Albert Balaguer

Medical doctors’ empathy is vital in their interaction with patients, impacting on patient trust and health outcomes. The Consultation and Relational Empathy (CARE) scale helps assess healthcare professionals’ empathy but there is a reasonable doubt about its validity when directly implemented in simulation contexts. This study adapts and validates a version of the CARE scale for simulated patients (Sp-SIMCARE), filling a gap in empathy assessment within medical training simulations. The contextual adaptation of the CARE scale for simulated patients followed a four-phase process: 1) preparation of a preliminary adaptation proposal; 2) drafting the first version; 3) piloting the initial version with simulated patients; and 4) refining the final Sp-SIMCARE version. A panel of five experts collaborated with five simulated patients to ensure clarity, relevance, and language equivalence. The validation was conducted using typical primary care scenarios. Simulated patients assessed the performance of undergraduate medical students in four primary patient roles: acute, chronic, with high functional component, and with a hostile attitude. Psychometric parameters that were evaluated included convergent validity (assessed by simulated patients using a global score), acceptability and face validity, homogeneity, and internal reliability. The adaptation process resulted in a clear, relevant, and comprehensible scale, ensuring uniform understanding among users. Validation involved 95 students in 270 encounters with eight simulated patients. The final version showed convergent validity (Spearman’s rho=0.730, p<0.001), acceptability and face validity (1.96% “Does not apply”/missing values), homogeneity (item-total correlations 0.705-0.865) and reliability (Cronbach’s alpha=0.960). The Sp-SIMCARE scale appears to be a valid and reliable tool for simulated patients to assess empathy in future doctors during their training from a multidimensional perspective.

Introducción. La rápida integración de la inteligencia artificial (IA) en la educación biomédica ha generado una necesidad urgente de un marco que sirva de guía para el estudiantado y para el personal académico. En España, las instituciones están adoptando la IA con rapidez, pero sin una orientación regulatoria o pedagógica homogénea. Se requieren enfoques estructurados que permitan priorizar competencias my abordar los desafíos éticos, legales y educativos emergentes. Métodos. Se llevó a cabo un estudio Delphi coordinado por la UEM, utilizando REDCap para gestionar las rondas iterativas. El proyecto recibió apoyo financiero de la Sociedad Española de Educación Médica (SEDEM). Expertos en educación médica, algunos con conocimientos específicos en IA, participaron en una serie de cuestionarios en línea. A través de retroalimentación anonimizada, los participantes evaluaron, refinaron y priorizaron un conjunto de áreas donde el impacto de la IA resulta esencial. Resultados. Los expertos coincidieron en la necesidad de habilidades más allá de la alfabetización técnica, destacando el pensamiento crítico, la interpretación de resultados generados por IA, la conciencia sobre sesgos y la responsabilidad profesional. Las consideraciones éticas y legales, especialmente las relacionadas con la privacidad, la transparencia y la toma de decisiones, fueron altamente priorizadas. También subrayaron el carácter transversal de la IA, sugiriendo que las competencias deben integrarse en todo el currículo y no tratarse como contenidos aislados. Discusión. A pesar de la heterogeneidad institucional, el consenso convergió en áreas que equilibran la innovación con salvaguardas éticas. Los resultados respaldan el desarrollo de un marco competencial capaz de guiar el diseño curricular, orientar la formación del profesorado y promover un uso responsable y basado en la evidencia de la IA, sin comprometer la autonomía profesional.

Background: A recent systematic review highlighted the lack of consensus on the needs that should be assessed in palliative care to develop the initial therapeutic plan. An agreed clinical interview guide for Multidimensional needs Assessment in Palliative Care (MAP) has recently been proposed. Objective: To evaluate the feasibility of implementing the MAP guide in clinical practice. Methods: A multicenter explanatory sequential mixed-methods feasibility study was conducted, assessing five indicators: a) acceptability to patients and family members (assessed by phone); b) participation (proportion of eligible patients assessed); c) applicability (time to administer); d) clinical utility as perceived by physicians; and e) implementation in practice. Twenty-four palliative care physicians across 10 services (outpatient, in-patient, domiciliary care) administered the MAP guide in 239 initial assessments of patients with advanced cancer. A focus group was conducted with 17 of the physicians to gather insights. Results: Indicators of acceptability, participation, applicability, and perceived clinical utility were fulfilled in over 90% of interviews. Implementation fell just short of the criterion (78% of needs assessed vs. 80% threshold). Patients and families provided highly positive feedback on the appropriateness of the MAP guide. Physicians found it flexible and easy to integrate into clinical practice, helping them structure the initial assessment and offer a much more comprehensive assessment of patients’ needs. Conclusions: The study supports the feasibility of using the MAP guide to explore palliative care needs. The MAP guide can help ensure that professionals do not overlook unmet needs, which could increase suffering and undermine quality of life.

