Las emociones derivadas del contexto familiar y cómo trabajarlas. Una propuesta de intervención educativa para segundo curso de Educación Infantil

Las emociones desencadenan reacciones físicas y comportamentales que afectan a nuestros acontecimientos diarios. En los niños la mayoría de las emociones son generadas en sus dos contextos más cercanos, el familiar y el escolar. Por ello el presente Trabajo de Fin de Grado pretende demostrar qué tipo de variables dentro del contexto familiar pueden afectar a sus hijos, y les condicione en su aprendizaje y, a la vez, como consecuencia, se desencadenan diferentes tipos de emociones. A raíz de todo esto se presenta un Plan de Acción llamado “Un Proyecto Educativo para cada hijo”, cuyo principal objetivo es ayudar a los alumnos de segundo de Educación Infantil a reconocer, ubicar y tratar las emociones provenientes de los diferentes climas familiares. Para que los alumnos desarrollen un trato adecuado hacia las emociones que sienten no se puede trabajar únicamente en el contexto escolar, sino que los padres deben ser partícipes de su proceso de enseñanza-aprendizaje, en consecuencia, el siguiente proyecto presenta un Plan de Intervención donde los padres son un componente clave para su desarrollo.Emotions trigger physical and behavioral reactions that affect our daily events. In children, most of the emotions are generated in their two closest contexts, family and school. It has been proved that familiar context and experiences affects students in their school context. As a consequence, students may vary their behavior as per their familiar reality. This Final Degree Dissertation amins to help second year Kindergarten students to recognize, locate and treat their emotions by offering the Action Plan called "An Educational Project for each child". For students to develop an adequate treatment of the emotions they feel, it is not possible to work only in the school context, but parents must be participants in their teaching-learning process, consequently, the following project presents an Intervention Plan where parents are a key component in their development.Les emocions desencadenen reaccions físiques i comportamentals que afecten els nostres esdeveniments diaris. En els xiquets la majoria de les emocions són generades en els seus dos contextos més pròxims, el familiar i l´escolar, per això el present Treball de Fi de Grau demostra com allò que els alumnes viuen en el seu context familiar afecta directament a la seua persona en el context escolar i com el transformen en diferents tipus d'emocions. Arran de tot això es presenta un Pla d'Acció anomenat “Un Projecte Educatiu per a cada fill”, el principal objectiu del qual és ajudar als alumnes de segon d'Educació Infantil a reconéixer, situar i tractar les emocions provinents dels diferents climes familiars. Perquè els alumnes desenvolupen un tracte adequat cap a les emocions que senten no es pot treballar únicament en el context escolar, sinó que els pares han de ser partícips del seu procés d'ensenyament-aprenentatge, en conseqüència, el següent projecte presenta un Pla d'Intervenció on els pares són un component clau per al seu desenvolupament.Educació

Family satisfaction with critical care in the UK: a multicentre cohort study.

OBJECTIVE: To assess family satisfaction with intensive care units (ICUs) in the UK using the Family Satisfaction in the Intensive Care Unit 24-item (FS-ICU-24) questionnaire, and to investigate how characteristics of patients and their family members impact on family satisfaction. DESIGN: Prospective cohort study nested within a national clinical audit database. SETTING: Stratified, random sample of 20 adult general ICUs participating in the Intensive Care National Audit & Research Centre Case Mix Programme. PARTICIPANTS: Family members of patients staying at least 24 hours in ICU were recruited between May 2013 and June 2014. INTERVENTIONS: Consenting family members were sent a postal questionnaire 3 weeks after the patient died or was discharged from ICU. Up to four family members were recruited per patient. MAIN OUTCOME MEASURES: Family satisfaction was measured using the FS-ICU-24 questionnaire. MAIN RESULTS: A total of 12 346 family members of 6380 patients were recruited and 7173 (58%) family members of 4615 patients returned a completed questionnaire. Overall and domain-specific family satisfaction scores were high (mean overall family satisfaction 80, satisfaction with care 83, satisfaction with information 76 and satisfaction with decision-making 73 out of 100) but varied significantly across adult general ICUs studied and by whether the patient survived ICU. For family members of ICU survivors, characteristics of both the family member (age, ethnicity, relationship to patient (next-of-kin and/or lived with patient) and visit frequency) and the patient (acute severity of illness and receipt of invasive mechanical ventilation) were significant determinants of family satisfaction, whereas, for family members of ICU non-survivors, only patient characteristics (age, acute severity of illness and duration of stay) were significant. CONCLUSIONS: Overall family satisfaction in UK adult general ICUs was high but varied significantly. Adjustment for differences in family member/patient characteristics is important to avoid falsely identifying ICUs as statistical outliers. TRIAL REGISTRATION NUMBER: ISRCTN47363549

Improving risk prediction model quality in the critically ill:data linkage study

Background: A previous National Institute for Health and Care Research study [Harrison DA, Ferrando-Vivas P, Shahin J, Rowan KM. Ensuring comparisons of health-care providers are fair: development and validation of risk prediction models for critically ill patients. Health Serv Deliv Res 2015;3(41)] identified the need for more research to understand risk factors and consequences of critical care and subsequent outcomes. Objectives: First, to improve risk models for adult general critical care by developing models for mortality at fixed time points and time-to-event outcomes, end-stage renal disease, type 2 diabetes, health-care utilisation and costs. Second, to improve risk models for cardiothoracic critical care by enhancing risk factor data and developing models for longer-term mortality. Third, to improve risk models for in-hospital cardiac arrest by enhancing risk factor data and developing models for longer-term mortality and critical care utilisation. Design: Risk modelling study linking existing data. Setting: NHS adult critical care units and acute hospitals in England. Participants: Patients admitted to an adult critical care unit or experiencing an in-hospital cardiac arrest. Interventions: None. Main outcome measures: Mortality at hospital discharge, 30 days, 90 days and 1 year following critical care unit admission; mortality at 1 year following discharge from acute hospital; new diagnosis of end-stage renal disease or type 2 diabetes; hospital resource use and costs; return of spontaneous circulation sustained for > 20 minutes; survival to hospital discharge and 1 year; and length of stay in critical care following in-hospital cardiac arrest. Data sources: Case Mix Programme, National Cardiac Arrest Audit, UK Renal Registry, National Diabetes Audit, National Adult Cardiac Surgery Audit, Hospital Episode Statistics and Office for National Statistics. Results: Data were linked for 965,576 critical care admissions between 1 April 2009 and 31 March 2016, and 83,939 in-hospital cardiac arrests between 1 April 2011 and 31 March 2016. For admissions to adult critical care units, models for 30-day mortality had similar predictors and performance to those for hospital mortality and did not reduce heterogeneity. Models for longer-term outcomes reflected increasing importance of chronic over acute predictors. New models for end-stage renal disease and diabetes will allow benchmarking of critical care units against these important outcomes and identification of patients requiring enhanced follow-up. The strongest predictors of health-care costs were prior hospitalisation, prior dependency and chronic conditions. Adding pre- and intra-operative risk factors to models for cardiothoracic critical care gave little improvement in performance. Adding comorbidities to models for in-hospital cardiac arrest provided modest improvements but were of greater importance for longer-term outcomes. Limitations: Delays in obtaining linked data resulted in the data used being 5 years old at the point of publication: models will already require recalibration. Conclusions: Data linkage provided enhancements to the risk models underpinning national clinical audits in the form of additional predictors and novel outcomes measures. The new models developed in this report may assist in providing objective estimates of potential outcomes to patients and their families. Future work: (1) Develop and test care pathways for recovery following critical illness targeted at those with the greatest need; (2) explore other relevant data sources for longer-term outcomes; (3) widen data linkage for resource use and costs to primary care, outpatient and emergency department data

Pharmacological and non-pharmacological treatments and outcomes for new-onset atrial fibrillation in ICU patients : the CAFE scoping review and database analyses

