HISTORIA CLÍNICA INFORMATIZADA DE ENFERMERÍA EN EL DEPARTAMENTO DE TORREVIEJA SALUD COMO INSTRUMENTO DE GESTIÓN DE CALIDAD

In the information society of the 21st century, it is a fact that the Electronic Clinical History (ECH) is not developed in every country. In Torrevieja Salud Health Department, Alicante (Spain), they work with a unique ECH that includes all divisions, including the nursing ones and an advanced operability level in regards to data management.    Objectives: 1.- To develop all the information sources to facilitate the communication at all levels of care, so any professional in the community or at the hospital can retrieve information about the patient. 2.- To gather the nursing staff and computer technicians knowledge by working together. Methodology: In order to improve the nursing records, they have used a computer program named “FLORENCE”, which is a model of a unique clinical history for the Health Department of Torrevieja. Florence is divided in two environments: Florence Gestión (accountant,-financial, and HH RR scopes) and FLORENCE (clinical assitance scope). This program comes as the result of the teamwork from IT and nursing staff who are knowledgeable of the concerns of the professionals. A product with double value because it combines the nursing methodology and state-of-art technological advances. Conclusions:  Nursing records are valued as an effective instrument to empower the continuation of nursing care and coordinate that care at the best quality, as they are registered in a unique and single program. On the other hand, it ensures constant availability of all the information of the health-disease episodes of a patient, and most importantly, the information is kept confidential.  En la sociedad de la información del siglo XXI, la historia clínica electrónica (HCE) es un hecho que no está por igual desarrollado en todos los países. En el Departamento de Salud de Torrevieja, Alicante, se trabaja con un modelo de HCE único que engloba a todas las áreas incluida  enfermería y en un nivel avanzado de operabilidad en cuanto a manejo de datos.   Objetivos: 1.- Desarrollo de los sistemas de información con el fin de facilitar la comunicación e intercambio de datos entre los distintos profesionales de atención especializada y primaria que componen el Departamento de Salud. 2.- Aunar y optimizar los conocimientos propios  de los profesionales enfermeros e informáticos, a través del trabajo en conjunto.   Metodología: Para llevar a cabo esta mejora en los registros  de enfermería se ha utilizado la aplicación informática, “Florence”, modelo de Historia Clinica Electrónica única y global para el Departamento de Salud de Torrevieja que consta de dos entornos: Florence Gestión (área financiera- contable y  área de recursos humanos) y Florence clínico (área clínico-asistencial).   A través del trabajo en equipo de Informáticos y profesionales de enfermería que conocen el sistema e inquietudes de los profesionales se obtiene un producto doblemente valorado en cuanto a metodología enfermera y suma de los últimos conocimientos tecnológicos. Conclusiones:  Los registros de enfermería se consideran un instrumento efectivo para reflejar toda la información necesaria para poder coordinar y proporcionar unos cuidados de enfermería de máxima calidad al estar almacenados de forma integral. Por otro lado se asegura la disponibilidad de toda la información de los procesos salud-enfermedad de un individuo, asegurando la confidencialidad.

Diseño e implementación de juegos en el aula utilizando herramientas de respuesta de audiencia

El aprendizaje basado en juegos se basa en introducir el juego en las aulas para mejorar aspectos como el rendimiento, la concentración y el esfuerzo del alumnado. En la actualidad, proporciona un recurso muy útil para incrementar la motivación del alumnado universitario, generando un mejor clima entre compañeros y entre alumno y profesor, el cual en muchas ocasiones se traduce en mejores resultados académicos. Sin embargo, diseñar juegos que consigan con éxito los objetivos de enseñanza-aprendizaje deseados no es una tarea trivial. Este trabajo propone tres juegos basados en la participación por equipos que pueden ser fácilmente implementados utilizando plataformas online existentes. En el diseño de los mismos, se ha tenido en cuenta la experiencia previa de los alumnos en el uso de herramientas de respuesta de audiencia, así como en su participación en juegos en el aula. Tras llevar a cabo los juegos en distintas asignaturas relacionadas con el campo de las TIC, se ha evaluado el impacto de esta actividad mediante encuestas de satisfacción cumplimentadas por el alumnado.The so-called game-based learning strategies are based on introducing games in the classrooms to improve aspects such as student performance, concentration and effort. Currently, they provide a very useful resource to increase the motivation of university students, generating a better atmosphere among peers and between student and teacher, which in turn is generally translated into better academic results. However, the design of games that successfully achieve the desired teaching-learning objectives is not a trivial task. This paper proposes three games based on team participation that can be easily implemented using existing online platforms. The design of these games has taken into account the previous experience of the students in the use of audience response tools, as well as their participation in games in the classroom. After carrying out the games in different ICT-related subjects, we evaluated the impact of this activity using questionnaires collecting students’ assessments.Este proyecto ha sido financiado por la UV (Servei de Formació Permanent i Innovació Educativa) en el contexto del proyecto UV-SFPIE_GER18-848990

