58%) patients of the DRIPP group, some drug dose adjustments were made vs. 19 (15%) in the non-DRIPP (p = 0.03). There were no significant differences in terms of discontinuation of treatment or hematological toxicity between groups. The OS and PFS in one year was 64% (95%CI 34-83) and 50% (95%CI 23-72) for the pre-DRIPP group, 82% (95%CI 71-89) and 72% (95%CI 60-81) for the DRIPP group, 58% (95% CI 41-72) and 56% (95% CI 38-70) for the non-DRIPP group, (p = 0.08). The analysis was adjusted for probable confounders and no differences were found. CONCLUSIONS This is the first study to evaluate the DRIPP as a decision-making tool in patients with lymphoma and showed a trend towards improvement in the OS in evaluated patients.
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Affiliation(s)
- Fernando Warley
- Hematology Section, Internal Medicine Department, Hospital Italiano de Bueno Aires, Argentina.
| | - Mariana Kalmus
- Hematology Section, Internal Medicine Department, Hospital Italiano de Bueno Aires, Argentina
| | - Nancy Cristaldo
- Hematology Section, Internal Medicine Department, Hospital Italiano de Bueno Aires, Argentina
| | - Victoria Otero
- Hematology Section, Internal Medicine Department, Hospital Italiano de Bueno Aires, Argentina
| | - Ileana L Ismael
- University Institute Hospital Italiano de Buenos Aires, Argentina
| | - Bruno Boietti
- University Institute Hospital Italiano de Buenos Aires, Argentina
| | - Maximiliano Smietniansky
- Geriatric section, Internal Medicine Department, Hospital Italiano de Buenos Aires, Argentina; DRIPP program coordinator, Buenos Aires, Argentina
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Klén R, Huespe IA, Gregalio FA, Lalueza Blanco AL, Pedrera Jimenez M, Garcia Barrio N, Valdez PR, Mirofsky MA, Boietti B, Gómez-Huelgas R, Casas-Rojo JM, Antón-Santos JM, Pollan JA, Gómez-Varela D. Development and validation of COEWS (COVID-19 Early Warning Score) for hospitalized COVID-19 with laboratory features: A multicontinental retrospective study. eLife 2023; 12:e85618. [PMID: 37615346 PMCID: PMC10479961 DOI: 10.7554/elife.85618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 08/23/2023] [Indexed: 08/25/2023] Open
Abstract
Background The emergence of new SARS-CoV-2 variants with significant immune-evasiveness, the relaxation of measures for reducing the number of infections, the waning of immune protection (particularly in high-risk population groups), and the low uptake of new vaccine boosters, forecast new waves of hospitalizations and admission to intensive care units. There is an urgent need for easily implementable and clinically effective Early Warning Scores (EWSs) that can predict the risk of complications within the next 24-48 hr. Although EWSs have been used in the evaluation of COVID-19 patients, there are several clinical limitations to their use. Moreover, no models have been tested on geographically distinct populations or population groups with varying levels of immune protection. Methods We developed and validated COVID-19 Early Warning Score (COEWS), an EWS that is automatically calculated solely from laboratory parameters that are widely available and affordable. We benchmarked COEWS against the widely used NEWS2. We also evaluated the predictive performance of vaccinated and unvaccinated patients. Results The variables of the COEWS predictive model were selected based on their predictive coefficients and on the wide availability of these laboratory variables. The final model included complete blood count, blood glucose, and oxygen saturation features. To make COEWS more actionable in real clinical situations, we transformed the predictive coefficients of the COEWS model into individual scores for each selected feature. The global score serves as an easy-to-calculate measure indicating the risk of a patient developing the combined outcome of mechanical ventilation or death within the next 48 hr.The discrimination in the external validation cohort was 0.743 (95% confidence interval [CI]: 0.703-0.784) for the COEWS score performed with coefficients and 0.700 (95% CI: 0.654-0.745) for the COEWS performed with scores. The area under the receiver operating characteristic curve (AUROC) was similar in vaccinated and unvaccinated patients. Additionally, we observed that the AUROC of the NEWS2 was 0.677 (95% CI: 0.601-0.752) in vaccinated patients and 0.648 (95% CI: 0.608-0.689) in unvaccinated patients. Conclusions The COEWS score predicts death or MV within the next 48 hr based on routine and widely available laboratory measurements. The extensive external validation, its high performance, its ease of use, and its positive benchmark in comparison with the widely used NEWS2 position COEWS as a new reference tool for assisting clinical decisions and improving patient care in the upcoming pandemic waves. Funding University of Vienna.
