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

Las educadoras y técnicos de párvulos y su relación con la convivencia escolar en el aula

Tesis (Educación Parvularia, Licenciado en Educación)La Educación Parvularia en Chile, además de haber sido incluida en la reforma curricular, se ha beneficiado por la concretización de incluir el segundo nivel de transición II como obligatorio. Reconociendo a esta etapa educativa, como transcendental en los niños y niñas menores de 6 años. De esta forma se validan las investigaciones realizadas por diferentes autores, de los cuales podemos mencionar a Jean Piaget , quien a través de su Teoría de Desarrollo Cognitivo indicó: que parte de la enseñanza se produce "de dentro hacia afuera". Tomando en cuenta que, es el resultado de los procesos evolutivos naturales, por lo tanto, la acción educativa debe favorecer los procesos constructivos personales, intencionando las actividades al descubrimiento por medio de un modelo pedagógico piagetiano, que hace referencia principalmente a las interacciones sociales horizontales. Por esta razón se realizará una investigación en relación con los aprendizajes esperados para desarrollar y fortalecer las habilidades sociales en los niños y niñas del nivel transición II. Donde se espera que las estrategias educativas, que utilizan las Educadoras y Técnicos de Párvulos, apunten a favorecer los cambios evolutivos naturales, y que a través de la interacción social, logren crear un ambiente armónico, donde el proceso de aprendizaje sea guía para la formación de un ser socialmente hábil, el que proyectándose pueda discutir, aceptar las discrepancias, enfrentar y solucionar conflictos de cualquier índole, creando ambientes desafiantes para su desarrollo. Durante el proceso de la investigación, se darán a conocer Las Políticas Públicas Educativas, un tema en desarrollo, a raíz de los constantes hechos de violencia por parte del alumnado y comunidad educativa. De las cuales se han editado innumerables documentos de apoyo al profesorado para fomentar las relaciones sociales dentro del ámbito educativo. En el transcurso de la última década, el Ministerio de Educación ha publicado diversos documentos como resultado de la Reforma Educacional chilena, aludiendo específicamente a La Política de Convivencia Escolar, implementado para los diferentes niveles de educación escolar. Este material, además está acompañado por manuales que apoyan la labor educativa y social en la enseñanza básica y media. Para la Educación Pre Escolar, se elaboraron las Bases Curriculares de la Educación Parvularia, compuesto por ámbitos de aprendizajes, incluyendo el de Formación Personal y Social, donde se desarrollan diferentes aprendizajes esperados los que favorecen e incentivan el progreso de habilidades e interacciones sociales, la valoración de sí mismo, la pertenencia social y la formación valórica. Es en esta área donde se profundizará la investigación, identificando las estrategias que utilizan o integran las Educadoras y Técnicos de Párvulos en la actualidad. Se observará el trato de los siguientes temas: resolución de conflictos, relaciones interpersonales, desarrollo de valores y conductas que tengan relación con la Convivencia Escolar, su forma de aplicarlos y su inclusión dentro de los planes anuales, semestrales o semanales, en los niveles seleccionados para la exploración. A continuación se presentarán los antecedentes obtenidos a través del estudio realizado durante el seminario de grado dedicado al tema expuesto

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

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective