Supervivencia global en pacientes con cáncer gástrico avanzado o metastásico en los últimos 10 años en el Centro Médico Nacional «20 de noviembre del ISSSTE»

ResumenAntecedentesLa introducción de nuevos fármacos para el tratamiento de los pacientes con cáncer gástrico irresecable, recurrente o metastásico ha reportado un modesto incremento en la supervivencia libre de progresión (SLP) y la supervivencia global (SG).ObjetivoDeterminar el impacto de la aplicación de los nuevos esquemas de quimioterapia paliativa en la SG de los pacientes con cáncer gástrico del Centro Médico Nacional 20 de noviembre, ISSSTE.Material y métodosEstudio retrospectivo, descriptivo. Analizamos expedientes de pacientes con cáncer gástrico irresecable o metastásico, tratados con quimioterapia paliativa de enero de 2002 a diciembre de 2012 en el Centro Médico Nacional 20 de noviembre, ISSSTE. Se evaluó la SG, SLP y los esquemas de quimioterapia más frecuentemente utilizados. Se asignaron los casos a 2 cohortes de acuerdo a la fecha de inicio de la quimioterapia, conformando la cohorte A los pacientes tratados de enero de 2002 hasta diciembre de 2006 y la cohorte B de enero de 2007 a diciembre de 2012. Se estableció estos periodos dado que representaba el cambio en los esquemas de tratamiento utilizados; es decir; la introducción de esquemas que incluyen antraciclinas, oxaliplatino, capecitabina y docetaxel.ResultadosRevisamos los expedientes de 291 pacientes con cáncer gástrico; excluimos a 221 pacientes por estar en etapas tempranas (i, ii o iii) resecables, recibir tratamiento con quimioterapia fuera de la unidad o no ser candidatos a quimioterapia. Finalmente incluimos 70 casos con tratamiento de primera línea. La mediana de SG para pacientes de la cohorte A fue de 11.2 vs. 10.5 meses para los pacientes de la cohorte B. La mediana de SLP en primera línea de tratamiento fue 8.5 vs. 5.2 meses respectivamente. Ambos resultados sin diferencia estadísticamente significativa.ConclusiónEn nuestro centro, no hay impacto de los nuevos esquemas de tratamiento en SLP o SG. Un tamaño de muestra pequeño y el hecho de que pacientes con pobre estado funcional recibieran quimioterapia podrían ser factores que influyeron en los resultados del estudio, en el cual se observó una tendencia a favor de los nuevos esquemas de quimioterapia, pero sin demostrar significación estadística.AbstractBackgroundThe introduction of new drugs for the treatment of patients with advanced, recurrent or metastatic gastric cancer has resulted in a small benefit in overall survival (OS) and progression free survival (PFS).ObjectiveTo determine the impact of new chemotherapy schedules on the OS of patients with advanced or metastic gastric cancer treated at the Centro Medico Nacional 20 de noviembre, ISSSTE.Material and methodologyRetrolective, descriptive study, the clinical files of patients with advanced, recurrent or metastatic gastric cancer treated with chemotherapy at the Centro Medico Nacional 20 de noviembre, ISSSTE, from january 2002 to december 2012, were analyzed. Chemotherapy schedules, OS and PFS were evaluated. Patients were assigned to two cohorts: those treated from january 2002 to december 2006 were included in cohort A and those treated from january 2007 to december 2012 in cohort B. These time periods were determined based on the years when newer chemotherapy agents (anthracyclines, oxaliplatin, capecitabine and docetaxel) were introduced in our institution.Results291 clinical files were analyzed; 221 patients were excluded for they had clinical stage I, II or resectable III disease, started first line chemotherapy as outpatients of our institution or were not candidates for chemotherapy. 70 cases treated with first line chemotherapy were included. OS for patients in cohort A was 11.2 months vs 10.5 months for patients in cohort B. PFS was 8.5 months vs 5.2, respectively. There was no statistical difference in either comparison.ConclusionThere was no impact of the introduction of newer chemotherapy agents in OS or PFS in patients treated in our institution. A small sample size and the fact that patients with poor performance status received chemotherapy could have had influenced the results of our study, in which tendency towards a better outcome for patients treated with newer chemotherapy schemes was observed, although a statistically significant benefit was not proven

Environmental education and ecological awareness in students of the Educational Institution 32068 Santa Rosa de Mayobamba, Huánuco 2020

The purpose of the study was to prove that there is a high relationship between Environmental Education and Ecological Awareness in the students of the Educational Institution 32068 Santa Rosa de Mayobamba, Huánuco 2020; in this sense, a correlational research and non-experimental design was developed, working with a population-sample of 35 teachers, including the director of the educational institution. The data were collected with a test assessed with four dimensions and five indicators for each of them, for variable one, and without dimensions, with ten items for variable two. In the data processing correlational statistics and simple linear regression were used, obtaining the following result and conclusion: the null hypothesis is rejected based on the results of Consequently, it is concluded that there is a very high positive correlation between Environmental Education and Ecological Awareness in the Educational Institution 32068, and in accordance with what has been said, it is affirmed that Environmental Education has a high explanatory power () on Ecological Awareness of teachers and other educational actors of the Santa Rosa de Mayobamba Educational Institution 2020

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

International audienceBackground: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background: Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods: WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings: Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0-4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2-6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation: In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates. Funding: European Society of Intensive Care Medicine, European Respiratory Society