Design and validation of an instrument to listen the student voice in specialized open classrooms

Las voces del alumnado con necesidades educativas especiales graves y permanentes, generalmente, han sido excluidas de los procesos de investigación en los que han estado implicados. De ahí, la necesidad de disponer de instrumentos que permitan recoger sus opiniones y darles visibilidad, siendo el objetivo principal de este trabajo el diseño y la validación de un cuestionario adaptado a las características del alumnado con necesidades educativas especiales graves y permanentes escolarizados en las Aulas Abiertas Especializadas (AAE). Se ha contado con la participación de 21 profesionales expertos en educación inclusiva y en metodología, empleando como estrategia metodológica principal la técnica de grupos focales. La naturaleza mixta de los datos conlleva un doble tratamiento, para lo cual se empleó el programa Atlas-Ti Versión 8, así como el paquete estadístico SPSS V.24 para analizar la concordancia inter-jueces. Los resultados muestran que se ha diseñado un cuestionario válido para el fin que se pretendía, erigiéndose los grupos focales como una vía adecuada para la construcción y validación de instrumentos.The voices of students with serious and permanent special educational needs have been excluded from the research processes in which they have been involved. Therefore, it is necessary to have instruments to collect their opinions and give them visibility. The main objective of this work is to design and validate an adapted questionnaire to the characteristics of students with serious and permanent special education needs who are enrolled in the Open Specialized Classrooms. This work has counted with the participation of 21 professionals in inclusive education and methodology, using the technique of focal groups as the main methodological strategy. The mixed nature of the data implies a double treatment, for which the Atlas-Ti Version 8 program was used and the statistical package SPSS V.24 to analyse the inter-judge concordance. The results show that a valid questionnaire has been designed for the purpose that was intended. Moreover, the focus groups have been established as an adequate way to construct and validate instruments.Este trabajo forma parte del proyecto de investigación “Medidas específicas de atención a la diversidad: evaluación de las aulas abiertas especializadas en la Región de Murcia” concedido por el Ministerio de Economía y Competitividad, España

Aproximación terapéutica a las infecciones por microorganismos multirresistentes.

RESUMEN: La infección nosocomial por microorganismos multirresistentes se asocia en la mayoría de los casos a un retraso en el inicio de un tratamiento adecuado y a un fracaso terapéutico, prolongando la estancia hospitalaria, los costes y la mortalidad. Los microorganismos multirresistentes de mayor importancia clínica son: Staphylococcus aureus resistente a meticilina, Enterococcus resistente a vancomicina, enterobacterias multirresistentes, Pseudomonas aeruginosa y Acinetobacter multirresistente. Entre los factores de riesgo para presentar infecciones por microorganismos multirresistentes destacan el tener una estancia hospitalaria prolongada, el ingreso en unidades de cuidados intensivos, el empleo de antibióticos de amplio espectro y la presencia de dispositivos invasivos. Es de gran importancia la correcta elección de la antibioterapia para el tratamiento de infecciones por microorganismos multirresistentes, pero no son menos importantes algunas actitudes básicas descritas en esta revisión, que pueden evitar que estas infecciones lleguen a producirse, con lo que ahorraremos al paciente riesgo, tiempo de hospitalización y toxicidad farmacológica.ABSTRACT: Nosocomial infection by multiresistant microorganisms is associated with delayed initiation of adequate therapy and therapeutic failure, prolonging hospital stay, cost and mortality. Multiresistant microorganisms with a higher clinically relevance are: methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, multiresistant enterobacteria, Pseudomonas aeruginosa and multiresistant Acinetobacter. The risk factors for infection due to multiresistant microorganisms are mainly: to have a prolonged hospital stay, stay in a intensive care unit, the use of broad-spectrum antibiotics and the presence of invasive devices. It is really important the correct choice of antibiotherapy to treat infections by multiresistant microorganisms. However, there are not less important some basic attitudes described in this review, which could prevent that these infections happen, decreasing the patient risk, time of hospitalization and drug toxicity

Uso racional de los antibióticos y multirresistencia. Nuevos antimicrobianos.

RESUMEN: El uso inadecuado de antibióticos es actualmente un problema mundial que requiere la revisión de las políticas sanitarias, dada la repercusión que tiene tanto a nivel individual como social. Es de gran importancia detectar la infección l oantes posible, identificar el foco y el patógeno causal, así como su susceptibilidad antibiótica para establecer un tratamiento antibiótico apropiado. Las resistencias a antibióticos son un problema que va aumentando tanto a nivel comunitario como hospitalario, generando una mayor morbilidad, mortalidad y gastos hospitalarios. Debido a esto en los últimos años se han creado en distintos centros hospitalarios programas de optimización de tratamientos antimicrobianos (PROA). Por otro lado, el aumento de las resistencias ha favorecido un incremento en el desarrollo y posterior comercialización de nuevas moléculas antibióticas frente a los principales microorganismos hospitalarios multirresistentes.ABSTRACT: The bad use of antibiotics is a growing problem in global public health that requires action by all government sectors and society in general. It is very important to detect the infection as soon as possible, identify the source of infection, causative pathogen and its antibiotic susceptibility to establish an appropriate antibiotic treatment. The antibiotic resistance is a problem that is increasing over time at Community and in hospitals, generating an increase in morbidity and mortality. Because of this, years ago, antimicrobial stewardships programs began to be created in different hospitals (called PROA in this document). On the other hand, increased resistance has favored the development and commercialization of new molecules of antibiotics against most of the multiresistant microorganisms

Efficiency of a self-administered outpatient parenteral antimicrobial therapy (s-opat) for infectiveendocarditis within the context of a shortened hospital admission based on hospital at homeprogram

OBJECTIVE: This study aimed to evaluate the efficiency of treatment of infectious endocarditis (IE) via Self-administered Outpatient Parenteral Antimicrobial Therapy (S-OPAT) supported by a shortening hospital admission program in a hospitalization-at-home unit (HAH), including a short review of the literature. METHODS: Ambispective cohort study of 57 episodes of IE in 54 patients treated in an HAH unit between 1988 and 2014 who receive S-OPAT after prior intra-hospital clinical stabilization. Characteristics of each episode of IE, safety and efficiency of the care model, were analyzed. RESULTS: Forty-three (76%) patients were males with a median age of 61 years (SD = 16.5). A total of 37 (65%) episodes affected the native valve (42% the aortic valve). In 75%, a micro-organism was isolated, of which 88% were Gram-positive bacteria. No deaths occurred during HAH program, clinical complications appeared in 30% of episodes, only 6 patients were re-admitted to hospital although no patient died. In the 12 months' follow-up 3 cases had a recurrence. The average cost of a day stay in HAH was €174 while in traditional cardiology hospitalization was €1100. The total average cost of treatment of each episode of IE managed entirely in hospital was calculated as €54,723. Application of the S-OPAT model based on HAH meant a cost reduction of 32.72%. CONCLUSIONS: In suitably selected patients, treatment of IE based on S-OPAT supported by a shortening hospital admission care program by means of referral to a HAH unit is a safe and efficient care model which entails a significant cost saving for the public healthcare system

Genetics of adult attachment: An updated review of the literature

Attachment style, which has been theorized to be rooted in childhood bonding experiences, influences adult cognitive, emotional and interpersonal functioning. Despite its relationship with early experiences, research indicates that the continuity of attachment style across childhood and adulthood is only partial, being a malleable tendency that is shaped throughout development, with an increasing influence of genetics, as it occurs in other cognitive and behavioral phenotypes. Genetic research indicates that up to 45% of the variability in anxious and 39% in avoidant adult attachment style could be explained by genetic causes, but the precise mechanisms remain unclear. A narrative review is conducted analyzing the existing literature regarding the implication of candidate genes related to oxytocin, dopaminergic pathways, serotonergic pathways and brain-derived neurotrophic factor in adult attachment, with both vulnerability and differential susceptibility approaches, yielding mixed results. We highlight the lack of genome-wide studies and the scarcity of epigenetic investigation. Based on the existing data, we conclude that the genetics of adult attachment is an area that requires further research to clarify its etiological role and that it should be preferably approached as an interaction between nature and nurture

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

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

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Morbilidad y mortalidad en el cierre esternal diferido

El cierre de la esternotomía tras la cirugía cardiaca constituye uno de los momentos fundamentales de la cirugía pues frecuentemente el acercamiento de los bordes quirúrgicos puede ser causa de un grave deterioro de la función cardiaca. Esto es relevante en todos aquellos pacientes en los que durante la cirugía presentan inestabilidad hemodinámica: Sangrado, edema miocárdico, arritmias y pacientes que precisan de asistencia ventricular y/ó balón de contrapulsación aórtico. Los objetivos de esta Tesis son identificar factores de riesgo asociados con infección nosocomial y los factores pronóstico de mortalidad, en los pacientes intervenidos de Cirugía Cardiaca que precisaron cierre esternal diferido, determinar la incidencia de la infección nosocomial y de sus tipos según la localización anatómica, estudiar la flora microbiana e identificar los factores de riesgo preoperatorios, intraoperatorios y postoperatorias asociados al riesgo de desarrollar una infección nosocomial y analizar la mortalidad asociada a esta técnica quirúrgica y sus causas