Optimal start in dialysis shows increased survival in patients with chronic kidney disease

Objective To compare the survival among patients with chronic kidney disease who had optimal starts of renal replacement therapy, dialysis or hemodialysis, with patients who had suboptimal starts. Methods A retrospective cohort consisting of >18 year-old patients who started renal replacement therapy, using peritoneal dialysis or hemodialysis, in any public hospital or associated center of the Andalusian Public Health System, between the 1st of January of 2006 and the 15th of March of 2017. The optimal start was defined when all the following criteria were met: a planned dialysis start, a minimum of six-month follow-up by a nephrologist, and a first dialysis method coinciding with the one registered at 90 days. The information was obtained from the registry of the Information System of the Transplant Autonomic Coordination of Andalusia. Results A total of 10,692 patients were studied. 4,377 (40.9%) of these patients died. A total of 4,937 patients (46.17%) achieved optimal starts of renal replacement therapy and showed higher survival rates (HR 0.669; 95% CI 0.628–0.712) in the multivariate analysis of Cox regression model

Identification of factors associated with diagnostic error in primary care

Background Missed, delayed or incorrect diagnoses are considered to be diagnostic errors. The aim of this paper is to describe the methodology of a study to analyse cognitive aspects of the process by which primary care (PC) physicians diagnose dyspnoea. It examines the possible links between the use of heuristics, suboptimal cognitive acts and diagnostic errors, using Reason’s taxonomy of human error (slips, lapses, mistakes and violations). The influence of situational factors (professional experience, perceived overwork and fatigue) is also analysed.Methods Cohort study of new episodes of dyspnoea in patients receiving care from family physicians and residents at PC centres in Granada (Spain). With an initial expected diagnostic error rate of 20%, and a sampling error of 3%, 384 episodes of dyspnoea are calculated to be required. In addition to filling out the electronic medical record of the patients attended, each physician fills out 2 specially designed questionnaires about the diagnostic process performed in each case of dyspnoea. The first questionnaire includes questions on the physician’s initial diagnostic impression, the 3 most likely diagnoses (in order of likelihood), and the diagnosis reached after the initial medical history and physical examination. It also includes items on the physicians’ perceived overwork and fatigue during patient care. The second questionnaire records the confirmed diagnosis once it is reached. The complete diagnostic process is peer-reviewed to identify and classify the diagnostic errors. The possible use of heuristics of representativeness, availability, and anchoring and adjustment in each diagnostic process is also analysed. Each audit is reviewed with the physician responsible for the diagnostic process. Finally, logistic regression models are used to determine if there are differences in the diagnostic error variables based on the heuristics identified.Discussion This work sets out a new approach to studying the diagnostic decision-making process in PC, taking advantage of new technologies which allow immediate recording of the decision-making process.The authors gratefully acknowledge funding of this research from the Spanish Research Agency. Ministry of Health (Fondo de Investigaciones Sanitarias) FIS PI10/01468 and the European Regional Development Fund (ERDF)

Devising an Electric Power System: A CDIO Approach Applied to Electrical Engineering

The study of electric power systems within the field of Electrical Engineering is usually approached by computer simulations because any actual test is quite complex to be implemented. Having the aim to improve student learning about this topic, a new subject called “Devising an Electric Power System” was organized following a CDIO (Conceive-Design- Implement-Operate) approach. The subject is programmed for one academic year and based entirely on laboratory work. The students are divided into three groups. Every group would have to work on a device that includes a solar PV generator and a pumping controlled drive, both connected to a three–phase grid. The process followed by the students along the academic year begins with a short theoretical introduction and simulation studies where they conceive and design control strategies. These control strategies are for the solar PV generator (i.e., programing the “Maximum Power Point Tracking” MPPT) as well as for the pumping electric drive (i.e., following a V/f strategy or a vector control). The process is continued by practical implementation of the simulated algorithms previously obtained. In this step, the students implement and operate the systems until they become robust and well adjusted, and ready for the intermediate partial competition among the three groups. During this practical implementation stage, the innovative competence is better enhanced. At the moment that each group has implemented an electric generator and an electric consumption (load), they follow the third and last part of the subject that is focused on “electric utility” business strategy. The students will have to comply with the rules of the electricity market by offering energy packages to be generated and consumed at a certain price. The price and volume of energy to be generated/consumed are determined by the convergence point of supply and demand, as determined by the marginal pricing model. Once the market is cleared, the students have to realize their generation/consumption commitments by operating the real power system they have conceived and implemented. After the first academic year of this subject, the students’ evaluation was highly acceptable. The specific technological contents of the subject were learnt by the method called “learning by doing” that allows students to improve their skills in team building, innovation and communications. In addition, a good work atmosphere among students and teachers has arisen

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

Valor de la hemodiálisis concertada y la hospitalaria mediante un análisis de decisión multicriterio

