Utility of FEV1/FEV6 index in patients with multimorbidity hospitalized for decompensation of chronic diseases

Spirometry remains essential for the diagnosis of airway obstruction. Nevertheless, its performance in elderly hospitalized patients with multimorbidity can be difficult. The aim of this study is to assess the utility of the COPD-6 portable device in this population. We included all patients hospitalized for exacerbation of chronic diseases in a medical ward specialized in the care of multimorbidity patients, between September 2017 and May 2018. A questionnaire including sociodemographic, cognitive and functional impairment, among other variables, was completed the last day of admission. Subsequently, patients attempted to perform three valid respiratory manoeuvres with the COPD-6 device and then conventional spirometry. A total of 184 patients were included (mean age of 79.61 years, 55% men). Forty-seven (25.54%) patients were able to perform complete spirometric manoeuvres and 99 (53.8%) could perform a valid FEV1/FEV6 determination. The inability to perform a valid spirometry was related with the patient's age, functional physical disability, cognitive impairment or the presence of delirium or dysphagia during admission. Only 9% of patients with a Mini Mental Cognitive Examination (MMEC) lower than 24 points could perform a valid spirometry. Of the patients with an MMEC < 24 points and unable to perform spirometry, 34% were able to complete the FEV1/FEV6 manoeuvres. No differences were found in the Charlson index, multimorbidity scale, number of domiciliary drugs, or length of stay between those patients able and those not able to perform respiratory manoeuvres. The agreement between the values for FEV1 measured with COPD-6 and those observed in the spirometry was good (r: 0.71; p<0.0001). Inability to perform a valid spirometry during hospitalization in elderly patients with multimorbidity is frequent and related with functional and cognitive impairment. FEV1/FEV6 determination using the COPD-6 portable device allows an important percentage of the patients with limitations to complete spirometric measurement

Risk factors associated with inappropriate empirical antimicrobial treatment in bloodstream infections. A cohort study

Introduction: Bloodstream infections (BSI) are a major cause of mortality all over the world. Inappropriate empirical antimicrobial treatment (i-EAT) impact on mortality has been largely reported. However, information on related factors for the election of i-EAT in the treatment of BSI in adults is lacking. The aim of the study was the identification of risk-factors associated with the use of i-EAT in BSI.Methods: A retrospective, observational cohort study, from a prospective database was conducted in a 400-bed acute-care teaching hospital including all BSI episodes in adult patients between January and December 2018. The main outcome variable was EAT appropriation. Multivariate analysis using logistic regression was performed.Results: 599 BSI episodes were included, 146 (24%) received i-EAT. Male gender, nosocomial and healthcare-associated acquisition of infection, a high Charlson Comorbidity Index (CCI) score and the isolation of multidrug resistant (MDR) microorganisms were more frequent in the i-EAT group. Adequation to local guidelines’ recommendations on EAT resulted in 91% of appropriate empirical antimicrobial treatment (a-EAT). Patients receiving i-EAT presented higher mortality rates at day 14 and 30 when compared to patients with a-EAT (14% vs. 6%, p = 0.002 and 22% vs. 9%, p &lt; 0.001 respectively). In the multivariate analysis, a CCI score ≥3 (OR 1.90 (95% CI 1.16–3.12) p = 0.01) and the isolation of a multidrug resistant (MDR) microorganism (OR 3.79 (95% CI 2.28–6.30), p &lt; 0.001) were found as independent risk factors for i-EAT. In contrast, female gender (OR 0.59 (95% CI 0.35–0.98), p = 0.04), a correct identification of clinical syndrome prior to antibiotics administration (OR 0.26 (95% CI 0.16–0.44), p &lt; 0.001) and adherence to local guidelines (OR 0.22 (95% CI 0.13–0.38), p &lt; 0.001) were identified as protective factors against i-EAT.Conclusion: One quarter of BSI episodes received i-EAT. Some of the i-EAT related factors were unmodifiable (male gender, CCI score ≥3 and isolation of a MDR microorganism) but others (incorrect identification of clinical syndrome before starting EAT or the use of local guidelines for EAT) could be addressed to optimize the use of antimicrobials

Afavoreix la metodologia per projectes la interculturalitat a l’aula d’infantil?

