Strategic analysis of Cultural y Deportiva Leonesa. Present and future

[ES] La Cultural y Deportiva Leonesa, un club de fútbol centenario que ha pasado por momentos difíciles, actualmente se encuentra en Primera RFEF y tiene estabilidad económica. En el presente Trabajo Fin de Grado se lleva a cabo, en primer lugar, una descripción de su historia y sus principales características, como paso previo a la realización de un análisis de su entorno general de cara a identificar las oportunidades y amenazas a las que el Club debe hacer frente. Seguidamente, se realiza un análisis interno para identificar sus recursos y capacidades estratégicos (fortalezas) así como sus propias debilidades. A partir de ambos análisis se ha elaborado una matriz DAFO para delimitar la situación actual del Club en términos estratégicos, con la finalidad de identificar posibles acciones de mejora para el futuro y optimizar así su situación a nivel empresarial y deportivo.[EN] Cultural y Deportiva Leonesa, is a century-old football club that has gone through many difficult moments. It is currently in the Spanish “Primera RFEF” league and is economically stable. In this Final Degree Project, a description of its history and its main characteristics has been carried out, as a previous step to carrying out an analysis of its general environment in order to identify the opportunities and threats that the Club now face. Following this, an internal analysis was carried out to identify its resources and strategic capabilities (strengths) as well as its own specific weaknesses. Based on both analyses, a SWOT matrix was drawn up to define the current situation of the Club in strategic terms, in order to identify possible improvement actions for the future and thus optimize its situation at a business and sporting level

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

Protocolo de manejo ambulatorio de la paciente con sospecha de retención de restos ovulares tras parto/cesárea o aborto. Hospital Universitario Gregorio Marañón

Protocolo de manejo ambulatorio de la paciente con sospecha de retención de restos ovulares tras parto ó cesárea ó aborto que tiene como objetivo principal definir el circuito para el manejo ambulatorio de las pacientes con sospecha de retención de restos ovulares tras parto vaginal / cesárea ó tras aborto de 1º o 2º Trimestre. Objetivos específicos: Disminuir la morbilidad de este grupo de pacientes (especialmente vulnerable desde el punto de vista físico y psicológico) mediante el diagnóstico, seguimiento y tratamiento correcto. Estratificar el riesgo inicial de estas pacientes teniendo en cuenta su estado clínico y los hallazgos ecográficos, para decidir el tratamiento más adecuado (expectante, tratamiento médico, quirúrgico o embolización arterial pélvica). Mejorar la seguridad de las pacientes y profesionales en el manejo de esta patología. Fomentar el trabajo en equipo (entre obstetras, ginecólogos, radiólogos y radiólogos intervencionistas) mejorando la atención de las pacientes.Depto. de Salud Pública y Materno - InfantilFac. de Medicinaunpu

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

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients

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