Heart Failure Is a Poor Prognosis Risk Factor in Patients Undergoing Cholecystectomy: Results from a Spanish Data-Based Analysis

Background: The incidence of cholecystectomy is increasing as the result of the aging worldwide. Our aim was to determine the influence of heart failure on in-hospital outcomes in patients undergoing cholecystectomy in the Spanish National Health System (SNHS). Methods: We conducted a retrospective study using the Spanish National Hospital Discharge Database. Patients older than 17 years undergoing cholecystectomy in the period 2007–2015 were included. Demographic and administrative variables related to patients’ diseases as well as procedures were collected. Results: 478,111 episodes of cholecystectomy were identified according to the data from SNHS hospitals in the period evaluated. From all the episodes, 3357 (0.7%) were excluded, as the result the sample was represented by 474,754 episodes. Mean age was 58.3 (+16.5) years, and 287,734 (60.5%) were women (p < 0.001). A primary or secondary diagnosis of HF was identified in 4244 (0.89%) (p < 0.001) and mean age was 76.5 (+9.6) years. A higher incidence of all main complications studied was observed in the HF group (p < 0.001), except stroke (p = 0.753). Unadjusted in-hospital mortality was 1.1%, 12.9% in the group with HF versus 1% in the non HF group (p < 0.001). Average length of hospital stay was 5.4 (+8.9) days, and was higher in patients with HF (16.2 + 17.7 vs. 5.3 + 8.8; p < 0.001). Risk-adjusted in-hospital mortality models’ discrimination was high in both cases, with AUROC values = 0.963 (0.960–0.965) in the APRG-DRG model and AUROC = 0.965 (0.962–0.968) in the CMS adapted model. Median odds ratio (MOR) was high (1.538 and 1.533, respectively), stating an important variability of risk-adjusted outcomes among hospitals. Conclusions: The presence of HF during admission increases in hospital mortality and lengthens the hospital stay in patients undergoing cholecystectomy. However, mortality and hospital stay have significantly decreased during the study period in both groups (HF and non HF patients)

Impact of Heart Failure on In-Hospital Outcomes after Surgical Femoral Neck Fracture Treatment

Background: Femoral neck fracture (FNF) is a common condition with a rising incidence, partly due to aging of the population. It is recommended that FNF should be treated at the earliest opportunity, during daytime hours, including weekends. However, early surgery shortens the available time for preoperative medical examination. Cardiac evaluation is critical for good surgical outcomes as most of these patients are older and frail with other comorbid conditions, such as heart failure. The aim of this study was to determine the impact of heart failure on in-hospital outcomes after surgical femoral neck fracture treatment. Methods: We performed a retrospective study using the Spanish National Hospital Discharge Database, 2007–2015. We included patients older than 64 years treated for reduction and internal fixation of FNF. Demographic characteristics of patients, as well as administrative variables, related to patient’s diseases and procedures performed during the episode were evaluated. Results: A total of 234,159 episodes with FNF reduction and internal fixation were identified from Spanish National Health System hospitals during the study period; 986 (0.42%) episodes were excluded, resulting in a final study population of 233,173 episodes. Mean age was 83.7 (±7) years and 179,949 (77.2%) were women (p < 0.001). In the sample, 13,417 (5.8%) episodes had a main or secondary diagnosis of heart failure (HF) (p < 0.001). HF patients had a mean age of 86.1 (±6.3) years, significantly older than the rest (p < 0.001). All the major complications studied showed a higher incidence in patients with HF (p < 0.001). Unadjusted in-hospital mortality was 4.1%, which was significantly higher in patients with HF (18.2%) compared to those without HF (3.3%) (p < 0.001). The average length of stay (LOS) was 11.9 (±9.1) and was also significantly higher in the group with HF (16.5 ± 13.1 vs. 11.6 ± 8.7; p < 0.001). Conclusions: Patients with HF undergoing FNF surgery have longer length of stay and higher rates of both major complications and mortality than those without HF. Although their average length of stay has decreased in the last few years, their mortality rate has remained unchanged

¿Necesitamos un asistente virtual para apoyo y formación permanente de profesores, alumnos y egresados en nuestra página web?

Se trata de identificar las necesidades no resueltas y otras cuestiones de interés, y proponer la utilización del asistente virtual como herramienta de apoyo en el acceso, la formación presente y futura, con carácter permanente, al alumno y al profesor; ello supone su utilidad en el momento presente y en el futuro, como herramienta de formación y acceso permanente. La originalidad del Proyecto estriba precisamente en el planteamiento de la incorporación de la asistencia virtual e inteligencia artificial para la asistencia y apoyo a los alumnos y profesores. El uso de la tecnología es cada vez más mayor, y puede revertir en beneficio al alumno desde una perspectiva más amplia de la que un profesor individualmente puede ofrecerle; se lograría así el acceso a la información con una intervención humana mínima, en cualquier momento y en cuestiones generales de amplio espectro, al que cada profesor en su especialidad no llega a abarcar, y los programas voluntarios de mentorías tampoco

