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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

Desarrollo y puesta en práctica de recursos educativos digitales para laboratorios de idiomas

Los laboratorios de idiomas son una herramienta de gran valor en el apoyo a la enseñanza de lenguas. En una Facultad como la de Filología, donde se enseñan más de XX lenguas, este tipo de laboratorios se ha convertido en algo imprescindible. Los laboratorios de idiomas facilitan la enseñanza mediante el acceso a recursos educativos punteros. Sin embargo, estos mismos laboratorios exigen un esfuerzo por parte del profesorado, ya que su uso exige una preparación específica no siempre rápidamente asimilable. Por este motivo, desde el vicedecanato de innovación y tecnologías de Facultad de Filología se ofrece apoyo constante al profesorado por lo que respecta tanto a la formación en el uso de los laboratorios como a la resolución de problemas específicos que surgen durante la utilización de los mismos. La formación en el uso de los laboratorios de idiomas se realiza mediante talleres impartidos por el técnico de laboratorios de la Facultad. Estos suelen tener lugar unas dos veces al año. Adicionalmente, como ocurrió en diciembre de 2014, la empresas Roycan, suministradora del software utilizado en los laboratorios de la Facultad, ofrece talleres más exhaustivos. A pesar de los esfuerzos realizados tanto desde el vicedecanato como, sobre todo, por parte de los profesores, es una evidencia que los laboratorios de idiomas tienen un potencial de explotación mayor que el uso que se les da en la actualidad. Aunque son muchos los profesores que los utilizan, otros tantos que desearían también utilizarlos se sienten intimidados por el desafío tecnológico que ello implica. Esto podría solucionarse no sólo mediante un plan formativo en el uso de laboratorios de idiomas de mayor calado que el ahora existente sino también mediante la creación de un banco de recursos educativos reutilizables por los usuarios de los laboratorios de idiomas. Lo primero, el plan formativo, serviría para allanar las dificultades tecnológicas intrínsecas al uso de los laboratorios; lo segundo, la creación del banco de recursos, serviría, entre otras cosas, para que el acceso de nuevos usuarios a los laboratorios resultara más fácil desde un punto de vista pedagógico, ya que la existencia de recursos concebidos específicamente para los laboratorios les serviría como guía inicial, a partir de la cual puedan ellos empezar a crear sus propios materiales, idealmente también reutilizables por otros. Este proyecto es continuación de una de las líneas que nos hemos marcado institucionalmente en la Facultad de Filología con respecto a la innovación tecnológica: la creación de material didáctico digital de calidad y su explotación en la docencia. En previos PIMCD se abordó: 1) la elaboración de una recomendación de calidad (PIMCD 236-2011/2012; resultados en: http://eprints.ucm.es/12533/) que ha derivado en un proyecto de AENOR. 2) la creación de un repositorio institucional con una pequeña colección de materiales de referencia de buenas prácticas (PIMCD 268-2010/2011; http://mediaserver.filol.ucm.es). 3) la explotación de los materiales de referencia en cursos y módulos de cursos virtuales (PIMCD 231-2013; http://mediaserver.filol.ucm.es/materiales; y PIMCD 278-2014; resultados disponibles en el canal YouTube educativo de la Facultad de Filología). Asimismo, la Facultad de Filología ha venido colaborando con la empresa Roycan mediante diversos convenios firmados en los últimos años. Con motivo del presente proyecto se establecerá otro convenio, actualmente en fase de preparación, que formalice y establezca las bases de la presente colaboración.Oficina para la Calidad UCMBibliotecaFac. de Ciencias Económicas y EmpresarialesFALSEsubmitte

Effectiveness of the MULTIPAP Plus intervention in youngest-old patients with multimorbidity and polypharmacy aimed at improving prescribing practices in primary care:study protocol of a cluster randomized trial

