Plan de comunicación interna y externa de la Facultad de Ciencias Sociales. Programa de Actividades Complementarias y de Difusión Cultural de la Facultad II

Memoria ID-0258. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2014-2015

Farmacovigilancia en pediatría : programa de monitorización intensiva en pacientes hospitalizados realizado en la sala de pre-escolares del Hospital Universitario de Granada

Reducción altaSe ha comprobado fehacientemente en el campo de la medicina interna de los adultos que es practico efectuar programas de farmacovigilancia en pacientes hospitalizados en gran escala y en muchos centros, para vigilar reacciones farmacológicas perjudiciales, reconociéndose la necesidad de un programa de monitorización intensiva en niños de edades comprendida entre los 13 y los 96 meses, hospitalizados en el servicio de pediatría del hospital universitario de granada. De un total de 828 niños seleccionados durante dos años, fueron monitorizados finalmente 695, de los que 597 recibieron medicamentos durante su estancia en el hospital, apareciendo algún tipo de farmacopatología en el 4,3% de los mismos, de los que 18 eran varones. Los broncodilatadores fueron los medicamentos implicados con mas frecuencia en la aparición de reacciones adversas, seguidos de los antibacterianos, antiepilécticos, corticoides y antianémicos, con porcentajes de 40, 30, 20, 7 y 3% respectivamente. Las manifestaciones clínicas de las reacciones adversas fueron principalmente de tipo gastrointestinal, del sistema nervioso central, cardiovasculares, dermatológicas y endocrinas respectivamente, con porcentajes de 40, 38, 10, 10 y 2% respectivamente. El 46,6% de las reacciones adversas detectadas fueron catalogadas como moderadas, el 43,3% como leves y el 10% como graves, en relación con la intensidad de las manifestaciones clínicas. Tras la aplicación de los criterios de imputabilidad se aprecio que el 36,6% eran posibles, el 33,3% ciertas y el 30% probables. En relación con los mecanismos de producción de las reacciones adversas se detecto que el 15,4% de las mismas podían ser catalogadas como del tipo b o inesperadas, perteneciendo el resto al tipo a, esperadas y, por tanto, evitables en la mayoría de las ocasiones. Los mecanismos de acción fueron farmacodinámicos en el 38,4% de los casos; debidos a interacciones farmacológicas en el 23% de las situaciones; determinados por mecanismos de toxicidad en el 19,2% de los pacientes; inducidos por mecanismos alérgicos en el 11,5% en el 11,5% y pro reacciones catalogadas de idiosincrasia en el 7,9% del total de enfermos con reacciones adversasUniv. de Granada, Departamento de Farmacología-Radiología y Pediatría. Leída el 20-07-8

Discovering HIV related information by means of association rules and machine learning

Acquired immunodeficiency syndrome (AIDS) is still one of the main health problems worldwide. It is therefore essential to keep making progress in improving the prognosis and quality of life of affected patients. One way to advance along this pathway is to uncover connections between other disorders associated with HIV/AIDS-so that they can be anticipated and possibly mitigated. We propose to achieve this by using Association Rules (ARs). They allow us to represent the dependencies between a number of diseases and other specific diseases. However, classical techniques systematically generate every AR meeting some minimal conditions on data frequency, hence generating a vast amount of uninteresting ARs, which need to be filtered out. The lack of manually annotated ARs has favored unsupervised filtering, even though they produce limited results. In this paper, we propose a semi-supervised system, able to identify relevant ARs among HIV-related diseases with a minimal amount of annotated training data. Our system has been able to extract a good number of relationships between HIV-related diseases that have been previously detected in the literature but are scattered and are often little known. Furthermore, a number of plausible new relationships have shown up which deserve further investigation by qualified medical experts

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

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P &lt; 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)