How to develop research by Professors and students to achieve a better teaching: transfer of results within and from the public University

El proyecto trata de mejorar la visibilidad de la relación entre investigación y docencia, permitiendo a los estudiantes conocer otra labor de sus profesores en la Universidad y animando su participación en actividades de transferencia a la sociedad.This project tries to enhance the visibility between research and teaching. It allows the students to know other tasks carried out by the University Professors. It seeks ways to promote their participation in activities of transfer of knowledge to society.Depto. de Derecho Mercantil, Financiero y TributarioFac. de DerechoFALSEsubmitte

Совместная работа в виртуальных средах с помощью проблемно-ориентированного обучения

El objetivo es potenciar una competencia crucial como es el trabajo colaborativo y en equipo de los alumnos mediante la utilización de entornos virtuales en el aprendizaje en las enseñanzas universitarias basado en problemas Resulta innegable que el trabajo en equipo y colaborativo fomenta la motivación de los estudiantes y favorece el aprendizaje, debido al propio efecto social que genera la pertenencia a un grupo. Contribuyendo, asimismo, al desarrollo de la capacidad de debate y argumentación, el razonamiento crítico y creativo o la organización de procesos de trabajo complejos, entre otras muchas competencias esenciales. El proyecto pone el foco en el trabajo colaborativo en entornos digitales dentro del aprendizaje basado en problemas y persigue favorecer un modelo de aprendizaje más participativo, mediante el uso de los recursos que nos ofrecen las nuevas tecnologías de la comunicación, aumentando la interacción de los estudiantes, incluso en entornos digitales. El trabajo colaborativo supone la creación de grupos integrados por varios estudiantes con, a priori, el mismo nivel formativo, y con una asunción compartida del liderazgo y la responsabilidad en el proceso de aprendizaje. El trabajo colaborativo se basa, además, en la autonomía de trabajo de sus integrantes que presentan funcionalidades y competencias heterogéneas, y que tienen que desarrollar y fortalecer elementos como la confianza, la comunicación, la gestión de conflictos y solución de problemas y la adopción de decisiones.The aim is to enhance a crucial competence such as collaborative and teamwork of students through the use of virtual environments in problem-based learning in university education. It is undeniable that team and collaborative work fosters students' motivation and favours learning, due to the very social effect that belonging to a group generates. It also contributes to the development of debate and argumentation skills, critical and creative reasoning or the organisation of complex work processes, among many other essential competences. The project focuses on collaborative work in digital environments within problem-based learning and aims to promote a more participatory learning model, through the use of the resources offered by new communication technologies, increasing student interaction, even in digital environments. Collaborative work involves the creation of groups made up of several students with, a priori, the same level of training, and with a shared assumption of leadership and responsibility in the learning process. Collaborative work is also based on the working autonomy of its members, who have heterogeneous functionalities and competences, and who have to develop and strengthen elements such as trust, communication, conflict management and problem solving and decision-making.L'obiettivo è quello di migliorare una competenza cruciale come il lavoro collaborativo e di gruppo degli studenti attraverso l'uso di ambienti virtuali nell'apprendimento basato su problemi nell'istruzione universitaria. È innegabile che il lavoro di gruppo e collaborativo promuova la motivazione degli studenti e favorisca l'apprendimento, proprio per l'effetto sociale che l'appartenenza a un gruppo genera. Contribuisce inoltre allo sviluppo delle capacità di discussione e argomentazione, del ragionamento critico e creativo o dell'organizzazione di processi di lavoro complessi, oltre a molte altre competenze essenziali. Il progetto si concentra sul lavoro collaborativo in ambienti digitali nell'ambito dell'apprendimento basato su problemi e mira a promuovere un modello di apprendimento più partecipativo, attraverso l'uso delle risorse offerte dalle nuove tecnologie di comunicazione, aumentando l'interazione degli studenti, anche in ambienti digitali. Il lavoro collaborativo prevede la creazione di gruppi composti da più studenti con, a priori, lo stesso livello di formazione e con un'assunzione condivisa di leadership e responsabilità nel processo di apprendimento. Il lavoro collaborativo si basa anche sull'autonomia di lavoro dei suoi membri, che hanno funzionalità e competenze eterogenee e devono sviluppare e rafforzare elementi come la fiducia, la comunicazione, la gestione dei conflitti, la risoluzione dei problemi e il processo decisionale.L'objectif est d'améliorer une compétence cruciale telle que le travail collaboratif et d'équipe des étudiants par l'utilisation d'environnements virtuels dans l'apprentissage par problème dans l'enseignement universitaire. Il est indéniable que le travail en équipe et en collaboration stimule la motivation des élèves et favorise l'apprentissage, en raison de l'effet social même que génère l'appartenance à un groupe. Elle contribue également au développement des capacités de débat et d'argumentation, du raisonnement critique et créatif ou de l'organisation de processus de travail complexes, parmi de nombreuses autres compétences essentielles. Le projet se concentre sur le travail collaboratif dans les environnements numériques dans le cadre de l'apprentissage par problèmes et vise à promouvoir un modèle d'apprentissage plus participatif grâce à l'utilisation des ressources offertes par les nouvelles technologies de communication, en augmentant l'interaction des étudiants, même dans les environnements numériques. Le travail collaboratif implique la création de groupes composés de plusieurs étudiants ayant, a priori, le même niveau de formation, et assumant ensemble le leadership et la responsabilité du processus d'apprentissage. Le travail collaboratif repose également sur l'autonomie de travail de ses membres, qui ont des fonctionnalités et des compétences hétérogènes, et qui doivent développer et renforcer des éléments tels que la confiance, la communication, la gestion des conflits, la résolution de problèmes et la prise de décision.Ziel ist es, durch den Einsatz virtueller Umgebungen beim problembasierten Lernen in der Hochschulbildung eine entscheidende Kompetenz wie die Zusammenarbeit und die Teamarbeit von Studierenden zu fördern. Es ist unbestreitbar, dass Team- und Kooperationsarbeit die Motivation der Schüler fördert und das Lernen begünstigt, und zwar aufgrund des sozialen Effekts, den die Zugehörigkeit zu einer Gruppe bewirkt. Sie trägt auch zur Entwicklung von Diskussions- und Argumentationsfähigkeiten, kritischem und kreativem Denken oder der Organisation komplexer Arbeitsprozesse bei, neben vielen anderen wichtigen Kompetenzen. Das Projekt konzentriert sich auf die kollaborative Arbeit in digitalen Umgebungen im Rahmen des problembasierten Lernens und zielt darauf ab, ein partizipativeres Lernmodell zu fördern, indem die von den neuen Kommunikationstechnologien gebotenen Ressourcen genutzt werden und die Interaktion zwischen den Studierenden auch in digitalen Umgebungen verstärkt wird. Bei der Zusammenarbeit werden Gruppen gebildet, die sich aus mehreren Studenten zusammensetzen, die von vornherein das gleiche Ausbildungsniveau haben und die gemeinsam die Leitung und Verantwortung für den Lernprozess übernehmen. Die Zusammenarbeit beruht auch auf der Arbeitsautonomie ihrer Mitglieder, die über heterogene Funktionen und Kompetenzen verfügen und Elemente wie Vertrauen, Kommunikation, Konfliktmanagement, Problemlösung und Entscheidungsfindung entwickeln und stärken müssen.O objectivo é reforçar uma competência crucial como a colaboração e o trabalho de equipa dos estudantes através da utilização de ambientes virtuais na aprendizagem baseada em problemas no ensino universitário. É inegável que o trabalho em equipa e em colaboração promove a motivação dos estudantes e favorece a aprendizagem, devido ao próprio efeito social que a pertença a um grupo gera. Também contribui para o desenvolvimento de capacidades de debate e argumentação, de raciocínio crítico e criativo ou para a organização de processos de trabalho complexos, entre muitas outras competências essenciais. O projecto centra-se no trabalho colaborativo em ambientes digitais no âmbito da aprendizagem baseada em problemas e visa promover um modelo de aprendizagem mais participativo através da utilização dos recursos oferecidos pelas novas tecnologias de comunicação, aumentando a interacção dos estudantes, mesmo em ambientes digitais. O trabalho colaborativo envolve a criação de grupos compostos por vários estudantes com, a priori, o mesmo nível de formação, e com uma assunção partilhada de liderança e responsabilidade no processo de aprendizagem. O trabalho colaborativo baseia-se também na autonomia de trabalho dos seus membros, que têm funcionalidades e competências heterogéneas, e que têm de desenvolver e reforçar elementos tais como confiança, comunicação, gestão de conflitos e resolução de problemas e tomada de decisões.Цель - повысить такую важную компетенцию, как совместная и командная работа студентов посредством использования виртуальных сред в проблемно-ориентированном обучении в университетском образовании. Неоспоримо, что командная и совместная работа повышает мотивацию учащихся и способствует обучению, благодаря тому самому социальному эффекту, который порождает принадлежность к группе. Она также способствует развитию навыков ведения дискуссий и аргументации, критического и творческого мышления или организации сложных рабочих процессов, а также многих других важных компетенций. Проект сосредоточен на совместной работе в цифровой среде в рамках проблемно-ориентированного обучения и направлен на продвижение модели обучения с более широким участием, посредством использования ресурсов, предлагаемых новыми коммуникационными технологиями, увеличивая взаимодействие студентов даже в цифровой среде. Совместная работа предполагает создание групп, состоящих из нескольких студентов, имеющих априори одинаковый уровень подготовки, и совместно принимающих на себя руководство и ответственность в процессе обучения. Совместная работа также основана на рабочей автономии ее членов, которые обладают разнородными функциональными возможностями и компетенциями, и которые должны развивать и укреплять такие элементы, как доверие, коммуникация, управление конфликтами, решение проблем и принятие решений.Depto. de Derecho del Trabajo y Seguridad SocialFac. de DerechoFALSEUniversidad Complutense de Madridsubmitte