Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Análisis de la eficiencia de los grupos de investigación por ramas de conocimiento

Resumen tomado de la publicaciónSe analiza, mediante el Análisis Envolvente de Datos (DEA), la eficiencia técnica del conjunto de grupos de investigación del sistema universitario de una comunidad autónoma, pertenecientes a las cinco ramas del conocimiento. Se establece un modelo que puede ayudar a la toma de decisiones por parte de los órganos de gobierno de cualquier Comunidad Autónoma en la medida en que suministra información detallada y objetiva de las causas de las (in)eficiencia(s) de los diferentes grupos de investigación: Arte y Humanidades, Ciencias, Ciencias de la Salud, Ciencias Sociales y Jurídicas y, por último, Ingeniería y Arquitectura. Se complementa con un análisis cluster que ayuda a explicar los aspectos más relevantes de las ramas evaluadas (ventajas y o debilidades).NavarraUniversidad de Navarra. Biblioteca; 31080 Pamplona; +34948425600; +3494817731080; [email protected]

Estudio de la eficiencia técnica de los grupos de investigación de economía en Andalucía

Resumen tomado de la publicaciónSe analiza, mediante la técnica del Análisis Envolvente de Datos (DEA), la eficiencia técnica del conjunto de grupos de investigación pertenecientes al área de Economía de las nueve universidades públicas de Andalucía. Esta labor se complementa con un análisis cluster que ayuda a explicar los aspectos más relevantes (ventajas y o debilidades) de las unidades evaluadas. Se ofrece un modelo que puede ayudar a la toma de decisiones por parte de los órganos de gobierno de esta importante Comunidad Autónoma, en la medida en que suministra información detallada y objetiva de las causas de las (in)eficiencia(s) de los grupos de investigación.NavarraUniversidad de Navarra. Biblioteca; 31080 Pamplona; +34948425600; +3494817731080; [email protected]

Investigaciones de Economía de la Educación 5

Este trabajo analiza, mediante el Análisis Envolvente de Datos (DEA), la eficiencia técnica del conjunto de grupos de investigación del sistema universitario de una comunidad autónoma, pertenecientes a las cinco ramas del conocimiento: Arte y Humanidades, Ciencias, Ciencias de la Salud, Ciencias Sociales y Jurídicas y, por último, Ingeniería y Arquitectura. Este estudio se complementa con un análisis cluster que ayuda a explicar los aspectos más relevantes de las ramas evaluadas (ventajas y/o debilidades). Nuestra aportación, por tanto, establece un modelo que puede ayudar a la toma de decisiones por parte de los órganos de gobierno de cualquier Comunidad Autónoma en la medida en que suministra información detallada y objetiva de las causas de las (in)eficiencia(s) de los diferentes grupos de investigación.Eficiencia Técnica; Análisis Envolvente de Datos; Análisis Cluster; Universidad; Investigación; Ramas de Conocimiento

Aprender no es aburrido

Este proyecto pretende fomentar el interés de los alumnos por el aprendizaje y que adquieran los conceptos mínimos de las distintas materias que componen el currículo de ESO. A la vez, se trabajan las destrezas básicas y las técnicas de estudio a través de juegos. Cada grupo elabora un juego de mesa de preguntas y respuestas y diseñan ellos mismos el tablero y las reglas del juego. Estos juegos se intercambian entre los distintos grupos y se usan para repasar los contenidos de las asignaturas. Además se realiza un juego que consiste en tres pruebas individuales de conocimientos y dos pruebas colectivas de investigación que permiten a cada clase ir sumando puntos. La clase que queda primera gana una excursión. El proyecto ha recibido una gran acogida por parte del alumnado que se ha esforzado por trabajar en equipo, y también ha recibido una valoración muy positiva por parte del profesorado que considera que ha incidido positivamente en los resultados académicos de los alumnos. El proyecto adjunta tres CD-ROM con el juego de Historia del Arte de segundo de Bachillerato, Educación Física de primero de Bachillerato y de memoria visual; y un anexo con la lista de materiales elaborados y fotografías del desarrollo de la experiencia.Madrid (Comunidad Autónoma). Consejería de Educación. Dirección General de Ordenación AcadémicaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients

Role of age and comorbidities in mortality of patients with infective endocarditis.

The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups: A total of 3120 patients with IE (1327  There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in th

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective