Citations

<title>RESUMEN</title> <p>A pesar de que la Práctica Basada en la Evidencia (PBE) ha estandarizado los tratamientos psicológicos, la realidad clínica sigue enfrentándose a una barrera persistente: la dificultad de traducir los resultados de ensayos clínicos grupales a la singularidad de cada paciente en contextos reales. Como respuesta, la Salud Mental de Precisión (SMP) propone una evolución del modelo actual, integrando el cuidado basado en la medición y la toma de decisiones basada en datos para ajustar la intervención a las necesidades específicas de cada persona, gracias en gran medida a desarrollos tecnológicos recientes como la Inteligencia Artificial (IA). En este contexto, el presente artículo persigue dos objetivos fundamentales. En primer lugar, sintetiza los pilares operativos de la SMP, analizando cómo la medición rutinaria y las predicciones algorítmicas pueden potenciar el juicio clínico del profesional. En segundo lugar, se introduce el proyecto NOVA (Navigating Outcomes via Analytics), un proyecto traslacional diseñado para superar las barreras actitudinales, tecnológicas, estadísticas y contextuales de la implementación de herramientas de SMP en España. Se discute sobre los pasos necesarios para cerrar la brecha entre la innovación tecnológica y la práctica asistencial en psicología, acelerando la adopción sostenible de una psicología de precisión en el mundo real.</p>

Abstract Aortic valvar atresia is a congenital cardiovascular malformation in which there is no patency of the aortic valve, and thus no communication between aorta and either ventricle. A hypoplastic ascending aorta is a constant feature, usually in the context of a small left ventricle and mitral valve. A subset of this group is aortic atresia with a ventricular septal defect with well-developed mitral valve and balanced ventricles. This morphological variant is often misdiagnosed as common arterial trunk on echocardiography and computerised tomography. In the absence of coarctation or focal narrowing of the aortic arch, one can misdiagnose this entity as common arterial trunk with a single coronary artery from the brachiocephalic artery. Patients with this variant may have hypoplastic left heart physiology, but can potentially undergo a biventricular repair. Herein, we describe aortic valvar atresia with a large pulmonary trunk and ventricular septal defect, with balanced ventricles and a well-developed mitral valve. The patient was originally misdiagnosed as having a common arterial trunk. We emphasise the morphological differences, as well as the surgical importance, including technical considerations, conduction of cardiopulmonary bypass, and myocardial protection.

Abstract Mohs Surgery from 2016 to 2022: Declining Medicaid Reimbursement and ACA Expansion Impact Mohs micrographic surgery (MMS) is the standard of care for many nonmelanoma skin cancers, yet access remains highly variable due to low reimbursement rates. Only 39.5% of Mohs surgeons nationally accept Medicaid. While the Affordable Care Act (ACA) Medicaid expansion improved coverage for low-income adults, its effects on dermatologic reimbursement remain unclear. This study provides the first comprehensive analysis of inflation-adjusted Medicaid reimbursement trends for MMS and determines whether ACA Medicaid expansion translated into improved payment rates. Average physician reimbursement per patient for MMS procedures (CPT codes 17311–17314) from 2016 to 2022 was extracted from a large insurance claims database and adjusted for inflation to 2022 U.S. dollars. States were categorized by Medicaid expansion status, and linear regression assessed reimbursement trends. Between 2016 and 2022, national weighted average reimbursement for MMS first stage (CPT 17311) declined 18.33%, while MMS additional stages (CPT 17312) decreased 25.52% (p = 0.0182). When stratified by expansion status, CPT 17311 reimbursement declined − 5.71% in expansion states versus increasing + 5.80% in non-expansion states (p = 0.00121). Reimbursement for non-high-risk anatomic areas declined 26.10% and 32.6%, respectively. Inflation-adjusted Medicaid payments for MMS declined substantially from 2016 to 2022, with greater reductions in Medicaid expansion states. While ACA expansion increased coverage, it introduced financial pressures through lower fee schedules, potentially threatening physician participation and access to essential dermatologic surgery for vulnerable populations.