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Affiliation(s)
- Riku Klén
- Turku PET Centre, University of Turku and Turku University HospitalTurkuFinland
| | - Ivan A Huespe
- Italian Hospital of Buenos AiresBuenos AiresArgentina
| | | | - Antonio Lalueza Lalueza Blanco
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense UniversityMadridSpain
| | - Miguel Pedrera Jimenez
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense UniversityMadridSpain
| | - Noelia Garcia Barrio
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense UniversityMadridSpain
| | | | - Matias A Mirofsky
- Hospital Municipal de Agudos Dr Leónidas LuceroBahía BlancaArgentina
| | - Bruno Boietti
- Italian Hospital of Buenos AiresBuenos AiresArgentina
| | - Ricardo Gómez-Huelgas
- Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of MalagaMálagaSpain
| | | | | | | | - David Gómez-Varela
- Division of Pharmacology & Toxicology, Department of Pharmaceutical Sciences, University of ViennaViennaAustria
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Huespe IA, Ferraris A, Lalueza A, Valdez PR, Peroni ML, Cayetti LA, Mirofsky MA, Boietti B, Gómez-Huelgas R, Casas-Rojo JM, Antón-Santos JM, Núñez-Cortés JM, Lumbreras C, Ramos-Rincón JM, Barrio NG, Pedrera-Jiménez M, Martin-Escalante MD, Ruiz FR, Onieva-García MÁ, Toso CR, Risk MR, Klén R, Pollán JA, Gómez-Varela D. COVID-19 vaccines reduce mortality in hospitalized patients with oxygen requirements: Differences between vaccine subtypes. A multicontinental cohort study. J Med Virol 2023; 95:e28786. [PMID: 37212340 DOI: 10.1002/jmv.28786] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/21/2023] [Accepted: 05/01/2023] [Indexed: 05/23/2023]
Abstract
The aim of this study was to analyze whether the coronavirus disease 2019 (COVID-19) vaccine reduces mortality in patients with moderate or severe COVID-19 disease requiring oxygen therapy. A retrospective cohort study, with data from 148 hospitals in both Spain (111 hospitals) and Argentina (37 hospitals), was conducted. We evaluated hospitalized patients for COVID-19 older than 18 years with oxygen requirements. Vaccine protection against death was assessed through a multivariable logistic regression and propensity score matching. We also performed a subgroup analysis according to vaccine type. The adjusted model was used to determine the population attributable risk. Between January 2020 and May 2022, we evaluated 21,479 COVID-19 hospitalized patients with oxygen requirements. Of these, 338 (1.5%) patients received a single dose of the COVID-19 vaccine and 379 (1.8%) were fully vaccinated. In vaccinated patients, mortality was 20.9% (95% confidence interval [CI]: 17.9-24), compared to 19.5% (95% CI: 19-20) in unvaccinated patients, resulting in a crude odds ratio (OR) of 1.07 (95% CI: 0.89-1.29; p = 0.41). However, after considering the multiple comorbidities in the vaccinated group, the adjusted OR was 0.73 (95% CI: 0.56-0.95; p = 0.02) with a population attributable risk reduction of 4.3% (95% CI: 1-5). The higher risk reduction for mortality was with messenger RNA (mRNA) BNT162b2 (Pfizer) (OR 0.37; 95% CI: 0.23-0.59; p < 0.01), ChAdOx1 nCoV-19 (AstraZeneca) (OR 0.42; 95% CI: 0.20-0.86; p = 0.02), and mRNA-1273 (Moderna) (OR 0.68; 95% CI: 0.41-1.12; p = 0.13), and lower with Gam-COVID-Vac (Sputnik) (OR 0.93; 95% CI: 0.6-1.45; p = 0.76). COVID-19 vaccines significantly reduce the probability of death in patients suffering from a moderate or severe disease (oxygen therapy).
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Affiliation(s)
- Ivan A Huespe
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
- Medicine Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Augusto Ferraris
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Antonio Lalueza
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | | | - Maria L Peroni
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Luis A Cayetti
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Matias A Mirofsky
- Hospital Municipal de Agudos "Dr. Leónidas Lucero", Bahía Blanca, Argentina
| | - Bruno Boietti
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Gómez-Huelgas
- Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA), Málaga, Spain
| | | | | | | | - Carlos Lumbreras
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | | | - Noelia G Barrio
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | - Miguel Pedrera-Jiménez
- 12 de Octubre University Hospital, Research Institute of Hospital 12 de Octubre (imas+12), Complutense University, Madrid, Spain
| | | | | | | | - Carlos R Toso
- Medicine Department, University of Buenos Aires, Buenos Aires, Argentina
| | - Marcelo R Risk
- Instituto de Medicina Traslacional e Ingeniería Biomédica (IMTIB), CONICET-HIBA-IUHI, Buenos Aires, Argentina
| | - Riku Klén
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Javier A Pollán
- Intensive Care Unit, Italian Hospital of Buenos Aires, Buenos Aires, Argentina
| | - David Gómez-Varela
- Department of Pharmaceutical Sciences, Division of Pharmacology and Toxicology, University of Vienna, Vienna, Austria
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Klappenbach R, Lartigue B, Beauchamp M, Boietti B, Santero M, Bosque L, Monteverde E. Hip fracture registries in low- and middle-income countries: a scoping review. Arch Osteoporos 2023; 18:51. [PMID: 37067611 DOI: 10.1007/s11657-023-01241-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 04/04/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE The study aims to identify, describe, and organize the currently available evidence regarding hip fracture (HF) registries in low- and middle-income countries (LMICs). METHODS We conducted a scoping review adhering to PRISMA-ScR guidelines. We searched MEDLINE (PubMed), Google Scholar, Global Index Medicus, websites related to HF, and study references for eligible studies. Two reviewers independently performed the study selection and data extraction, including studies describing the use of individual patient records with the aim to improve the quality of care in older people with HF in LMICs. RESULTS A total of 222 abstracts were screened, 59 full-text articles were reviewed, and 10 studies regarding 3 registries were included in the analysis. Malaysia and Mexico implemented a HF registry in public hospitals whereas Argentina implemented a registry in the private setting. The Mexican registry, the most recent one, is the only one that publishes annual reports. There was significant variability in data fields between registries, particularly in functional evaluation and follow-up. The Ministry of Health finances the Malaysian registry, while Argentinian and Mexican registries founding was unclear. CONCLUSION The adoption of HF registries in LMICs is scarce. The few experiences show promising results but higher support is required to develop more registries. Long-term sustainability remains a challenge.
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Affiliation(s)
| | - Betina Lartigue
- Fundación Trauma, Tacuarí 352 (PC 1071), Buenos Aires, Argentina
| | - María Beauchamp
- Fundación Trauma, Tacuarí 352 (PC 1071), Buenos Aires, Argentina
| | - Bruno Boietti
- Sociedad Argentina de Gerontología Y Geriatría, Buenos Aires, Argentina
| | - Marilina Santero
- Fundación Trauma, Tacuarí 352 (PC 1071), Buenos Aires, Argentina
| | - Laura Bosque
- Fundación Trauma, Tacuarí 352 (PC 1071), Buenos Aires, Argentina
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Warley F, Kalmus M, Cristaldo N, Ismael IL, Boietti B, Smietniansky M. Impact of dose intensity in older patients with diffuse large B-cell lymphoma. Medicina (B Aires) 2023; 83:854-856. [PMID: 37870356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023] Open
Affiliation(s)
- Fernando Warley
- Sección Hematología, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires Argentina. E-mail:
| | - Mariana Kalmus
- Sección Hematología, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires Argentina
| | - Nancy Cristaldo
- Sección Hematología, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires Argentina
| | - Ileana L Ismael
- Instituto Universitario, Hospital Italiano de Buenos Aires, Buenos Aires Argentina
| | - Bruno Boietti
- Instituto Universitario, Hospital Italiano de Buenos Aires, Buenos Aires Argentina
| | - Maximiliano Smietniansky
- Sección Geriatría, Departamento de Medicina Interna, Hospital Italiano de Buenos Aires, Buenos Aires Argentina
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Sommer J, Torre AC, Bibiloni N, Plazzotta F, Vázquez Peña F, Terrasa SA, Boietti B, Bruchanski L, Mazzuoccolo L, Luna D. Telemedicina: validación de un cuestionario para evaluar la experiencia de los profesionales de la salud. Rev Panam Salud Publica 2022; 46:e173. [PMID: 36320203 PMCID: PMC9595219 DOI: 10.26633/rpsp.2022.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022] Open
Abstract
Objetivo. El siguiente trabajo tiene como objetivo desarrollar y validar un cuestionario para evaluar la experiencia de los profesionales de la salud con los sistemas de telemedicina. Métodos. A partir de la versión abreviada en español y validada localmente del cuestionario para pacientes desarrollado por Parmanto y col., un grupo de expertos consensuó una versión para evaluar la experiencia de profesionales de la salud que brindan servicios de telemedicina. El comportamiento psicométrico de los ítems se testeó en una primera muestra de 129 profesionales a través de un análisis factorial exploratorio. Luego, se evaluó su comprensibilidad a través de entrevistas cognitivas. Por último, en una nueva muestra de 329 profesionales, se evaluó la validez de constructo del cuestionario mediante un análisis factorial confirmatorio (AFC), y su validez de criterio externo, mediante la evaluación de su puntaje con el de una pregunta de resumen. Resultados. Se obtuvo un cuestionario de 12 ítems con una estructura de dos factores con indicadores de ajuste aceptables, documentada mediante AFC. La fiabilidad, la validez convergente y la validez discriminante fueron apropiadas. La validez de criterio externo mostró resultados óptimos. Conclusiones. El instrumento obtenido cuenta con propiedades psicométricas adecuadas y contribuirá a la evaluación objetiva de la experiencia de los profesionales que realizan telemedicina.
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Affiliation(s)
- Janine Sommer
- Departamento de Informática en salud, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Ana Clara Torre
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Nuria Bibiloni
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernando Plazzotta
- Departamento de Informática en salud, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernando Vázquez Peña
- Departamento de Investigación, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Sergio Adrián Terrasa
- Departamento de Investigación, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Bruno Boietti
- Departamento de Investigación, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Lucila Bruchanski
- Departamento de Informática en salud, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Luis Mazzuoccolo
- Servicio de Dermatología, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
| | - Daniel Luna
- Departamento de Informática en salud, Hospital Italiano de Buenos Aires, Ciudad Autónoma de Buenos Aires, Argentina
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Klén R, Purohit D, Gómez-Huelgas R, Casas-Rojo JM, Antón-Santos JM, Núñez-Cortés JM, Lumbreras C, Ramos-Rincón JM, García Barrio N, Pedrera-Jiménez M, Lalueza Blanco A, Martin-Escalante MD, Rivas-Ruiz F, Onieva-García MÁ, Young P, Ramirez JI, Titto Omonte EE, Gross Artega R, Canales Beltrán MT, Valdez PR, Pugliese F, Castagna R, Huespe IA, Boietti B, Pollan JA, Funke N, Leiding B, Gómez-Varela D. Development and evaluation of a machine learning-based in-hospital COVID-19 disease outcome predictor (CODOP): A multicontinental retrospective study. eLife 2022; 11:e75985. [PMID: 35579324 PMCID: PMC9129872 DOI: 10.7554/elife.75985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 04/24/2022] [Indexed: 11/29/2022] Open
Abstract
New SARS-CoV-2 variants, breakthrough infections, waning immunity, and sub-optimal vaccination rates account for surges of hospitalizations and deaths. There is an urgent need for clinically valuable and generalizable triage tools assisting the allocation of hospital resources, particularly in resource-limited countries. We developed and validate CODOP, a machine learning-based tool for predicting the clinical outcome of hospitalized COVID-19 patients. CODOP was trained, tested and validated with six cohorts encompassing 29223 COVID-19 patients from more than 150 hospitals in Spain, the USA and Latin America during 2020-22. CODOP uses 12 clinical parameters commonly measured at hospital admission for reaching high discriminative ability up to 9 days before clinical resolution (AUROC: 0·90-0·96), it is well calibrated, and it enables an effective dynamic risk stratification during hospitalization. Furthermore, CODOP maintains its predictive ability independently of the virus variant and the vaccination status. To reckon with the fluctuating pressure levels in hospitals during the pandemic, we offer two online CODOP calculators, suited for undertriage or overtriage scenarios, validated with a cohort of patients from 42 hospitals in three Latin American countries (78-100% sensitivity and 89-97% specificity). The performance of CODOP in heterogeneous and geographically disperse patient cohorts and the easiness of use strongly suggest its clinical utility, particularly in resource-limited countries.
