Beneficios de la atención en unidades de ictus: Análisis por subgrupos de pacientes.

La atención al ictus agudo ha cambiado en los últimos años. Uno de los principales avances ha sido el inicio de la atención a los pacientes en unidades de ictus (UI). Este recurso es, sin embargo, limitado y por ello es preciso optimizar su utilización. Para ello es imprescindible conocer qué enfermos se beneficiarán en mayor medida del mismo. Se compara de modo retrospectivo una cohorte de pacientes con diagnóstico de ictus atendidos en una planta de Neurología frente a enfermos atendidos en una UI. Se realizan análisis por subgrupos para establecer qué pacientes se benefician más. Resultados: las UI reducen la probabilidad de muerte o dependencia al alta y a los seis meses, aumentando la probabilidad de estancia en domicilio. Los enfermos más beneficiados son los de edades comprendidas entre 61 y 79 años, los que sufren un ictus isquémico no extenso y los de mayor gravedad.Departamento de Medicina, Dermatología y Toxicologí

Las Vallinas (Teverga, Asturias). An Iron Age and roman farmsteas in northern Spain

[ES] Los obstáculos para la prospección a lo largo del paisaje costero del Golfo de Vizcaya, las limitaciones estructurales y materiales de las unidades de asentamiento más pequeñas, y la falta de un control exhaustivo de las alteraciones actuales del terreno, han ocasionado un vacío en el conocimiento sobre la posible presencia de granjas o caseríos en espacios abiertos durante la Edad del Hierro en la región cantábrica. Presentamos por primera vez la existencia de estas granjas, con los hallazgos en Las Vallinas que confirman el uso agrícola del terreno. Al comparar la información de esta alquería con la de castros habitados de la misma época, aportamos una visión más amplia del desarrollo económico de los antiguos Astures desde finales de la Prehistoria hasta el inicio de la ocupación romana. El impacto de la romanización provocó una alteración sin precedentes de las antiguas estructuras sociales y económicas de los Astures en esta zona, dando lugar a una lenta y continua recuperación de la economía rural a partir de finales del siglo I d.C[EN] Obstacles to prospection along the coastal landscape of the Bay of Biscay, structural and material limitations in smaller settlement units, and a lack of comprehensive monitoring of current alterations to the terrain, have all left a dearth of knowledge about the possible presence of open Iron Age farms or hamlets in the Cantabrian region. Presented here for the first time, we demonstrate the existence of these farms with findings verifying agricultural land use at Las Vallinas. In comparing information from this farm with that from inhabited hillforts of the same period, we are also given a wider picture of the economic development of the ancient Astures from the end of prehistory to the beginning of Roman occupation. The impact of Romanization caused an unprecedented upheaval of the old social and economic structures of the Asturs in the area, instigating a slow and steady recovery of a rural economy from the late 1st century AD

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

EPIdemiology of Surgery-Associated Acute Kidney Injury (EPIS-AKI) : Study protocol for a multicentre, observational trial

More than 300 million surgical procedures are performed each year. Acute kidney injury (AKI) is a common complication after major surgery and is associated with adverse short-term and long-term outcomes. However, there is a large variation in the incidence of reported AKI rates. The establishment of an accurate epidemiology of surgery-associated AKI is important for healthcare policy, quality initiatives, clinical trials, as well as for improving guidelines. The objective of the Epidemiology of Surgery-associated Acute Kidney Injury (EPIS-AKI) trial is to prospectively evaluate the epidemiology of AKI after major surgery using the latest Kidney Disease: Improving Global Outcomes (KDIGO) consensus definition of AKI. EPIS-AKI is an international prospective, observational, multicentre cohort study including 10 000 patients undergoing major surgery who are subsequently admitted to the ICU or a similar high dependency unit. The primary endpoint is the incidence of AKI within 72 hours after surgery according to the KDIGO criteria. Secondary endpoints include use of renal replacement therapy (RRT), mortality during ICU and hospital stay, length of ICU and hospital stay and major adverse kidney events (combined endpoint consisting of persistent renal dysfunction, RRT and mortality) at day 90. Further, we will evaluate preoperative and intraoperative risk factors affecting the incidence of postoperative AKI. In an add-on analysis, we will assess urinary biomarkers for early detection of AKI. EPIS-AKI has been approved by the leading Ethics Committee of the Medical Council North Rhine-Westphalia, of the Westphalian Wilhelms-University Münster and the corresponding Ethics Committee at each participating site. Results will be disseminated widely and published in peer-reviewed journals, presented at conferences and used to design further AKI-related trials. Trial registration number NCT04165369

Impact of COVID-19 outbreak on ischemic stroke admissions and in-hospital mortality in North-West Spain

Background and purpose Spain has been one of the countries heavily stricken by COVID-19. But this epidemic has not affected all regions equally. We analyzed the impact of the COVID-19 pandemic on hospital stroke admissions and in-hospital mortality in tertiary referral hospitals from North-West Spain.Methods Spanish multicenter retrospective observational study based on data from tertiary hospitals of the NORDICTUS network. We recorded the number of patients admitted for ischemic stroke between 30 December 2019 and 3 May 2020, the number of IVT and EVT procedures, and in-hospital mortality.Results In the study period, 2737 patients were admitted with ischemic stroke. There was a decrease in the weekly mean admitted patients during the pandemic (124 vs. 173, p<0.001). In-hospital mortality of stroke patients increased significantly (9.9% vs. 6.5%, p = 0.003), but there were no differences in the proportion of IVT (17.3% vs. 16.1%, p = 0.405) or EVT (22% vs. 23%, p = 0.504).Conclusion We found a decrease in the number of ischemic stroke admissions and an increase in in-hospital mortality during the COVID-19 epidemic in this large study from North-West Spain. There were regional changes within the network, not fully explained by the severity of the pandemic in different regions.Peer reviewe

Currículo Educación Primaria y relación entre criterios de evaluación y estándares de aprendizaje evaluables

Corresponde al Gobierno del Principado de Asturias regular la ordenación y el currículo de las enseñanzas de educación primaria, a efectos de su implantación en el año académico 2014-2015 para los cursos primero, tercero y quinto, y en el año académico 2015-2016 para los cursos segundo, cuarto y sexto. En esta publicación se recogen las relaciones entre los diferentes elementos del currículo de educación primaria y los criterios de evaluación del mismo conforme al Decreto 82/2014, de 28 de agosto, de la Consejería de Educación, Cultura y Deporte del Principado de Asturias. La publicación incluye dicho Decreto. Se describen los contenidos, metodología didáctica y criterios de evaluación y estándares de aprendizaje evaluables de las distintas materias troncales, específicas y de las asignaturas de libre configuraciónES

TALLER EXPERIMENTAL I MATERIA Y ESPACIO

El Taller Experimental I Materia y Espacio surge como propuesta docente de la CÁTEDRA BLANCA, dentro del Departamento de Proyectos Arquitectónicos, para los alumnos recién ingresados en la ETSAM.Durante el primer semestre se les introduce en la arquitectura apoyándose en el hormigón como material de proyecto. Es este material, donado por CEMEX, el que articula el aprendizaje del alumno.Individualmente y en grupo, diseñarán y ejecutarán sus propios encofrados,que se convertirán en objeto de diferentes investigaciones guiadas por los profesores.El empleo del hormigón no sólo aporta el conocimiento de las ideas que hay tras buena parte de la arquitectura moderna, que los alumnos empiezan a conocer. También se convierte en un argumento práctico que los involucra: ejercitando su visión espacial para representar y construir el negativo de la pieza deseada, despertando su curiosidad por cómo estos materiales de encofrado pueden transferir sus cualidades al hormigón y cómo condicionan el hormigonado y el desencofrado, pero, sobre todo, haciéndolos conscientes de que la arquitectura está tanto en la técnica que resuelve estos problemas como en la poética que ordena estas acciones, y que ambos aspectos son necesarios e inseparables.Con esta directriz, el curso se articula en torno a tres ejercicios, que se complementan con trabajos y presentaciones en grupo y visitas a arquitecturas en hormigón

Impact of COVID‐19 outbreak in reperfusion therapies of acute ischemic stroke in North‐West Spain

Since the first reported case in early December 2019, severe acute respiratory coronavirus 2 (SARS‐CoV‐2) infection, known as Coronavirus Disease 2019 (COVID‐19), has spread all over the world (1‐3). As of June 4th, more than 6 million cases and 350,000 deaths have been reported worldwide (4). Treating these patients and containing the outbreak has become the main priority in any center, arising the risk of possible collateral damage on patients with other acute diseases due to the collapse of the pre‐ and intra‐hospital emergency care systems.Peer reviewe

Predictors of complications and mortality following left colectomy with primary stapled anastomosis for cancer: results of a multicentric study with 1111 patients

Aim: Reports detailing the morbidity–mortality after left colectomy are sparse and do not allow definitive conclusions to be drawn. We aimed to identify risk factors for anastomotic leakage, perioperative mortality and complications following left colectomy for colonic malignancies. Method: We undertook a STROBE-compliant analysis of left colectomies included in a national prospective online database. Forty-two variables were analysed as potential independent risk factors for anastomotic leakage, postoperative morbidity and mortality. Variables were selected using the ‘least absolute shrinkage and selection operator’ (LASSO) method. Results: We analysed 1111 patients. Eight per cent of patients had a leakage and in 80% of them reoperation or surgical drainage was needed. A quarter of patients (24.9%) experienced at least one minor complication. Perioperative mortality was 2%, leakage being responsible for 47.6% of deaths. Obesity (OR 2.8, 95% CI 1.00–7.05, P = 0.04) and total parenteral nutrition (TPN) (OR 3.7, 95% CI 1.58–8.51, P = 0.002) were associated with increased risk of leakage, whereas female patients had a lower risk (OR 0.36, 95% CI 0.18–0.67, P = 0.002). Corticosteroids (P = 0.03) and oral anticoagulants (P = 0.01) doubled the risk of complications, which was lower with hyperlipidaemia (OR 0.3, P = 0.02). Patients on TPN had more complications (OR 4.02, 95% CI 2.03–8.07, P = 0.04) and higher mortality (OR 8.7, 95% CI 1.8–40.9, P = 0.006). Liver disease and advanced age impaired survival, corticosteroids being the strongest predictor of mortality (OR 21.5, P = 0.001). Conclusion: Requirement for TPN was associated with more leaks, complications and mortality. Leakage was presumably responsible for almost half of deaths. Hyperlipidaemia and female gender were associated with lower rates of complications. These findings warrant a better understanding of metabolic status on perioperative outcome after left colectomy