NECESIDADES DEL CUIDADOR DEL ENFERMO DE ALZHEIMER TERMINAL.

Alzheimer’s disease is the leading cause of dementia in western society. Due to the invalidating nature, the social impact of this disease is high, as patients need soon the presence of a caregiver. For these reasons, the social and economic costs of Alzheimer’s disease are of considerable importance. The objectives of this study are to ascertain the principal caregiver’s needs, to identify activities which are performed at a high cost to caregivers in terms of physical, financial and psychological resources and to assess if caregivers have the required resources to perform them. This is an observational, descriptive, cross-sectional, non-comparative and prospective study. Our sample was composed of 35 caregivers of Alzheimer’s patients of a geriatric residence (Residencia Geriátrica San Basilio, Murcia) and a Clinic (Clínica Belén, Murcia). A convenience sampling was used. Just the caregivers who accepted to participate were enrolled in this study. In our survey, the data were collected by means of a questionnaire, which was administered from April 20 through April 25 of the same year. Data analyses were performed using Microsoft EXCEL software. According to the caregivers, the most costly activity was the hygiene of patients (80%). In this line, 77% of participants stated that this activity was the most time-consuming. They also refer that they would need help from the multidisciplinary team for bathing the patients. In this sample, caregivers have the resources to perform the activities required but they would like to be helped in areas such as nutrition administration, handling medicines, mobilization of patients and postural changes and prevention of pressure ulcers.La enfermedad de Alzheimer es la primera causa de demencia en la población occidental. Su carácter invalidante delega asistencia permanente desde los estadios moderados de la enfermedad por lo que la dependencia de cuidados constituye su principal característica social. Esta enfermedad consume importantes recursos socio-sanitarios y provoca graves pérdidas en el paciente y en sus cuidadores. Los objetivos de este estudio de investigación son conocer las principales cargas de los cuidadores principales ante este tipo de enfermos terminales, identificar las actividades que suponen mayor carga para el cuidador principal y conocer si disponen de los recursos necesarios para realizar dichas actividades. Estudio observacional, descriptivo, transversal no comparativo, prospectivo. En 35 cuidadores principales de los pacientes incluidos en la Residencia Geriátrica San Basilio y Clínica Belén (Murcia), se realizó una encuesta transversal de una sola medición. Muestreo de conveniencia no probabilístico, seleccionando voluntarios que sean cuidadores principales de dichos centros. El método utilizado para la recolección de datos fue un cuestionario, que se realizó entre los días 20 y 25 de abril del mismo año. Para el análisis de los datos se utilizó la hoja de calculo Excel, por lo que se tuvieron que dar valores numéricos a cada una de las posibles respuestas, coincidiendo la primera letra del abecedario con el número uno y así sucesivamente. La actividad que le supone mayor carga de trabajo a los cuidadores es con un 80% la higiene, al igual que la que le dedica mayor tiempo con un 77% de los encuestados. Estos consideran que el baño-aseo es la tarea que mayor carga les conlleva y en la que necesitan mayor ayuda del equipo multidisciplinar. Los cuidadores disponen de los recursos necesarios para realizar sus actividades, aunque consideran la necesidad de disponer de ayuda en otras actividades que realizan como administración de nutrición, administración de medicación, movilización de cambios posturales y prevención de ulceras por presión

Determinación de la curva tensión-deformación en madera de ‘Pinus sylvestris’ L. para la simulación numérica de vigas de madera libre de defectos