Background New-onset atrial fibrillation occurs in around 10% of adults treated in an intensive care unit. New-onset atrial fibrillation may lead to cardiovascular instability and thromboembolism, and has been independently associated with increased length of hospital stay and mortality. The long-term consequences are unclear. Current practice guidance is based on patients outside the intensive care unit; however, new-onset atrial fibrillation that develops while in an intensive care unit differs in its causes and the risks and clinical effectiveness of treatments. The lack of evidence on new-onset atrial fibrillation treatment or long-term outcomes in intensive care units means that practice varies. Identifying optimal treatment strategies and defining long-term outcomes are critical to improving care. Objectives In patients treated in an intensive care unit, the objectives were to (1) evaluate existing evidence for the clinical effectiveness and safety of pharmacological and non-pharmacological new-onset atrial fibrillation treatments, (2) compare the use and clinical effectiveness of pharmacological and non-pharmacological new-onset atrial fibrillation treatments, and (3) determine outcomes associated with new-onset atrial fibrillation. Methods We undertook a scoping review that included studies of interventions for treatment or prevention of new-onset atrial fibrillation involving adults in general intensive care units. To investigate the long-term outcomes associated with new-onset atrial fibrillation, we carried out a retrospective cohort study using English national intensive care audit data linked to national hospital episode and outcome data. To analyse the clinical effectiveness of different new-onset atrial fibrillation treatments, we undertook a retrospective cohort study of two large intensive care unit databases in the USA and the UK. Results Existing evidence was generally of low quality, with limited data suggesting that beta-blockers might be more effective than amiodarone for converting new-onset atrial fibrillation to sinus rhythm and for reducing mortality. Using linked audit data, we showed that patients developing new-onset atrial fibrillation have more comorbidities than those who do not. After controlling for these differences, patients with new-onset atrial fibrillation had substantially higher mortality in hospital and during the first 90 days after discharge (adjusted odds ratio 2.32, 95% confidence interval 2.16 to 2.48; adjusted hazard ratio 1.46, 95% confidence interval 1.26 to 1.70, respectively), and higher rates of subsequent hospitalisation with atrial fibrillation, stroke and heart failure (adjusted cause-specific hazard ratio 5.86, 95% confidence interval 5.33 to 6.44; adjusted cause-specific hazard ratio 1.47, 95% confidence interval 1.12 to 1.93; and adjusted cause-specific hazard ratio 1.28, 95% confidence interval 1.14 to 1.44, respectively), than patients who did not have new-onset atrial fibrillation. From intensive care unit data, we found that new-onset atrial fibrillation occurred in 952 out of 8367 (11.4%) UK and 1065 out of 18,559 (5.7%) US intensive care unit patients in our study. The median time to onset of new-onset atrial fibrillation in patients who received treatment was 40 hours, with a median duration of 14.4 hours. The clinical characteristics of patients developing new-onset atrial fibrillation were similar in both databases. New-onset atrial fibrillation was associated with significant average reductions in systolic blood pressure of 5 mmHg, despite significant increases in vasoactive medication (vasoactive-inotropic score increase of 2.3; p < 0.001). After adjustment, intravenous beta-blockers were not more effective than amiodarone in achieving rate control (adjusted hazard ratio 1.14, 95% confidence interval 0.91 to 1.44) or rhythm control (adjusted hazard ratio 0.86, 95% confidence interval 0.67 to 1.11). Digoxin therapy was associated with a lower probability of achieving rate control (adjusted hazard ratio 0.52, 95% confidence interval 0.32 to 0.86) and calcium channel blocker therapy was associated with a lower probability of achieving rhythm control (adjusted hazard ratio 0.56, 95% confidence interval 0.39 to 0.79) than amiodarone. Findings were consistent across both the combined and the individual database analyses. Conclusions Existing evidence for new-onset atrial fibrillation management in intensive care unit patients is limited. New-onset atrial fibrillation in these patients is common and is associated with significant short- and long-term complications. Beta-blockers and amiodarone appear to be similarly effective in achieving cardiovascular control, but digoxin and calcium channel blockers appear to be inferior. Future work Our findings suggest that a randomised controlled trial of amiodarone and beta-blockers for management of new-onset atrial fibrillation in critically ill patients should be undertaken. Studies should also be undertaken to provide evidence for or against anticoagulation for patients who develop new-onset atrial fibrillation in intensive care units. Finally, given that readmission with heart failure and thromboembolism increases following an episode of new-onset atrial fibrillation while in an intensive care unit, a prospective cohort study to demonstrate the incidence of atrial fibrillation and/or left ventricular dysfunction at hospital discharge and at 3 months following the development of new-onset atrial fibrillation should be undertaken. Trial registration Current Controlled Trials ISRCTN13252515. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 71. See the NIHR Journals Library website for further project information

Use of selective gut decontamination in critically ill children: protocol for the Paediatric Intensive Care and Infection Control (PICnIC) pilot study.