Treball Final de Grau en Mestre o Mestra d'Educació Infantil. Codi: MP1040. Curs: 2015/2016 Universitat Jaume I. Departament d'EducacióEn el present treball de Final de Grau, d’ara endavant TFG, s’exposen els beneficis de treballar per projectes, la importància de treballar la diversitat cultural en Educació Infantil i la relació que existeix entre els dos aspectes clau, per la qual cosa, es presenta una part teòrica que reforça aquesta idea i una proposta d’intervenció en la qual mitjançant el treball per projectes, s’aplica la integració intercultural a una realitat d’aula diversa. Aquest TFG mostra que treballar per projectes és una metodologia que desenvolupa i potència substancialment els valors, està oberta a la participació de les famílies, s’adapta a les necessitats de l’alumnat i és flexibilitza a l’hora d’aplicar-se. És per això que, gràcies a aquesta metodologia, es pot integrar la diversitat cultural en l’etapa d’Infantil, sent els i les alumnes i les famílies els protagonistes de la creació de la identitat, procedència i cultura pròpies.n the present final year project, onwards “TFG”, presents the profits of working for projects, the importance of focusing on cultural diversity in early education and the relationship there is between the two key aspects. Thus, it also presents a theoretical part that reinforces this idea and a proposal of intervention in which, through the work for projects, the intercultural integration is applied to the reality of a diverse classroom. This TFG shows that working for projects is a methodology that substantially develops and fosters values, it is open to the participation of the families, it adapts to the needs of the pupils and it is flexible when it comes to its implementation. This is why, thanks to this methodology, it is possible to integrate cultural diversity in early years, being the pupils and their families the main protagonists of the creation of their own identity, background and culture

Projecte d’edició de les traduccions catalanes medievals de la primera part del Memorial d’Àngela de Foligno

Treball de fi de grau d'Humanitats. Curs 2017-2018Directora: Maria MorrásAquest treball pretén ser un projecte d’edició de la primera part de l’inici del corpus textual d’Àngela de Foligno, anomenat Memorial. Els fragments tinguts en consideració, doncs, seran el pròleg del seu confessor, els passos que va seguir la santa en la seva conversió, un fragment d’una visió posterior que ha sigut col·locat després dels passos en dues de les traduccions, i finalment la visió d’Assís, la que defineix i a la vegada desencadena el Liber d’Àngela de Foligno

Projecte d’edició de les traduccions catalanes medievals de la primera part del Memorial d’Àngela de Foligno

Treball de fi de grau d'Humanitats. Curs 2017-2018Aquest treball pretén ser un projecte d’edició de la primera part de l’inici del corpus textual d’Àngela de Foligno, anomenat Memorial. Els fragments tinguts en consideració, doncs, seran el pròleg del seu confessor, els passos que va seguir la santa en la seva conversió, un fragment d’una visió posterior que ha sigut col·locat després dels passos en dues de les traduccions, i finalment la visió d’Assís, la que defineix i a la vegada desencadena el Liber d’Àngela de Foligno

El valor estadístico de la vida en España

The valuation of the risk of life is a key element in the cost-benefit analysis in the majority of the public policies directed to reduce the mortality risk. Although the estimation of the costs is, in fact, non-problematic, the quantification and monetisation of benefits is highly complex due to the non-availability of a monetary value of a reduction in the risk of death. Using the hedonic wage models, this paper makes an estimation of the ‘statistical value of life’ upon the base of the Spanish labour market through the construction of indexes of risk that simultaneously incorporate the occupation and the activity branch for the 1995-1999 period.Value of statistical life, job risk, hedonic wage model

Pulse Wave Velocity and Blood Pressure Variability as Prognostic Indicators in Very Elderly Patients