Resumen: Objetivo: Evaluar el valor de la prestación de servicios de diálisis concertada frente a la hospitalaria para el tratamiento de la enfermedad renal crónica en España mediante la metodología de análisis de decisión multicriterio. Método: Se utilizó el marco de evaluación EVIDEM (Evidence and Value: Impact on Decision Making) para el cálculo del valor estimado de ambos modelos de prestación de la diálisis (concertada vs. hospitalaria) mediante un taller virtual en el que participaron diferentes perfiles: directivos y gestores, profesionales y responsables de unidades y representantes de pacientes y familiares. Las puntuaciones se combinaron mediante un modelo lineal aditivo, que combinó la ponderación del modelo con la puntuación individual de los criterios, y cada valor se transformó a una escala entre el 0 y 1. Resultados: La estimación del valor para la diálisis concertada fue de 0,29 (DE: ±0,2) y de 0,39 (DE: ±0,2) para la diálisis hospitalaria. Todos los perfiles otorgaron un mayor valor a la hemodiálisis hospitalaria. El mayor valor para la diálisis hospitalaria fue de los pacientes (0,44); el menor valor medio fue de los directivos (0,36) y el rango para la diálisis concertada estuvo entre los pacientes (0,31) y los cargos intermedios (0,27). Conclusiones: La hemodiálisis hospitalaria obtuvo un mayor valor que la diálisis concertada. En general, los panelistas afirmaron que resulta un ejercicio útil e interesante y que, en cierta medida, aporta seguridad en la toma de decisiones, ya que permite ordenar, racionalizar y considerar, de manera explícita y transparente, los diferentes criterios involucrados. Abstract: Objective: To evaluate the value of the provision of contracted versus hospital dialysis services for the treatment of chronic kidney disease in Spain using the multicriteria decision analysis methodology. Method: The EVIDEM (Evidence and Value: Impact on Decision Making) evaluation framework was used to calculate the estimated value of both dialysis delivery models (arranged vs. hospital) through a virtual workshop in which different profiles participated: directors and managers, professionals and heads of units and representatives of patients and relatives. The scores were combined using an additive lineal model, which combined the weight of the model with the individual score of the criteria, and each value was transformed to a scale between 0 and 1. Results: The estimated value for arranged dialysis was 0.29 (DS: ±0.2) and 0.39 (DS: ±0.2) for hospital dialysis. All profiles gave a higher value to hospital hemodialysis compared to contracted hemodialysis. The highest value for hospital dialysis was for patients (0.44), with the lowest mean value for directors (0.36) and the range for arranged dialysis being between patients (0.31) and intermediate positions (0.27). Conclusions: Hospital hemodialysis obtained a higher value than concerted dialysis. In general, the panelists affirmed that it is a useful and interesting exercise and that, to a certain extent, it provides security in decision-making, since it allows ordering, rationalizing and considering, in an explicit and transparent manner, the different criteria involved

Mapping capacity to conduct health technology assessment in Central, Eastern and South- Eastern Europe

Aim To provide insights into the capacity to conduct health technology assessment (HTA) in Central, Eastern, and South-Eastern Europe (CESEE), taking account of technical, financial, networking, and human resources. Methods An e-mail survey of 257 CESEE key informants involved in HTA was undertaken between March and April 2014. Contact e-mail addresses were identified from the internet. The survey questionnaire consisted of 3 sections: i) characteristics of the organization performing HTA, (ii) networking in HTA, and (iii) resources allocated for HTA. Results The survey was completed by 41 respondents representing a wide range of institutions from CESEE countries (response rate of 19.8%). Less than a quarter of respondents reported that their institutions had HTA-specific budgets, whereas the majority indicated that their institutions participated in HTA networks either at domestic or international levels. Although almost half of respondents indicated that their institutions offered HTA training, a shortage in skills training was suggested as the main barrier to HTA. Conclusion This is the first survey to thoroughly assess the state of HTA capacity in the CESEE region. To strengthen HTA capacity, CESEE countries should increase financial, technical, and training resources. To strengthen collaboration, the European Union and other international bodies should assist existing HTA networks in fulfilling their regional activities through leadership, advocacy to local policymakers, funding, and technical assistance

Resilience and adaptability in Pharmacy: Leveraging the teaching-learning experience in times of pandemic by CoVid19 applying B-Learning and learning analytics

Universidad Complutense de MadridDepto. de Farmacia Galénica y Tecnología AlimentariaFac. de FarmaciaFALSEsubmitte

Contextualizando la cerámica impressa : horizontes culturales en la Península Ibérica

Organizado por: GRAMPO: Grup de Recerques Arqueològiques al Mediterrani i Pròxim Orient. Universitat Autònoma de Barcelona PREMEDOC: Grup de Recerca de Prehistòria del Mediterràni Occidental. Universitat de València Servei d'Arqueologia. Ajuntament de Barcelona. Con la colaboración de: Museu d'Història de Barcelona. Ajuntament de BarcelonaDesde hace poco tiempo en el estudio sobre los orígenes de las primeras sociedades agrícolas en el Mediterráneo Occidental se ha generado un amplio debate en torno a la filiación y características culturales de los primeros grupos que practican una economía de subsistencia. En este contexto encuentra sentido la discusión sobre la presencia en la península Ibérica un momento relacionable con la denominada Impressa-Ligur presente en diferentes regiones del arco Ligur Provenzal. Este volumen, fruto de una reunión científica, reúne información actualizada sobre la posible presencia de estos contextos cerámicos en torno a la mitad del VI milenio cal en la península Ibérica dentro del marco más amplio del Mediterráneo occidental. Las primeras producciones cerámicas del Occidente son analizadas poniendo énfasis tanto en sus características como sobre todo en el contexto y la lectura histórica que aportan. Estructuradas por áreas geográficas, las 14 contribuciones realizadas por 38 investigadores nacionales e internacionales, ofrecen una visión inédita y original sobre una de las novedades más importantes de la investigación en Prehistoria reciente en el último decenio

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