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Affiliation(s)
- Riku Klén
- Turku PET Centre, University of Turku and Turku University HospitalTurkuFinland
| | - Disha Purohit
- Max Planck Institute of Experimental MedicineGöttingenGermany
| | - Ricardo Gómez-Huelgas
- Internal Medicine Department, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga (IBIMA), University of Málaga (UMA)MálagaSpain
| | | | | | | | - Carlos Lumbreras
- Internal Medicine Department, 12 de Octubre University HospitalMadridSpain
| | - José Manuel Ramos-Rincón
- Internal Medicine Department, General University Hospital of Alicante, Alicante Institute for 22 Health and Biomedical Research (ISABIAL)AlicanteSpain
| | | | | | | | | | | | | | - Pablo Young
- Hospital Británico of Buenos AiresBuenos AiresArgentina
| | | | | | | | | | | | | | | | - Ivan A Huespe
- Hospital Italiano de Buenos AiresBuenos AiresArgentina
| | - Bruno Boietti
- Hospital Italiano de Buenos AiresBuenos AiresArgentina
| | | | - Nico Funke
- Max Planck Institute for Experimental MedicineGöttingenGermany
| | - Benjamin Leiding
- Institute for Software and Systems Engineering at TU ClausthalClausthalGermany
| | - David Gómez-Varela
- Max Planck Institute for Experimental MedicineGöttingenGermany
- Systems Biology of Pain, Division of Pharmacology & Toxicology, Department of Pharmaceutical Sciences, University of ViennaViennaAustria
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Schapira M, Outumuro MB, Giber F, Pino C, Mattiussi M, Montero-Odasso M, Boietti B, Saimovici J, Gallo C, Hornstein L, Pollán J, Garfi L, Osman A, Perman G. Geriatric co-management and interdisciplinary transitional care reduced hospital readmissions in frail older patients in Argentina: results from a randomized controlled trial. Aging Clin Exp Res 2022; 34:85-93. [PMID: 34100241 DOI: 10.1007/s40520-021-01893-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/21/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Hospitalization is a moment of extreme vulnerability for frail older adults. There is scarce evidence on the effectiveness of geriatric co-management or transitional care interventions in Latin America. AIMS To assess whether geriatric co-management combined with an interdisciplinary transitional care intervention could reduce 30-day hospital readmission rate compared to usual care in hospitalized frail older patients in a tertiary hospital in Argentina. METHODS Single-blinded randomized controlled trial. Usual care treatment arm: all procedures performed during hospitalization were overseen by a senior internal medicine specialist and complied with pre-defined protocols. Patients had access to specialist care if needed, as well as hospital-at-home or home-based primary care services after discharge. Intervention treatment arm: in addition to usual care, a geriatric co-management team performed a comprehensive geriatric assessment during hospitalization, provided tailored recommendations to minimize geriatric syndromes and planned transition of care. A health and social care counselor oversaw continuity of care in patients' homes after discharge. RESULTS We included 120 participants in each of the intervention and usual care (control) arms. Thirty-day hospital readmissions were 47.7% lower in the intervention arm (18.3% vs 35.0%; P = 0.040); and emergency room visits within the first 6 months after discharge were 27.8% lower (43.3% vs 60.0%; P = 0.010). There was a non-statistically significant decrease in 6-month mortality in the intervention arm (25.0% vs 35.0%; P = 0.124). CONCLUSION Geriatric co-management of frail older patients during hospitalization combined with an interdisciplinary transitional care intervention reduced 30-day hospital readmissions and emergency visits 6 months after discharge. TRIAL REGISTRATION NUMBER Trial registration number: RENIS IS003081.
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11
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Giambruni JM, Pagano C, Ortiz Basso T, Burchakchi AI, Pozzoni MC, Diamint DV, Challiol CF, Gossn G, Boietti B. Topical prostaglandin analogues and development of epiretinal membrane. ACTA ACUST UNITED AC 2018; 93:169-173. [PMID: 29398231 DOI: 10.1016/j.oftal.2017.12.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/09/2017] [Accepted: 12/11/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine whether patients with glaucoma and epiretinal membrane (ERM) use a greater proportion of prostaglandin analogues (PA) than a control group of patients with glaucoma without ERM. METHOD A retrospective study of cases and controls was conducted in order to determine whether patients with glaucoma and ERM used a greater proportion of PA than a control group of patients with glaucoma without ERM. The diagnosis of de ERM was made by clinical examination and optical coherence tomography. RESULTS The mean age of the cases was 77 years (SD: 8.68; 95% CI: 74.3-79.4), compared to the controls with 63 years (SD: 16.6; 95% CI: 70.1-78.5). The cases included 50% (n=26) men and 50% women (n=26), whereas in the controls 25.4% (n=16) of the cases were men and 74.6% (n=47) women. PA treatment was used in 59.6% (n=31) and 60.3% (n=38) of the cases and controls, respectively. There was no statistically significant difference in PA use between the 2groups (P=.939). CONCLUSIONS In this study, an association between the use of AP and the development of ERM could not be demonstrated.
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Affiliation(s)
- J M Giambruni
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - C Pagano
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - T Ortiz Basso
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - A I Burchakchi
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - M C Pozzoni
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - D V Diamint
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - C F Challiol
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - G Gossn
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - B Boietti
- Departamento de Oftalmología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Smietniansky M, Gonzalez Zalazar E, Boietti B, Ardiles V, Cal M, Riggi E, Camera L, De Santibañes E. ASSOCIATION BETWEEN FRAILTY AND POSTOPERATIVE COMPLICATIONS IN PATIENTS UNDERGOING ABDOMINAL SURGERY. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.2103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- M. Smietniansky
- Internal Medicine - Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - E. Gonzalez Zalazar
- Internal Medicine - Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - B. Boietti
- Internal Medicine - Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - V. Ardiles
- Internal Medicine - Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - M. Cal
- Internal Medicine - Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - E. Riggi
- Internal Medicine - Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - L. Camera
- Internal Medicine - Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
| | - E. De Santibañes
- Internal Medicine - Geriatrics, Hospital Italiano de Buenos Aires, Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina
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13
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Benchimol J, Boietti B, Elizondo C, Giunta D, Barrientos S, Camera L, Waisman G. ONE-YEAR MORTALITY AFTER HIP FRACTURE IN OLD AND VERY OLD PATIENTS. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.3264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J. Benchimol
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - B. Boietti
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - C. Elizondo
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - D. Giunta
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - S. Barrientos
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - L. Camera
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
| | - G. Waisman
- Internal Medicine, Hospital Italiano de Buenos Aires (Argentina), Ciudad de Buenos Aires, Argentina
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14
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Vazquez FJ, Posadas-Martinez ML, Boietti B, Giunta D, Gandara E. Prevalence of Deep Vein Thrombosis in Hospitalized Patients With Suspected Pulmonary Embolism Ruled Out by Multislice CT Angiography. Clin Appl Thromb Hemost 2017; 24:360-363. [PMID: 28301914 DOI: 10.1177/1076029617696580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Current evidence suggests that for outpatients with suspected pulmonary embolism (PE), multislice computed tomographic angiography (CTPA) is sufficient to rule out PE. However, the accuracy of CTPA alone has not been established for hospitalized patients. Our goal was to determine the prevalence of deep vein thrombosis (DVT) in hospitalized patients who had PE ruled out by CTPA. We conducted a prospective cohort study of patients who developed symptoms indicative of PE, after being admitted to the hospital for any reason other than PE and were evaluated with multislice CTPA. The main outcome was proximal DVT. Between November 2011 and December 2014, 191 hospitalized patients were screened. A total of 99 patients satisfied our inclusion criteria. The average length of hospitalization for this group was 14 days (range: 2-127 days). While hospitalized, 54 (28%) patients underwent a major surgical procedure and 80 (79%) were receiving thromboprophylaxis. Of the 99 patients included, 7 (7.07%; 95% confidence intervals [CIs]: 3.4-13.8) were diagnosed with a proximal DVT. The likelihood of developing a proximal DVT was higher for those with subtle and nonspontaneously reported symptoms of DVT, odds ratio [OR] was 50.93 (95% CI: 5.35-2572) and for those classified as PE likely OR was 37.54 (95% CI: 4.05-186.1). Given the prevalence of DVT in hospitalized patients with suspected PE ruled out by a negative multislice CTPA, our study suggests that compression ultrasonography would, in fact, be justified for patients with these characteristics.
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Affiliation(s)
- Fernando Javier Vazquez
- 1 Internal Medicine Department, Hospital Italiano de Buenos Aires, Instituto Universitario del Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Boietti
- 2 Internal Medicine Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Diego Giunta
- 2 Internal Medicine Research Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Esteban Gandara
- 3 Internal Medicine Department, Research in Hematology Department, Hospital Privado de la Comunidad, Mar del Plata, Buenos Aires, Argentina
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