Análisis de la mortalidad de los pacientes críticos con necesidad de ventilación mecánica

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid, Facultad de Medicina, Departamento de Fisiología. Fecha de lectura: 21-12-201

Unplanned extubation in the ICU: a marker of quality assurance of mechanical ventilation

One of the most frequent complications associated with endotracheal intubation itself in intensive care units is unplanned extubation, which represents a potentially serious complication given that many patients may need reintubation while in poor condition. This scenario may account for an increase in morbidity and even in mortality. To be able to compare the rates of unplanned extubation in clinical practice, unplanned extubation should be expressed as incidence density of days at risk. Also, this complication (unplanned extubation and reintubation rates) may be used as a marker of quality of weaning care in intensive care units

Enseñanza remota de emergencia ante la pandemia Covid-19 en Educación Media Superior y Educación Superior

Este trabajo tiene por objetivo realizar una aproximación a las experiencias del profesorado y estudiantado de Educación Media y Superior en torno a la estrategia de enseñanza implementada durante la emergencia sanitaria por Covid-19. La muestra se integró por 44 docentes y 116 estudiantes originarios de un municipio del sur del estado de Sonora, México. Desde el punto de vista teórico se atiende a los principios de la Enseñanza Remota de Emergencia para enfrentar la crisis a través del trabajo escolar mediado por tecnología. Se diseñó un cuestionario ad hoc para explorar: a) el uso de dispositivos, conectividad y espacios alternativos de instrucción para dar continuidad a los estudios, b) la implementación de los recursos tecnológicos con base en la experiencia, dificultades y preparación, c) evaluación y apoyo recibido y d) adaptación y proyección de los aprendizajes. Los resultados evidencian el uso de laptop y teléfono inteligente como los dispositivos de mayor uso para el estudio, y el envío y recepción de información respectivamente. Además, se señala el incremento de tiempo dedicación y dificultades para la recepción-evaluación de las actividades escolares tanto en docentes como estudiantes. En cuanto al apoyo institucional la habilitación de cursos, softwares y plataformas virtuales representan las principales acciones para dar continuidad a los estudios. Destacando el esfuerzo, voluntad, manejo de tecnología, cambios de dinámica respecto al rol y la revalorización de las clases presenciales como los principales aprendizajes durante el confinamiento

Enseñanza remota de emergencia ante la pandemia Covid-19 en Educación Media Superior y Educación Superior

Este trabajo tiene por objetivo realizar una aproximación a las experiencias del profesorado y estudiantado de Educación Media y Superior en torno a la estrategia de enseñanza implementada durante la emergencia sanitaria por Covid-19. La muestra se integró por 44 docentes y 116 estudiantes originarios de un municipio del sur del estado de Sonora, México. Desde el punto de vista teórico se atiende a los principios de la Enseñanza Remota de Emergencia para enfrentar la crisis a través del trabajo escolar mediado por tecnología. Se diseñó un cuestionario ad hoc para explorar: a) el uso de dispositivos, conectividad y espacios alternativos de instrucción para dar continuidad a los estudios, b) la implementación de los recursos tecnológicos con base en la experiencia, dificultades y preparación, c) evaluación y apoyo recibido y d) adaptación y proyección de los aprendizajes. Los resultados evidencian el uso de laptop y teléfono inteligente como los dispositivos de mayor uso para el estudio, y el envío y recepción de información respectivamente. Además, se señala el incremento de tiempo dedicación y dificultades para la recepción-evaluación de las actividades escolares tanto en docentes como estudiantes. En cuanto al apoyo institucional la habilitación de cursos, softwares y plataformas virtuales representan las principales acciones para dar continuidad a los estudios. Destacando el esfuerzo, voluntad, manejo de tecnología, cambios de dinámica respecto al rol y la revalorización de las clases presenciales como los principales aprendizajes durante el confinamiento

Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection

La enfermedad por coronavirus 2019 (COVID-19) es una infección del tracto respiratorio causada por un nuevo coronavirus emergente que se reconoció por primera vez en Wuhan, China, en diciembre de 2019. Actualmente la Organización Mundial de la Salud (OMS) ha definido la infección como pandemia y existe una situación de emergencia sanitaria y social para el manejo de esta nueva infección. Mientras que la mayoría de las personas con COVID-19 desarrollan solo una enfermedad leve o no complicada, aproximadamente el 14% desarrollan una enfermedad grave que requiere hospitalización y oxígeno, y el 5% pueden requerir ingreso en una unidad de cuidados intensivos. En casos severos, COVID-19 puede complicarse por el síndrome de dificultad respiratoria aguda (SDRA), sepsis y shock séptico y fracaso multiorgánico. Este documento de consenso se ha preparado sobre directrices basadas en evidencia desarrolladas por un panel multidisciplinario de profesionales médicos de cuatro sociedades científicas españolas (Sociedad Española de Medicina Intensiva y Unidades Coronarias [SEMICYUC], Sociedad Española de Neumología y Cirugía Torácica [SEPAR], Sociedad Española de Urgencias y Emergencias [SEMES], Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor [SEDAR]) con experiencia en el manejo clínico de pacientes con COVID-19 y otras infecciones virales, incluido el SARS, así como en sepsis y SDRA. El documento proporciona recomendaciones clínicas para el soporte respiratorio no invasivo (ventilación no invasiva, oxigenoterapia de alto flujo con cánula nasal) en cualquier paciente con presentación sospechada o confirmada de COVID-19 con insuficiencia respiratoria aguda. Esta guía de consenso debe servir como base para una atención optimizada y garantizar la mejor posibilidad de supervivencia, así como permitir una comparación fiable de las futuras intervenciones terapéuticas de investigación que formen parte de futuros estudios observacionales o de ensayos clínicos.Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly emergent coronavirus, that was first recognized in Wuhan, China, in December 2019. Currently, the World Health Organization (WHO) has defined the infection as a global pandemic and there is a health and social emergency for the management of this new infection. While most people with COVID-19 develop only mild or uncomplicated illness, approximately 14% develop severe disease that requires hospitalization and oxygen support, and 5% require admission to an intensive care unit. In severe cases, COVID-19 can be complicated by the acute respiratory distress syndrome (ARDS), sepsis and septic shock, and multiorgan failure. This consensus document has been prepared on evidence-informed guidelines developed by a multidisciplinary panel of health care providers from four Spanish scientific societies (Spanish Society of Intensive Care Medicine [SEMICYUC], Spanish Society of Pulmonologists [SEPAR], Spanish Society of Emergency [SEMES], Spanish Society of Anesthesiology, Reanimation, and Pain [SEDAR]) with experience in the clinical management of patients with COVID-19 and other viral infections, including SARS, as well as sepsis and ARDS. The document provides clinical recommendations for the noninvasive respiratory support (noninvasive ventilation, high flow oxygen therapy with nasal cannula) in any patient with suspected or confirmed presentation of COVID-19 with acute respiratory failure. This consensus guidance should serve as a foundation for optimized supportive care to ensure the best possible chance for survival and to allow for reliable comparison of investigational therapeutic interventions as part of randomized controlled trials

Impacts of Use and Abuse of Nature in Catalonia with Proposals for Sustainable Management

This paper provides an overview of the last 40 years of use, and in many cases abuse, of the natural resources in Catalonia, a country that is representative of European countries in general, and especially those in the Mediterranean region. It analyses the use of natural resources made by mining, agriculture, livestock, logging, fishing, nature tourism, and energy production and consumption. This use results in an ecological footprint, i.e., the productive land and sea surface required to generate the consumed resources and absorb the resulting waste, which is about seven times the amount available, a very high number but very similar to other European countries. This overexploitation of natural resources has a huge impact on land and its different forms of cover, air, and water. For the last 25 years, forests and urban areas have each gained almost 3% more of the territory at the expense of agricultural land; those municipalities bordering the sea have increased their number of inhabitants and activity, and although they only occupy 6.7% of the total surface area, they account for 43.3% of the population; air quality has stabilized since the turn of the century, and there has been some improvement in the state of aquatic ecosystems, but still only 36% are in good condition, while the remainder have suffered morphological changes and different forms of nonpoint source pollution; meanwhile the biodiversity of flora and fauna remains still under threat. Environmental policies do not go far enough so there is a need for revision of the legislation related to environmental impact and the protection of natural areas, flora, and fauna. The promotion of environmental research must be accompanied by environmental education to foster a society which is more knowledgeable, has more control and influence over the decisions that deeply affect it. Indeed, nature conservation goes hand in hand with other social and economic challenges that require a more sustainable vision. Today's problems with nature derive from the current economic model, which is environmentally unsustainable in that it does not take into account environmental impacts. Lastly, we propose a series of reasonable and feasible priority measures and actions related to each use made of the country's natural resources, to the impacts they have had, and to their management, in the hope that these can contribute to improving the conservation and management of the environment and biodiversity and move towards sustainability