Background Burnout arises from prolonged, unresolved work-related stress and adversely affects professional performance and overall well-being. Resident doctors and medical students are particularly vulnerable because of the demands of balancing clinical, academic and related responsibilities. Aims This study aimed to assess self-reported burnout and related stressors among UK resident doctors and medical students, and estimate the economic impact of burnout-related absenteeism among resident doctors. Method Self-report questionnaires assessing burnout and related stressors were distributed to UK resident doctors and medical students. A total of 2793 responses were received: 1439 (51.5%) from resident doctors and 1354 (48.5%) from medical students. Economic losses from absenteeism were calculated with a human capital approach. Results Burnout was reported by 70% ( n = 1008) of resident doctors and 65.7% ( n = 889) of medical students. Notably, 56.8% ( n = 573) and 79.3% ( n = 705) of resident doctors and medical students affected by burnout, respectively, were unaware of available support services. Relocation stress (85.1% of residents and 62.6% of students), financial stress (53.9% of residents and 57.8% of students) and poor work–life balance (32.1% of residents and 20.7% of students) were commonly reported. The annual economic burden of absenteeism related to burnout among resident doctors was estimated to reach £251.5 million. Conclusions Burnout among UK resident doctors and medical students may reflect a combination of underlying factors, including financial strain, relocation stress and difficulties with work–life balance. These findings underscore the need for targeted interventions that support well-being and address financial and relocation challenges, which may, in turn, help prevent burnout and improve retention within the medical workforce. Reducing burnout and associated stressors may also help lessen its economic impact, allowing resources to be redirected towards patient care.

Aim Incorporating patient-reported outcomes (PROs) into clinical practice and real-world research is essential to enable a more holistic assessment of treatment effectiveness, beyond migraine frequency alone. Given the number of calcitonin gene-related peptide (CGRP)-targeted treatments available, switching between CGRP-targeted preventive therapies is a common practice. Real-world evidence on switching to intravenous eptinezumab in adults with migraine for whom prior subcutaneous or oral CGRP-targeted preventive therapies failed is limited. The ongoing INFUSE study was designed to evaluate the real-world effectiveness of switching to eptinezumab in US clinical practice among adults with migraine for whom ≥1 prior CGRP-targeted preventive therapy had failed. Methods INFUSE, a real-world, non-interventional study evaluating the effectiveness of eptinezumab in US clinical practice, included adults with migraine for whom ≥1 prior CGRP-targeted preventive therapy had failed and who were newly initiating eptinezumab treatment. PROs were collected electronically. To provide an overall assessment of the change in migraine disease, Patient Global Impression of Change (PGIC) was utilized. Other outcomes allowed for the evaluation of novel end points, such as brain fog and participant-defined good days. Results The baseline population included 190 participants (female, 88.9%; 35–54 years of age, 53.7%). At month 6, 44.1% (95% confidence interval (CI): 35.3–53.4%) of participants reported “much/very much improved” on PGIC, and 75.7% (95% CI: 66.9–82.7%) reported any improvement. Mean good days increased by 6.3 per month at month 6 ( P < 0.001). Among participants reporting brain fog at baseline (93.7%), 55.8% (95% CI: 46.2–64.9%) reported improvement at month 6. Conclusion This research provides insights into capturing the broader migraine burden and the holistic impact of preventive treatment and highlights the potential for achieving ambitious goals. In this population for whom ≥1 prior CGRP-targeted preventive therapy had failed, switching to eptinezumab was associated with participant-reported, clinically meaningful improvements in PROs, including frequency, disability, disease status, and brain fog.

Abstract Aims We aimed to compare procedural, echocardiographic, and clinical outcomes within the first year after transcatheter aortic valve implantation (TAVI) among inhospital and subacute patients to elective patients in the COMPARE-TAVI 1 cohort. Methods and results Among 1030 patients treated with TAVI, 927 (90%) had an elective procedure, 63 (6.1%) had a subacute procedure, and 40 (3.9%) had an inhospital procedure. Procedural characteristics and outcomes were comparable. Among elective, subacute, and inhospital patients, mortality at 30 days was 15 (1.6%), 0 (0%), and 0 (0%) and at 1 year 54 (5.8%), 4 (6.3%), and 2 (5.0%). Stroke at 30 days was 28 (3.0%), 0 (0%), and 3 (7.5%) and at 1 year 42 (4.5%), 5 (7.9%), and 3 (7.5%). New pacemaker at 30 days was 119 (14%), 12 (21%), and 6 (17%) and at 1 year 130 (16%), 14 (25%), and 7 (19%). Elective, subacute, and inhospital patients with LVEF ≤40%, improved their LVEF from 33% (28–37), 33% (27–37), and 28% (22–33) before TAVI to 46% (35–60), 43% (33–52), and 42% (33–55) at 30-days, and 54% (45–62), 53% (43–61), and 49% (39–63) at 1-year. Differences between the groups were not statistically significant. Conclusion After transfemoral TAVI with balloon-expandable valves in COMPARE-TAVI 1, procedural, echocardiographic, and clinical outcomes were comparable among elective, subacute, and inhospital patients within the first year.