The objective of this paper is to develop a twodimensional numerical model to simulate the response of Scots pine (Pinus sylvestris L.) defect free timber members in order to predict the behaviour of these members when subjected to external forces. For this purpose, data of the mechanical properties of Scots pine were obtained by performing experimental tests on specimens. We determined the stresses and deformations of timber beams in the elastic-plastic and plastic phases. In addition, we developed a finite element software that considered the orthotropic nature of timber, the non-linearity of the compression-reduction branch and the differing moduli of elasticity in tension and compression for Scots pine beams free from defects. The software developed simulates an experimental four point bending test according to UNE-EN 408 Standard.El objetivo de este trabajo es el desarrollo de un modelo numérico bidimensional de piezas de madera de Pinus sylvestris L. libre de defectos que prediga su comportamiento frente a solicitaciones externas. Para su desarrollo, fue necesario realizar ensayos experimentales sobre probetas de pequeño tamaño con el fin de obtener los datos de las propiedades mecánicas para el Pinus sylvestris L. de procedencia española. A partir de los datos experimentales obtenidos, se desarrolla un programa de elementos finitos que considera la ortotropía de la madera, la no linealidad de la rama compresión-acortamiento y los distintos módulos de elasticidad a tracción y a compresión para vigas libres de defectos. El programa simula el ensayo experimental de flexión en cuatro puntos según la Norma UNE-EN 408 y aborda la determinación de las tensiones y deformaciones de las vigas de madera en las tres fases de comportamiento: elástica, elastoplástica y plástica

Prevalence of and Risk Factors for Biliary Carriage of Bacteria Showing Worrisome and Unexpected Resistance Traits

Data on biliary carriage of bacteria and, specifically, of bacteria with worrisome and unexpected resistance traits (URB) are lacking. A prospective study (April 2010 to December 2011) was performed that included all patients admitted for<48 h for elective laparoscopic cholecystectomy in a Spanish hospital. Bile samples were cultured and epidemiological/clinical data recorded. Logistic regression models (stepwise) were performed using bactobilia or bactobilia by URB as dependent variables. Models (P< 0.001) showing the highest R2 values were considered. A total of 198 patients (40.4% males; age, 55.3 17.3 years) were included. Bactobilia was found in 44 of them (22.2%). The presence of bactobilia was associated (R2 Cox, 0.30) with previous biliary endoscopic retrograde cholangiopancreatography (ERCP) (odds ratio [OR], 8.95; 95% confidence interval [CI], 2.96 to 27.06; P< 0.001), previous admission (OR, 2.82; 95% CI, 1.10 to 7.24; P 0.031), and age (OR, 1.09 per year; 95% CI, 1.05 to 1.12; P< 0.001). Ten out of the 44 (22.7%) patients with bactobilia carried URB: 1 Escherichia coli isolate (CTX-M), 1 Klebsiella pneumoniae isolate (OXA-48), 3 high-level gentamicin-resistant enterococci, 1 vancomycin-resistant Enterococcus isolate, 3 Enterobacter cloacae strains, and 1 imipenem-resistant Pseudomonas aeruginosa strain. Bactobilia by URB (versus those by non-URB) was only associated (R2 Cox, 0.19) with previous ERCP (OR, 11.11; 95% CI, 1.98 to 62.47; P 0.006). For analyses of patients with bactobilia by URB versus the remaining patients, previous ERCP (OR, 35.284; 95% CI, 5.320 to 234.016; P<0.001), previous intake of antibiotics (OR, 7.200; 95% CI, 0.962 to 53.906; P 0.050), and age (OR, 1.113 per year of age; 95% CI, 1.028 to 1.206; P 0.009) were associated with bactobilia by URB (R2 Cox, 0.19; P<0.001). Previous antibiotic exposure (in addition to age and previous ERCP) was a risk driver for bactobilia by URB. This may have implications in prophylactic/therapeutic measures

An International Prospective Cohort Study To Validate 2 Prediction Rules for Infections Caused by Third-generation Cephalosporin-resistant Enterobacterales