Impacts of Use and Abuse of Nature in Catalonia with Proposals for Sustainable Management

This paper provides an overview of the last 40 years of use, and in many cases abuse, of the natural resources in Catalonia, a country that is representative of European countries in general, and especially those in the Mediterranean region. It analyses the use of natural resources made by mining, agriculture, livestock, logging, fishing, nature tourism, and energy production and consumption. This use results in an ecological footprint, i.e., the productive land and sea surface required to generate the consumed resources and absorb the resulting waste, which is about seven times the amount available, a very high number but very similar to other European countries. This overexploitation of natural resources has a huge impact on land and its different forms of cover, air, and water. For the last 25 years, forests and urban areas have each gained almost 3% more of the territory at the expense of agricultural land; those municipalities bordering the sea have increased their number of inhabitants and activity, and although they only occupy 6.7% of the total surface area, they account for 43.3% of the population; air quality has stabilized since the turn of the century, and there has been some improvement in the state of aquatic ecosystems, but still only 36% are in good condition, while the remainder have suffered morphological changes and different forms of nonpoint source pollution; meanwhile the biodiversity of flora and fauna remains still under threat. Environmental policies do not go far enough so there is a need for revision of the legislation related to environmental impact and the protection of natural areas, flora, and fauna. The promotion of environmental research must be accompanied by environmental education to foster a society which is Land 2021, 10, 144 3 of 53 more knowledgeable, has more control and influence over the decisions that deeply affect it. Indeed, nature conservation goes hand in hand with other social and economic challenges that require a more sustainable vision. Today’s problems with nature derive from the current economic model, which is environmentally unsustainable in that it does not take into account environmental impacts. Lastly, we propose a series of reasonable and feasible priority measures and actions related to each use made of the country’s natural resources, to the impacts they have had, and to their management, in the hope that these can contribute to improving the conservation and management of the environment and biodiversity and move towards sustainability.info:eu-repo/semantics/publishedVersio

Educar para el reconocimiento de sí mismo y de los otros significativos

This article reflects on the shaping of identity in schools through the recognition of self and significant others. The approach is based on five axes of analysis: the peer group, coexistence spaces and play at school, stigmatization and school integration, the role of teachers in shaping the self, and the care of self and others in the health emergency. As a theoretical reference, symbolic interactionism is referred to, highlighting the social function of the school towards the understanding of the self and the recognition of others in the school space.El presente artículo reflexiona en torno conformación de la identidad en los centros educativos a través del reconocimiento de sí mismo y de los otros significativos. El abordaje se realiza desde cinco ejes de análisis: el grupo de iguales, los espacios de convivencia y el juego en la escuela, estigmatización e integración escolar, el papel del profesorado en la conformación del sí mismo, el cuidado de sí y de los otros en la emergencia sanitaria. Como referente teórico se alude al interaccionismo simbólico, destacando la función social de la escuela hacia la comprensión de sí mismo y el reconocimiento de los otros en el espacio escolar

MicroRNAs as biomarkers of acute lung injury

Acute respiratory distress syndrome (ARDS) is a common and complex inflammatory lung diseases affecting critically ill patients requiring mechanical ventilation. MicroRNAs (miRNAs), a novel pathway of non-coding RNA molecules that regulate gene expression at the post-transcriptional level, have emerged as a novel class of gene expression, and can play important roles in inflammation or apoptosis, which are common manifestations of ARDS and diffuse alveolar damage (DAD). In the present review, we discuss the role of miRNAs as biomarkers of ARDS and DAD, and their potential use as therapeutic targets for this condition.Sin financiación3.689 JCR (2018) Q1, 121/244 Oncology0.958 SJR (2018) Q1, 602/2844 Medicine (miscellaneous)No data IDR 2018UE