There is scarce evidence for the prognostic importance of hemodynamic measures, such as blood pressure (BP), BP variability, and arterial stiffness, in the very elderly population with advanced chronic conditions. We aimed to evaluate the prognostic importance of 24 h BP, BP variability, and arterial stiffness in a cohort of very elderly patients admitted to the hospital due to a decompensated chronic disease. We studied 249 patients older than 80 (66% women; 60% congestive heart failure). Noninvasive 24 h monitoring was used to determine 24 h brachial and central BP, BP and heart rate variabilities, aortic pulse wave velocity, and BP variability ratios during admission. The primary outcome was 1-year mortality. Aortic pulse wave velocity (3.3 times for each SD increase) and BP variability ratio (31% for each SD increase) were associated with 1-year mortality, after adjustments for clinical confounders. Increased systolic BP variability (38% increase for each SD change) and reduced heart rate variability (32% increase for each SD change) also predicted 1-year mortality. In conclusion, increased aortic stiffness and BP and heart rate variabilities predict 1-year mortality in very elderly patients with decompensated chronic conditions. Measurements of such estimates could be useful in the prognostic evaluation of this specific population

Medición de la eficiencia hotelera

La eficiencia es uno de los factores que incide de forma más decisiva sobre las ganancias de productividad y competitividad de una industria. Sin embargo, en algunos segmentos de actividad, como el de la hostelería, la medición de la eficiencia ha sido escasamente tratada por la literatura económica aplicada, tanto a nivel nacional como internacional, debido, en gran medida, al carácter intangible de las actividades de servicios. En este contexto, el presente trabajo tiene como objetivo medir la eficiencia técnica de una muestra de cincuenta establecimientos de alojamiento turístico de las Islas Baleares, orientados al turismo de ‘sol y playa’ y de categoría media, a partir de la aplicación de las técnicas del Data Envelopment Analisis (DEA) y explicar las diferencias que se observan de acuerdo con los atributos que caracterizan a los establecimientos considerados. Para ello, se han utilizado los datos derivados de una encuesta donde se recogen, para el ejercicio del 2004, tanto las variables input y output que permiten nutrir el modelo como los factores que describen las características del establecimiento y del entorno en el que opera. Con todo, los resultados muestran que los establecimientos más eficientes son aquellos que presentan una mayor proporción de ingresos por servicios no derivados exclusivamente del alojamiento, mientras que no se aprecian diferencias significativas según el tamaño o el régimen de tenencia del establecimiento.Eficiencia empresarial; Data Envelopment Análisis; Industria hotelera

Utility of FEV1/FEV6 index in patients with multimorbidity hospitalized for decompensation of chronic diseases.

Spirometry remains essential for the diagnosis of airway obstruction. Nevertheless, its performance in elderly hospitalized patients with multimorbidity can be difficult. The aim of this study is to assess the utility of the COPD-6 portable device in this population. We included all patients hospitalized for exacerbation of chronic diseases in a medical ward specialized in the care of multimorbidity patients, between September 2017 and May 2018. A questionnaire including sociodemographic, cognitive and functional impairment, among other variables, was completed the last day of admission. Subsequently, patients attempted to perform three valid respiratory manoeuvres with the COPD-6 device and then conventional spirometry. A total of 184 patients were included (mean age of 79.61 years, 55% men). Forty-seven (25.54%) patients were able to perform complete spirometric manoeuvres and 99 (53.8%) could perform a valid FEV1/FEV6 determination. The inability to perform a valid spirometry was related with the patient's age, functional physical disability, cognitive impairment or the presence of delirium or dysphagia during admission. Only 9% of patients with a Mini Mental Cognitive Examination (MMEC) lower than 24 points could perform a valid spirometry. Of the patients with an MMEC < 24 points and unable to perform spirometry, 34% were able to complete the FEV1/FEV6 manoeuvres. No differences were found in the Charlson index, multimorbidity scale, number of domiciliary drugs, or length of stay between those patients able and those not able to perform respiratory manoeuvres. The agreement between the values for FEV1 measured with COPD-6 and those observed in the spirometry was good (r: 0.71; p<0.0001). Inability to perform a valid spirometry during hospitalization in elderly patients with multimorbidity is frequent and related with functional and cognitive impairment. FEV1/FEV6 determination using the COPD-6 portable device allows an important percentage of the patients with limitations to complete spirometric measurement