BackgroundThe progressive ageing of the population is leading to an increase in multimorbidity and polypharmacy, which in turn may increase the risk of hospitalization and mortality. The enhancement of care with information and communications technology (ICT) can facilitate the use of prescription evaluation tools and support system for decision-making (DSS) with the potential of optimizing the healthcare delivery process.ObjectiveTo assess the effectiveness and cost-effectiveness of the complex intervention MULTIPAP Plus, compared to usual care, in improving prescriptions for young-old patients (65-74 years old) with multimorbidity and polypharmacy in primary care.Methods/designThis is a pragmatic cluster-randomized clinical trial with a follow-up of 18 months in health centres of the Spanish National Health System. Unit of randomization: family physician. Unit of analysis: patient.PopulationPatients aged 65–74 years with multimorbidity (≥ 3 chronic diseases) and polypharmacy (≥ 5 drugs) during the previous 3 months were included.Sample sizen = 1148 patients (574 per study arm).InterventionComplex intervention based on the ARIADNE principles with three components: (1) family physician (FP) training, (2) FP-patient interview, and (3) decision-making support system.OutcomesThe primary outcome is a composite endpoint of hospital admission or death during the observation period measured as a binary outcome, and the secondary outcomes are number of hospital admission, all-cause mortality, use of health services, quality of life (EQ-5D-5L), functionality (WHODAS), falls, hip fractures, prescriptions and adherence to treatment. Clinical and sociodemographic factors will be explanatory variables.Statistical analysisThe main result is the difference in percentages in the final composite endpoint variable at 18 months, with its corresponding 95% CI. Adjustments by the main confounding and prognostic factors will be performed through a multilevel analysis. All analyses will be carried out in accordance to the intention-to-treat principle.DiscussionIt is important to prevent the cascade of negative health and health care impacts attributable to the multimorbidity-polypharmacy binomial. ICT-enhanced routine clinical practice could improve the prescription process in patient care.Trial registrationClinicalTrials.gov NCT04147130. Registered on 22 October 201

Effectiveness of the MULTIPAP Plus intervention in youngest-old patients with multimorbidity and polypharmacy aimed at improving prescribing practices in primary care: study protocol of a cluster randomized trial

del Cura-Gonzalez I, Lopez-Rodriguez JA, Leiva-Fernandez F, et al. Effectiveness of the MULTIPAP Plus intervention in youngest-old patients with multimorbidity and polypharmacy aimed at improving prescribing practices in primary care: study protocol of a cluster randomized trial. Trials. 2022;23(1): 479.Background: The progressive ageing of the population is leading to an increase in multimorbidity and polypharmacy, which in turn may increase the risk of hospitalization and mortality. The enhancement of care with information and communications technology (ICT) can facilitate the use of prescription evaluation tools and support system for decision-making (DSS) with the potential of optimizing the healthcare delivery process. Objective: To assess the effectiveness and cost-effectiveness of the complex intervention MULTIPAP Plus, compared to usual care, in improving prescriptions for young-old patients (65-74 years old) with multimorbidity and polypharmacy in primary care. Methods/design: This is a pragmatic cluster-randomized clinical trial with a follow-up of 18 months in health centres of the Spanish National Health System. Unit of randomization: family physician. Unit of analysis: patient. Population: Patients aged 65-74 years with multimorbidity (>= 3 chronic diseases) and polypharmacy (>= 5 drugs) during the previous 3 months were included. Sample size: n = 1148 patients (574 per study arm). Intervention: Complex intervention based on the ARIADNE principles with three components: (1) family physician (FP) training, (2) FP-patient interview, and (3) decision-making support system. Outcomes: The primary outcome is a composite endpoint of hospital admission or death during the observation period measured as a binary outcome, and the secondary outcomes are number of hospital admission, all-cause mortality, use of health services, quality of life (EQ-5D-5L), functionality (WHODAS), falls, hip fractures, prescriptions and adherence to treatment. Clinical and sociodemographic factors will be explanatory variables. Statistical analysis: The main result is the difference in percentages in the final composite endpoint variable at 18 months, with its corresponding 95% CI. Adjustments by the main confounding and prognostic factors will be performed through a multilevel analysis. All analyses will be carried out in accordance to the intention-to-treat principle. Discussion: It is important to prevent the cascade of negative health and health care impacts attributable to the multimorbidity-polypharmacy binomial. ICT-enhanced routine clinical practice could improve the prescription process in patient care

Role of age and comorbidities in mortality of patients with infective endocarditis.

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. 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: A total of 3120 patients with IE (1327  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 th

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