Background: Several clinical trials have shown that nirsevimab, an antibody targeting the respiratory syncytial virus (RSV), reduces RSV bronchiolitis requiring admission. In 2023–2024, Catalonia and Andorra adopted immunization strategies for children p < .001). The rate of immunized patients among those eligible was 59.7%. The estimated effectiveness for RSV‐associated lower respiratory tract infection was 81.0% (95% confidence interval: 60.9–90.7), and for preventing severe disease (the need for NIV/CMV), 85.6% (41.7–96.4%). No significant differences by immunization status were observed in patients with RSV concerning viral coinfections, the need for NIV/CMV or length of hospital stay.Conclusions: This study provides real‐world evidence of the effectiveness of nirsevimab in preventing RSV‐lower respiratory tract infection hospitalization and severe disease in infants during their first RSV season following a systematic immunization program. Immunized patients did not exhibit a higher rate of viral coinfections nor differences in clinical severity once admitted.

Background: Empathy is a crucial competence in the doctor-patient relationship that can be trained to enhance health outcomes. The Consultation and Relational Empathy (CARE) measure assists patients in evaluating empathy of health care professionals. While the CARE measure has received extensive validation for application in primary and specialty care in diverse languages, no version has been adapted and validated for use in simulation contexts. This study aimed at adapting and validating a CARE measure for simulated patients (Sp-SIMCARE). Methods: The contextual adaptation to simulation contexts was completed in four phases by a panel of five experts, in collaboration with five simulated patients to ensure clarity, relevance, and equivalence in language and content: 1) preparation of a preliminary contextual adaptation proposal; 2) first version drafting; 3) pilot evaluation of the first version with simulated patients; and 4) review and refinement of the Sp-SIMCARE final version. The validation of the new measure was conducted on typical primary care scenarios with simulated patients evaluating performance of undergraduate medical students at the International University of Catalunya (Barcelona, ​​Spain). Simulated patients adopted four prototypical primary care patient roles: a) acute; b) chronic; c) with a high functional component; and d) difficult to deal with. The newly developed scale underwent analysis for convergent validity, acceptability and face validity, homogeneity, and internal reliability. Results: The adaptation process ensured that the content of the Sp-SIMCARE scale was unambiguous, relevant, and presented in a comprehensive manner, with uniform meanings for all users. Validation was performed via 270 interviews involving 95 students (mean age, 23 years; 62.2% females). The final version demonstrated satisfactory convergent validity (Spearman's rho coefficient of 0.730; p < 0.001), high acceptability and face validity (proportion of ‘Does not apply’ responses/missing values at 1.96%), and strong homogeneity (corrected item-total correlations in the range 0.705 to 0.865), and reliability (Cronbach’s alpha of 0.960). Conclusions: The Sp-SIMCARE measure proved to be psychometrically valid and reliable for simulated patients to evaluate undergraduate medical students. The use of this tool could potentially assist in the design and implementation of interventions aimed at fostering empathy in future doctors throughout their training.

This study aimed to investigate the association between saliva soluble angiotensin-converting enzyme 2 (sACE2) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children and adults. We selected a convenience sample of adults with post-acute SARS-CoV-2 infection and their household children living in quarantined family households of the metropolitan Barcelona region (Spain) during the spring 2020 pandemic national lockdown. Participants were tested for saliva sACE2 quantification by western blot and nasopharyngeal SARS-CoV-2 RT-PCR detection. A total of 161 saliva samples [82 (50.9%) from children; 79 (49.1%) from females] yielded valid western blot and RT-PCR results. Saliva sACE2 was detected in 79 (96.3%) children and 76 (96.2%) convalescent adults. Twenty (24.4%) children and 20 (25.3%) convalescent adults were positive for SARS-CoV-2 in nasopharynx by RT-PCR. SARS-CoV-2 RT-PCR-negative children had a significantly higher mean proportional level of saliva sACE2 (0.540 × 10^–3%) than RT-PCR-positive children (0.192 × 10^–3%, p < 0.001) and convalescent adults (0.173 × 10^–3%, p < 0.001). In conclusion, children negative for nasopharyngeal SARS-CoV-2 RT-PCR appear to exhibit a higher concentration of saliva sACE2 than SARS-CoV-2 RT-PCR-positive children and convalescent adults. Release of adequate levels of sACE2 in saliva could play a protective role against SARS-CoV-2.