Impact of operatoŕs experience on peri-procedural outcomes with Watchman FLX: Insights from the FLX-SPA registry

Background: The Watchman FLX is a device upgrade of the Watchman 2.5 that incorporates several design enhancements intended to simplify left atrial appendage occlusion (LAAO) and improve procedural outcomes. This study compares peri-procedural results of LAAO with Watchman FLX (Boston Scientific, Marlborough, Massachusetts) in centers with varying degrees of experience with the Watchman 2.5 and Watchman FLX. Methods: Prospective, multicenter, 'real-world' registry including consecutive patients undergoing LAAO with the Watchman FLX at 26 Spanish sites (FLX-SPA registry). Implanting centers were classified according to the center's prior experience with the Watchman 2.5. A further division of centers according to whether or not they had performed ≤ 10 or > 10Watchman FLX implants was prespecified at the beginning of the study. Procedural outcomes of institutions stratified according to their experience with the Watchman 2.5 and FLX devices were compared. Results: 359 patients [mean age 75.5 (SD8.1), CHA2DS2-VASc 4.4 (SD1.4), HAS-BLED 3.8(SD0.9)] were included. Global success rate was 98.6%, successful LAAO with the first selected device size was achieved in 95.5% patients and the device was implanted at first attempt in 78.6% cases. There were only 9(2.5%) major peri-procedural complications. No differences in efficacy or safety results according to the centeŕs previous experience with Watchman 2.5 and procedural volume with Watchman FLX existed. Conclusions: The Watchman FLX attains high procedural success rates with complete LAA sealing in unselected, real-world patients, along with a low incidence of peri-procedural complications, regardless of operatoŕs experience with its previous device iteration or the number of Watchman FLX devices implanted

Spread of a SARS-CoV-2 variant through Europe in the summer of 2020.

Following its emergence in late 2019, the spread of SARS-CoV-21,2 has been tracked by phylogenetic analysis of viral genome sequences in unprecedented detail3–5. Although the virus spread globally in early 2020 before borders closed, intercontinental travel has since been greatly reduced. However, travel within Europe resumed in the summer of 2020. Here we report on a SARS-CoV-2 variant, 20E (EU1), that was identified in Spain in early summer 2020 and subsequently spread across Europe. We find no evidence that this variant has increased transmissibility, but instead demonstrate how rising incidence in Spain, resumption of travel, and lack of effective screening and containment may explain the variant’s success. Despite travel restrictions, we estimate that 20E (EU1) was introduced hundreds of times to European countries by summertime travellers, which is likely to have undermined local efforts to minimize infection with SARS-CoV-2. Our results illustrate how a variant can rapidly become dominant even in the absence of a substantial transmission advantage in favourable epidemiological settings. Genomic surveillance is critical for understanding how travel can affect transmission of SARS-CoV-2, and thus for informing future containment strategies as travel resumes. © 2021, The Author(s), under exclusive licence to Springer Nature Limited

Risk profiles and one-year outcomes of patients with newly diagnosed atrial fibrillation in India: Insights from the GARFIELD-AF Registry.

BACKGROUND: The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS: A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range {IQR}: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION: Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362

Harmonized D-dimer levels upon admission for prognosis of COVID-19 severity: Results from a Spanish multicenter registry (BIOCOVID-Spain study).

Coagulopathy is a key feature of COVID-19 and D-dimer has been reported as a predictor of severity. However, because D-dimer test results vary considerably among assays, resolving harmonization issues is fundamental to translate findings into clinical practice. In this retrospective multicenter study (BIOCOVID study), we aimed to analyze the value of harmonized D-dimer levels upon admission for the prediction of in-hospital mortality in COVID-19 patients. All-cause in-hospital mortality was defined as endpoint. For harmonization of D-dimer levels, we designed a model based on the transformation of method-specific regression lines to a reference regression line. The ability of D-dimer for prediction of death was explored by receiver operating characteristic curves analysis and the association with the endpoint by Cox regression analysis. Study population included 2663 patients. In-hospital mortality rate was 14.3%. Harmonized D-dimer upon admission yielded an area under the curve of 0.66, with an optimal cut-off value of 0.945 mg/L FEU. Patients with harmonized D-dimer ≥ 0.945 mg/L FEU had a higher mortality rate (22.4% vs. 9.2%; p