La corrección de la expresión escrita: las preferencias de los estudiantes.

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Effects of alirocumab on types of myocardial infarction: insights from the ODYSSEY OUTCOMES trial

Aims  The third Universal Definition of Myocardial Infarction (MI) Task Force classified MIs into five types: Type 1, spontaneous; Type 2, related to oxygen supply/demand imbalance; Type 3, fatal without ascertainment of cardiac biomarkers; Type 4, related to percutaneous coronary intervention; and Type 5, related to coronary artery bypass surgery. Low-density lipoprotein cholesterol (LDL-C) reduction with statins and proprotein convertase subtilisin–kexin Type 9 (PCSK9) inhibitors reduces risk of MI, but less is known about effects on types of MI. ODYSSEY OUTCOMES compared the PCSK9 inhibitor alirocumab with placebo in 18 924 patients with recent acute coronary syndrome (ACS) and elevated LDL-C (≥1.8 mmol/L) despite intensive statin therapy. In a pre-specified analysis, we assessed the effects of alirocumab on types of MI. Methods and results  Median follow-up was 2.8 years. Myocardial infarction types were prospectively adjudicated and classified. Of 1860 total MIs, 1223 (65.8%) were adjudicated as Type 1, 386 (20.8%) as Type 2, and 244 (13.1%) as Type 4. Few events were Type 3 (n = 2) or Type 5 (n = 5). Alirocumab reduced first MIs [hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77–0.95; P = 0.003], with reductions in both Type 1 (HR 0.87, 95% CI 0.77–0.99; P = 0.032) and Type 2 (0.77, 0.61–0.97; P = 0.025), but not Type 4 MI. Conclusion  After ACS, alirocumab added to intensive statin therapy favourably impacted on Type 1 and 2 MIs. The data indicate for the first time that a lipid-lowering therapy can attenuate the risk of Type 2 MI. Low-density lipoprotein cholesterol reduction below levels achievable with statins is an effective preventive strategy for both MI types.For complete list of authors see http://dx.doi.org/10.1093/eurheartj/ehz299</p

Effect of alirocumab on mortality after acute coronary syndromes. An analysis of the ODYSSEY OUTCOMES randomized clinical trial

Background: Previous trials of PCSK9 (proprotein convertase subtilisin-kexin type 9) inhibitors demonstrated reductions in major adverse cardiovascular events, but not death. We assessed the effects of alirocumab on death after index acute coronary syndrome. Methods: ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) was a double-blind, randomized comparison of alirocumab or placebo in 18 924 patients who had an ACS 1 to 12 months previously and elevated atherogenic lipoproteins despite intensive statin therapy. Alirocumab dose was blindly titrated to target achieved low-density lipoprotein cholesterol (LDL-C) between 25 and 50 mg/dL. We examined the effects of treatment on all-cause death and its components, cardiovascular and noncardiovascular death, with log-rank testing. Joint semiparametric models tested associations between nonfatal cardiovascular events and cardiovascular or noncardiovascular death. Results: Median follow-up was 2.8 years. Death occurred in 334 (3.5%) and 392 (4.1%) patients, respectively, in the alirocumab and placebo groups (hazard ratio [HR], 0.85; 95% CI, 0.73 to 0.98; P=0.03, nominal P value). This resulted from nonsignificantly fewer cardiovascular (240 [2.5%] vs 271 [2.9%]; HR, 0.88; 95% CI, 0.74 to 1.05; P=0.15) and noncardiovascular (94 [1.0%] vs 121 [1.3%]; HR, 0.77; 95% CI, 0.59 to 1.01; P=0.06) deaths with alirocumab. In a prespecified analysis of 8242 patients eligible for ≥3 years follow-up, alirocumab reduced death (HR, 0.78; 95% CI, 0.65 to 0.94; P=0.01). Patients with nonfatal cardiovascular events were at increased risk for cardiovascular and noncardiovascular deaths (P<0.0001 for the associations). Alirocumab reduced total nonfatal cardiovascular events (P<0.001) and thereby may have attenuated the number of cardiovascular and noncardiovascular deaths. A post hoc analysis found that, compared to patients with lower LDL-C, patients with baseline LDL-C ≥100 mg/dL (2.59 mmol/L) had a greater absolute risk of death and a larger mortality benefit from alirocumab (HR, 0.71; 95% CI, 0.56 to 0.90; Pinteraction=0.007). In the alirocumab group, all-cause death declined wit h achieved LDL-C at 4 months of treatment, to a level of approximately 30 mg/dL (adjusted P=0.017 for linear trend). Conclusions: Alirocumab added to intensive statin therapy has the potential to reduce death after acute coronary syndrome, particularly if treatment is maintained for ≥3 years, if baseline LDL-C is ≥100 mg/dL, or if achieved LDL-C is low. Clinical Trial Registration: URL: https://www.clinicaltrials.gov. Unique identifier: NCT01663402

WhatsApp as part of an EFL programme: Participation and interaction

This study examines the results of an intervention conducted with adult EFL learners in Barcelona, Spain, to foster engagement with the target language outside class time. As part of the programme, the messaging service WhatsApp was used to carry out a range of voluntary communicative tasks, in learners&apos; own time. Familiarity with this tool made it easy to use, and learner feedback was positive. Analysis of the resulting chat transcript indicated that (1) off-task participation increased as learners appropriated the space as a vehicle for their own communication, (2) off-task interactions fell predominantly into two categories: administrative and social, and (3) despite being voluntary and unevaluated, with minimum teacher intervention, English was overwhelmingly the language of choice within these interactions. We hope this study can serve as an example of the possibilities offered by the WhatsApp medium in an EFL context. © 2021 The Author(s) 2021. Published by Oxford University Press; all rights reserved

Extending language learning beyond the EFL classroom through WhatsApp

WhatsApp is a powerful tool for L2 learning because of its capacity to promote interaction between teacher and student, as well as among students. Its use has also been shown to support ubiquitous learning. In an attempt to extend language learning beyond the classroom, this study reports on the use of instant messaging through WhatsApp by a group of EFL learners (n = 23) who were regularly sent optional language-learning tasks by their teacher during an intensive summer course. By the end of a five-week-period, 764 messages had been produced, which are explored through a qualitative analysis in the present study, with particular attention to changes of participation as a result of time. Most of the messages in the WhatsApp group were produced by the students in the context of the teacher-initiated tasks and through them students had the chance to practice the language as well as engage in real communication, even though student participation tended to decrease over time. The WhatsApp group was also used for informal communication among the students and with the teacher (a total of 289 off-task messages) which, in contrast to on-task messages, grew over time. The nature of the interactions also tended to be more spontaneous and symmetrical, at times with more of a presence of textese. Negotiation of form and content was scarce, but both on-task and off-task messages turned out to be equally productive in engaging students to use English beyond the walls of the classroom. © 2021 Informa UK Limited, trading as Taylor &amp; Francis Group

Rehabilitación cardíaca. ¿Cómo mantener los cambios en el estilo de vida de nuestros pacientes?

Introducción: Los programas de rehabilitación cada vez se aplican a un mayor número de patologías cardíacas, necesitando adaptarse a las características de la enfermedad y del paciente. Existe algo común en estos pacientes, la dificultad para mantener la adherencia al cambio de estilo de vida. Objetivo: Evaluamos el mantenimiento de los cambios en el estilo de vida y factores de riesgo modificables de pacientes incluidos en nuestro programa a largo plazo. Metodología: Pacientes con cardiopatía isquémica, post recambio valvular, post by pass aortocoronario seleccionados en la consulta de enfermería de cardiología hospitalaria. A los tres meses, fueron derivados con el alta de enfermería a su Centro de Atención Primaria (CAP) repitiéndose la evaluación al año. Resultados: 110 pacientes con una edad media de 65 años, hipertensos un 89%, diabéticos un 26%, dislipémicos 81%, con sobrepeso el 45%, fumadores un 29%. Los Hipertensos pasaron del 23% a los tres meses al 24% al año, cumplían la dieta el 78%. Los diabéticos pasaron de una hemoglobina glucosilada de 6.7 a 5.8, mantenían la dieta el 79%. Dislipémicos del 81% al 58%, dieta el 85% igual anterior. Sobrepeso del 45% al 38%, realizaban bien la dieta el 49% ahora el 56%. El 90% habían dejado de fumar desde el ingreso, actualmente no fuman el 88%. Ejercicio físico del 85% al 90%. Trabajan el 24% y están jubilados el 60%. Han recuperado sus actividades cotidianas un 82% y siguen visitas de enfermería el 79%. Conclusiones: Los pacientes modificaron total o parcialmente los factores de riesgo, manteniendo la adherencia al cambio. El alta de enfermería es un instrumento a potenciar. Sirve de enlace entre el paciente y los profesionales de la salud

Rehabilitación cardíaca. ¿Cómo mantener los cambios en el estilo de vida de nuestros pacientes?

Introducción: Los programas de rehabilitación cada vez se aplican a un mayor número de patologías cardíacas, necesitando adaptarse a las características de la enfermedad y del paciente. Existe algo común en estos pacientes, la dificultad para mantener la adherencia al cambio de estilo de vida. Objetivo: Evaluamos el mantenimiento de los cambios en el estilo de vida y factores de riesgo modificables de pacientes incluidos en nuestro programa a largo plazo. Metodología: Pacientes con cardiopatía isquémica, post recambio valvular, post by pass aortocoronario seleccionados en la consulta de enfermería de cardiología hospitalaria. A los tres meses, fueron derivados con el alta de enfermería a su Centro de Atención Primaria (CAP) repitiéndose la evaluación al año. Resultados: 110 pacientes con una edad media de 65 años, hipertensos un 89%, diabéticos un 26%, dislipémicos 81%, con sobrepeso el 45%, fumadores un 29%. Los Hipertensos pasaron del 23% a los tres meses al 24% al año, cumplían la dieta el 78%. Los diabéticos pasaron de una hemoglobina glucosilada de 6.7 a 5.8, mantenían la dieta el 79%. Dislipémicos del 81% al 58%, dieta el 85% igual anterior. Sobrepeso del 45% al 38%, realizaban bien la dieta el 49% ahora el 56%. El 90% habían dejado de fumar desde el ingreso, actualmente no fuman el 88%. Ejercicio físico del 85% al 90%. Trabajan el 24% y están jubilados el 60%. Han recuperado sus actividades cotidianas un 82% y siguen visitas de enfermería el 79%. Conclusiones: Los pacientes modificaron total o parcialmente los factores de riesgo, manteniendo la adherencia al cambio. El alta de enfermería es un instrumento a potenciar. Sirve de enlace entre el paciente y los profesionales de la salud

Alirocumab in Patients With Polyvascular Disease and Recent Acute Coronary Syndrome : ODYSSEY OUTCOMES Trial

Patients with acute coronary syndrome (ACS) and concomitant noncoronary atherosclerosis have a high risk of major adverse cardiovascular events (MACEs) and death. The impact of lipid lowering by proprotein convertase subtilisin-kexin type 9 inhibition in such patients is undetermined. This pre-specified analysis from ODYSSEY OUTCOMES (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) determined whether polyvascular disease influenced risks of MACEs and death and their modification by alirocumab in patients with recent ACS and dyslipidemia despite intensive statin therapy. Patients were randomized to alirocumab or placebo 1 to 12 months after ACS. The primary MACEs endpoint was the composite of coronary heart disease death, nonfatal myocardial infarction, fatal or nonfatal ischemic stroke, or unstable angina requiring hospitalization. All-cause death was a secondary endpoint. Median follow-up was 2.8 years. Of 18,924 patients, 17,370 had monovascular (coronary) disease, 1,405 had polyvascular disease in 2 beds (coronary and peripheral artery or cerebrovascular), and 149 had polyvascular disease in 3 beds (coronary, peripheral artery, cerebrovascular). With placebo, the incidence of MACEs by respective vascular categories was 10.0%, 22.2%, and 39.7%. With alirocumab, the corresponding absolute risk reduction was 1.4% (95% confidence interval [CI]: 0.6% to 2.3%), 1.9% (95% CI: −2.4% to 6.2%), and 13.0% (95% CI: −2.0% to 28.0%). With placebo, the incidence of death by respective vascular categories was 3.5%, 10.0%, and 21.8%; the absolute risk reduction with alirocumab was 0.4% (95% CI: −0.1% to 1.0%), 1.3% (95% CI: −1.8% to 4.3%), and 16.2% (95% CI: 5.5% to 26.8%). In patients with recent ACS and dyslipidemia despite intensive statin therapy, polyvascular disease is associated with high risks of MACEs and death. The large absolute reductions in those risks with alirocumab are a potential benefit for these patients. (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab [ODYSSEY OUTCOMES]: NCT01663402