Background The possibility of bloodstream infections caused by third-generation cephalosporin-resistant Enterobacterales (3GC-R-BSI) leads to a trade-off between empiric inappropriate treatment (IAT) and unnecessary carbapenem use (UCU). Accurately predicting 3GC-R-BSI could reduce IAT and UCU. We externally validate 2 previously derived prediction rules for community-onset (CO) and hospital-onset (HO) suspected bloodstream infections. Methods In 33 hospitals in 13 countries we prospectively enrolled 200 patients per hospital in whom blood cultures were obtained and intravenous antibiotics with coverage for Enterobacterales were empirically started. Cases were defined as 3GC-R-BSI or 3GC-R gram-negative infection (3GC-R-GNI) (analysis 2); all other outcomes served as a comparator. Model discrimination and calibration were assessed. Impact on carbapenem use was assessed at several cutoff points. Results 4650 CO infection episodes were included and the prevalence of 3GC-R-BSI was 2.1% (n = 97). IAT occurred in 69 of 97 (71.1%) 3GC-R-BSI and UCU in 398 of 4553 non–3GC-R-BSI patients (8.7%). Model calibration was good, and the AUC was .79 (95% CI, .75–.83) for 3GC-R-BSI. The prediction rule potentially reduced IAT to 62% (60/97) while keeping UCU comparable at 8.4% or could reduce UCU to 6.3% (287/4553) while keeping IAT equal. IAT and UCU in all 3GC-R-GNIs (analysis 2) improved at similar percentages. 1683 HO infection episodes were included and the prevalence of 3GC-R-BSI was 4.9% (n = 83). Here model calibration was insufficient. Conclusions A prediction rule for CO 3GC-R infection was validated in an international cohort and could improve empirical antibiotic use. Validation of the HO rule yielded suboptimal performance

Determination of the stress-strain curve in specimens of Scots pine for numerical simulation of defect free beams

El objetivo de este trabajo es el desarrollo de un modelo numérico bidimensional de piezas de madera de Pinus sylvestris L. libre de defectos que prediga su comportamiento frente a solicitaciones externas. Para su desarrollo, fue necesario realizar ensayos experimentales sobre probetas de pequeño tamaño con el fin de obtener los datos de las propiedades mecánicas para el Pinus sylvestris L. de procedencia española. A partir de los datos experimentales obtenidos, se desarrolla un programa de elementos finitos que considera la ortotropía de la madera, la no linealidad de la rama compresión-acortamiento y los distintos módulos de elasticidad a tracción y a compresión para vigas libres de defectos. El programa simula el ensayo experimental de flexión en cuatro puntos según la Norma UNE-EN 408 y aborda la determinación de las tensiones y deformaciones de las vigas de madera en las tres fases de comportamiento: elástica, elastoplástica y plástica.The objective of this paper is to develop a twodimensional numerical model to simulate the response of Scots pine (Pinus sylvestris L.) defect free timber members in order to predict the behaviour of these members when subjected to external forces. For this purpose, data of the mechanical properties of Scots pine were obtained by performing experimental tests on specimens. We determined the stresses and deformations of timber beams in the elastic-plastic and plastic phases. In addition, we developed a finite element software that considered the orthotropic nature of timber, the non-linearity of the compression-reduction branch and the differing moduli of elasticity in tension and compression for Scots pine beams free from defects. The software developed simulates an experimental four point bending test according to UNE-EN 408 Standard.Ministerio de Ciencia e Innovación. Plan Nacional de I+D+i. Ref.: AGL2009-11331. Título del proyecto de investigación: “Propuesta metodológica de cálculo y ensayo de tipologías de uniones carpinteras recientemente implantadas en estructuras de madera e influencia de los nudos en la capacidad de carga” (2009-2012)S

Klebsiella pneumoniae Strains Producing Extended-Spectrum B-Lactamases in Spain: Microbiological and Clinical Features

Extended-spectrum B-lactamases (ESBL) of the CTX-M, SHV, and TEM families were recognized in 76 (67%), 31 (27%), and 6 (5%) isolates, respectively, among 162 ESBL-producing Klebsiella pneumoniae (ESBLKp) strains obtained in a multicenter study in Spain. Predisposing factors for ESBL-Kp acquisition included invasive procedures, mechanical ventilation, and previous antimicrobial use

How are trainees in clinical microbiology and infectious diseases supervised in Europe? An international cross-sectional questionnaire survey by the Trainee Association of ESCMID

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Impact of Early Interferon-β Treatment on the Prognosis of Patients with COVID-19 in the First Wave: A Post Hoc Analysis from a Multicenter Cohort

Background: Interferon-p is an attractive drug for repurposing and use in the treatment of COVID-19, based on its in vitro antiviral activity and the encouraging results from clinical trials. The aim of this study was to analyze the impact of early interferon-p treatment in patients admitted with COVID-19 during the first wave of the pandemic. Methods: This post hoc analysis of a COVID-19@Spain multicenter cohort included 3808 consecutive adult patients hospitalized with COVID-19 from 1 January to 17 March 2020. The primary endpoint was 30-day all-cause mortality, and the main exposure of interest was subcutaneous administration of interferon-beta, defined as early if started <= 3 days from admission. Multivariate logistic and Cox regression analyses were conducted to identify the associations of different variables with receiving early interferon-beta therapy and to assess its impact on 30-day mortality. A propensity score was calculated and used to both control for confounders and perform a matched cohort analysis. Results: Overall, 683 patients (17.9%) received early interferon-p therapy. These patients were more severely ill. Adjusted HR for mortality with early interferon-p was 1.03 (95% CI, 0.82-1.30) in the overall cohort, 0.96 (0.82-1.13) in the PS-matched subcohort, and 0.89 (0.60-1.32) when interferon-beta treatment was analyzed as a time-dependent variable. Conclusions: In this multicenter cohort of admitted COVID-19 patients, receiving early interferon-beta therapy after hospital admission did not show an association with lower mortality. Whether interferon-beta might be useful in the earlier stages of the disease or specific subgroups of patients requires further research

Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections A Randomized Clinical Trial

Importance The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. Objective To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. Design, Setting, and Participants This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. Interventions Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or parenteral ertapenem for the comparator group after 4 days. Main Outcomes and Measures The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. Results Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, −9.4 percentage points; 1-sided 95% CI, −21.5 to ∞ percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, −5.4 percentage points; 1-sided 95% CI, −∞ to 4.9; percentage points; P = .19), an increased rate of adverse event–related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). Conclusions and Relevance This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event–related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

A systematic review on the excess health risk of antibiotic-resistant bloodstream infections for six key pathogens in Europe

Background Antimicrobial resistance is a global threat, which requires novel intervention strategies, for which priority pathogens and settings need to be determined. Objectives We evaluated pathogen-specific excess health burden of drug-resistant bloodstream infections (BSIs) in Europe. Methods A systematic review and meta-analysis. Data sources MEDLINE, Embase, and grey literature for the period January 1990 to May 2022. Study eligibility criteria Studies that reported burden data for six key drug-resistant pathogens: carbapenem-resistant (CR) Pseudomonas aeruginosa and Acinetobacter baumannii, third-generation cephalosporin or CR Escherichia coli and Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium. Excess health outcomes compared with drug-susceptible BSIs or uninfected patients. For MRSA and third-generation cephalosporin E. coli and K. pneumoniae BSIs, five or more European studies were identified. For all others, the search was extended to high-income countries. Participants Paediatric and adult patients diagnosed with drug-resistant BSI. Interventions Not applicable. Assessment of risk of bias An adapted version of the Joanna-Briggs Institute assessment tool. Methods of data synthesis Random-effect models were used to pool pathogen-specific burden estimates. Results We screened 7154 titles, 1078 full-texts and found 56 studies on BSIs. Most studies compared outcomes of drug-resistant to drug-susceptible BSIs (46/56, 82.1%), and reported mortality (55/56 studies, 98.6%). The pooled crude estimate for excess all-cause mortality of drug-resistant versus drug-susceptible BSIs ranged from OR 1.31 (95% CI 1.03–1.68) for CR P. aeruginosa to OR 3.44 (95% CI 1.62–7.32) for CR K. pneumoniae. Pooled crude estimates comparing mortality to uninfected patients were available for vancomycin-resistant Enterococcus and MRSA BSIs (OR of 11.19 [95% CI 6.92–18.09] and OR 6.18 [95% CI 2.10–18.17], respectively). Conclusions Drug-resistant BSIs are associated with increased mortality, with the magnitude of the effect influenced by pathogen type and comparator. Future research should address crucial knowledge gaps in pathogen- and infection-specific burdens to guide development of novel interventions