INTRODUCTION: Healthcare-associated infections (HCAIs) are a major cause of morbidity and mortality in critically ill children. In critically ill adults, there are data that suggest the use of Selective Decontamination of the Digestive tract (SDD), alongside standard infection control measures reduce mortality and the incidence of HCAIs. SDD-enhanced infection control has not been compared directly with standard infection prevention strategies in the Paediatric Intensive Care Unit (PICU) population. The aim of this pilot study is to determine the feasibility of conducting a multicentre cluster randomised controlled trial (cRCT) in critically ill children comparing SDD with standard infection control. METHODS AND ANALYSIS: Paediatric Intensive Care and Infection Control is a parallel group pilot cRCT, with integrated mixed-methods study, comparing incorporation of SDD into infection control procedures to standard care. After a 1-week pretrial ecology surveillance period, recruitment to the cRCT will run for a period of 18 weeks, comprising: (1) baseline control period (2) pre, mid and post-trial ecology surveillance periods and (3) intervention period. Six PICUs (in England, UK) will begin with usual care in period 1, then will be randomised 1:1 by the trial statistician using computer-based randomisation, to either continue to deliver usual care or commence delivery of the intervention (SDD) in period 2. Outcomes measures include parent and healthcare professionals' views on trial feasibility, adherence to the SDD intervention, estimation of recruitment rate and understanding of potential patient-centred primary and secondary outcome measures for the definitive trial. The planned recruitment for the cRCT is 324 participants. ETHICS AND DISSEMINATION: The trial received favourable ethical opinion from West Midlands-Black Country Research Ethics Committee (reference: 20/WM/0061) and approval from the Health Research Authority (IRAS number: 239324). Informed consent is not required for SDD intervention or anonymised data collection but is sought for investigations as part of the study, any identifiable data collected and monitoring of medical records. Results will be disseminated via publications in peer-reviewed medical journals. TRIAL REGISTRATION NUMBER: ISRCTN40310490

Selective digestive tract decontamination to prevent healthcare associated infections in critically ill children: the PICNIC multicentre randomised pilot clinical trial.

Healthcare-associated infections (HCAIs) are a major cause of morbidity and mortality in critically ill children. Data from adult studies suggest Selective Decontamination of the Digestive tract (SDD) may reduce the incidence of HCAIs and improve survival. There are no data from randomised clinical trials in the paediatric setting. An open label, parallel group pilot cRCT and mixed-methods perspectives study was conducted in six paediatric intensive care units (PICUs) in England. Participants were children (> 37 weeks corrected gestational age, up to 16 years) requiring mechanical ventilation expected to last for at least 48 h. Sites undertook standard care for a period of 9 weeks and were randomised into 3 sites which continued standard care and 3 where SDD was incorporated into infection control practice for eligible children. Interviews and focus groups were conducted for parents and staff working in PICU. 434 children fulfilled eligibility criteria, of whom 368 (85%) were enrolled. This included 207 in the baseline phase (Period One) and 161 in the intervention period (Period Two). In sites delivering SDD, the majority (98%) of children received at least one dose of SDD and of these, 68% commenced within the first 6 h. Whilst admission swabs were collected in 91% of enrolled children, consent for the collection of additional swabs was low (44%). Recruited children were representative of the wider PICU population. Overall, 3.6 children/site/week were recruited compared with the potential recruitment rate for a definitive cRCT of 3 children/site/week, based on data from all UK PICUs. Parents (n = 65) and staff (n = 44) were supportive of the aims of the study, suggesting adaptations for a larger definitive trial including formulation and administration of SDD paste, approaches to consent and ecology monitoring. Stakeholders identified preferred clinical outcomes, focusing on complications of critical illness and quality-of-life. A definitive cRCT in SDD to prevent HCAIs in critically ill children is feasible but should include adaptations to ecology monitoring along with the dosing schedule and packaging into a paediatric specific format. A definitive study is supported by the findings with adaptations to ecology monitoring and SDD administration.Trial Registration: ISRCTN40310490 Registered 30/10/2020

Bases per al desenvolupament del model organitzatiu d’atenció integral a la població adulta amb necessitats pal·liatives i en situació de final de la vida

Atenció integral; Població adulta; Cures pal·liatives; Malalties limitantsComprehensive care; Adult population; Palliative care; Limiting illnessesAtención integral; Población adulta; Cuidados paliativos; Enfermedades limitantesAquest document, emmarcat en el Pla de salut 2016-2020, pretén considerar i alinear les directrius en l’atenció al final de la vida i cures pal·liatives derivades del Pla director sociosanitari, així com les impulsades pel Programa de prevenció i atenció a la cronicitat en matèria de cronicitat avançada. Recull les bases per al desenvolupament del model d’atenció al final de la vida a Catalunya, entenent l’etapa de final de vida amb una mirada àmplia, que va des de la fase avançada de la malaltia fins a la mort, i fins i tot més enllà, amb el procés de dol dels familiars i persones de l’entorn

El grupu neandertal de la Cueva d'El Sidrón (Borines, Piloña).

Na monografía clásica de Puig y Larraz (1896: 250-252) amiéntense delles cavidaes del Conceyu de Piloña2 , pero non la Cueva d’El Sidrón (Fig. 1). Esta conocíase, ensin dulda, dende la Guerra Civil y el maquis al servir d’abellugu a persiguíos políticos, y guarda una alcordanza imborrable nuna de les sos múltiples entraes, yá qu’ellí ta enterrada Olvido Otero González (1908-1938). Per El Sidrón pasaron munches persones a lo llargo de los años, pero en 1994 prodúxose’l descubrimientu per parte d’unos espeleólogos xixoneses d’unos güesos humanos que dieron un importante xiru a la conocencia de los nuesos antepasaos neandertale

Bases per al desenvolupament del model organitzatiu d’atenció integral a la població infantil i juvenil amb necessitats pal·liatives i en situació de final de la vida

Atenció integral; Població infantil i juvenil; Cures pal·liatives; Malalties limitantsAtención integral; Población infantil y juvenil; Cuidados paliativos; Enfermedades limitantesComprehensive care; Children and youth population; Palliative care; Limiting illnessesLes cures pal·liatives pediàtriques proporcionen una atenció integral, interdisciplinària i transversal als nens i joves que tenen malalties limitants per a la vida, necessitats pal·liatives i/o que es troben en situació de final de la vida. Aquest document, emmarcat en el Pla de Salut de Catalunya 2016-2020, recull les bases per al desenvolupament del model pediàtric d’atenció al final de la vida a Catalunya. Inicialment, prenent com a referència documents d’organitzacions internacionals i estatals, es defineix què són les cures pal·liatives pediàtriques, a qui van dirigides i quines són les singularitats i especificitats respecte a les cures pal·liatives de la població adulta. També inclou una anàlisi de situació en què es descriuen quines són les necessitats pal·liatives de la població pediàtrica, de quins recursos es disposa per atendre aquestes necessitats i on s’atenen els nens i joves en els darrers dies de vida. S’estima que a Catalunya hi ha entre 1.500 i 1.800 nens i joves que tenen una malaltia limitant per a la seva vida. D’aquests, entre 750 i 900 tenen necessitat de ser atesos per equips de cures pal·liatives pediàtriques. Tenint en compte les dades de mortalitat dels darrers anys, aproximadament 400 nens i joves (menors de 20 anys) moren anualment en el nostre territori. D’aquests, el 63% moren per causes previsibles i es consideren subsidiaris de rebre cures pal·liatives pediàtriques. Encara que són diferents els àmbits, nivells i recursos assistencials que intervenen o poden intervenir en l’atenció que requereix el nen o el jove i la seva família, la majoria de les morts de la població pediàtrica es produeixen a l’hospital d’aguts. Posteriorment es presenta quina és la visió dels professionals, pacients i cuidadors respecte a les cures pal·liatives pediàtriques a Catalunya. Aquesta percepció es va recollir a través de grups de treball presencials i telemàtics i va permetre identificar aspectes clau que el model pediàtric d’atenció pal·liativa havia de considerar i cobrir. Es van identificar nou grups de garanties que el model pediàtric d’atenció pal·liativa i al final de la vida havia de preveure: àrea clínica; atenció centrada en la persona; competència professional; cuidar el cuidador; equitat, accessibilitat, continuïtat i proximitat; atenció domiciliària; coordinació assistencial; avaluació, millora, innovació i recerca, i adequació estructural i tecnològica. Finalment, mantenint els grups de garanties establerts a partir de la visió dels professionals, pacients i cuidadors, el document recull un conjunt de recomanacions per assolir aquelles garanties que han estat identificades i prioritzades com a imprescindibles per oferir a la població pediàtrica una atenció pal·liativa de qualitat. Concretament, es plantegen 42 recomanacions generals, 10 recomanacions específiques per a determinats grups de població susceptibles de rebre cures pal·liatives pediàtriques (perinatals i malalties minoritàries)i 8 recomanacions específiques per a diferents àmbits assistencials