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

Diseño estratégico de vanguardia

La integración del diseño con la vanguardia se observa natural, esto es, el diseño es una disciplina abductiva y la vanguardia persigue fines prospectivos, es decir, en ambos casos se trata de objetivos de posibilidad futura. De tal suerte, este libro, emanado de una parte de las ponencias rigurosamente arbitradas del Coloquio Internacional de Diseño 2016, está dividido en tres secciones o capítulos, a saber, el capítulo uno relacionado con la teoría y metodología para proyectos de diseño de vanguardia, el segundo sobre la tecnología, la innovación y la sostenibilidad de vanguardia de dichos proyectos, y finalmente el último capítulo, vinculado con la gestión estratégica de proyectos de vanguardia.La historia se forja de hechos e interpretaciones, de pasados construidos y de presentes en procesos constantes, estudiados en forma estricta por las ciencias. Por su parte, el futuro ostenta la posibilidad de ser indefinidamente planeado con base en las variopintas aproximaciones teóricas y empíricas que dan fundamento a este tipo de ciencia; éstas son denominadas prospectivas y sus bases vanguardias. Resulta importante señalar, que estas posibilidades sólo permiten tener una idea hipotética de lo que será la realidad y el mundo de vida de los seres vivos y su contexto, no obstante, se trata de la única manera racional que tiene el ser humano de prever ese futuro posible. Las distintas ciencias y disciplinas nos permiten construir históricamente estas posibilidades partiendo de datos, hechos, significados y un sinfín de informaciones que le dan cuerpo y sentido a tales posibilidades. En este sentido, la vanguardia, como base del conocimiento prospectivo, observa la necesidad de ser escrita, leída y discutida en los términos más estrictos con el fin de volver las predicciones más precisas. El diseño por su parte, es definido de manera sucinta como la disciplina proyectual estratégica y sistémica de la posibilidad, dirigida a procesos de significación utilitaria y simbólica para la comprensión –o interpretación– y modificación –o proyectación– de niveles de realidad (referentes y sujetos) desde diversos aparatos teóricos y empíricos –perspectivas disciplinarias–

Gestión del conocimiento: perspectiva multidisciplinaria. Volumen 13

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 13 de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada, de acceso abierto a todas las áreas del conocimiento, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico. Con esta colección, se aspira contribuir con el cultivo, la comprensión, la recopilación y la apropiación social del conocimiento en cuanto a patrimonio intangible de la humanidad, con el propósito de hacer aportes con la transformación de las relaciones socioculturales que sustentan la construcción social de los saberes y su reconocimiento como bien público. El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 13, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro cuenta con el apoyo de los grupos de investigación: Universidad Sur del Lago “Jesús María Semprúm” (UNESUR) - Zulia – Venezuela; Universidad Politécnica Territorial de Falcón Alonso Gamero (UPTFAG) - Falcón – Venezuela; Universidad Politécnica Territorial de Mérida Kléber Ramírez (UPTM) - Mérida - Venezuela; Universidad Guanajuato (UG) - Campus Celaya - Salvatierra - Cuerpo Académico de Biodesarrollo y Bioeconomía en las Organizaciones y Políticas Públicas (CABBOPP) - Guanajuato – México; Centro de Altos Estudios de Venezuela (CEALEVE) - Zulia – Venezuela, Centro Integral de Formación Educativa Especializada del Sur (CIFE - SUR) - Zulia – Venezuela; Centro de Investigaciones Internacionales SAS (CEDINTER) - Antioquia – Colombia y diferentes grupos de investigación del ámbito nacional e internacional que hoy se unen para estrechar vínculos investigativos, para que sus aportes científicos formen parte de los libros que se publiquen en formatos digital e impreso

All-cause mortality in the cohorts of the Spanish AIDS Research Network (RIS) compared with the general population: 1997Ł2010

Abstract Background: Combination antiretroviral therapy (cART) has produced significant changes in mortality of HIVinfected persons. Our objective was to estimate mortality rates, standardized mortality ratios and excess mortality rates of cohorts of the AIDS Research Network (RIS) (CoRIS-MD and CoRIS) compared to the general population. Methods: We analysed data of CoRIS-MD and CoRIS cohorts from 1997 to 2010. We calculated: (i) all-cause mortality rates, (ii) standardized mortality ratio (SMR) and (iii) excess mortality rates for both cohort for 100 personyears (py) of follow-up, comparing all-cause mortality with that of the general population of similar age and gender. Results: Between 1997 and 2010, 8,214 HIV positive subjects were included, 2,453 (29.9%) in CoRIS-MD and 5,761 (70.1%) in CoRIS and 294 deaths were registered. All-cause mortality rate was 1.02 (95% CI 0.91-1.15) per 100 py, SMR was 6.8 (95% CI 5.9-7.9) and excess mortality rate was 0.8 (95% CI 0.7-0.9) per 100 py. Mortality was higher in patients with AIDS, hepatitis C virus (HCV) co-infection, and those from CoRIS-MD cohort (1997. Conclusion: Mortality among HIV-positive persons remains higher than that of the general population of similar age and sex, with significant differences depending on the history of AIDS or HCV coinfection

Psicothema

Resumen tomado de la publicaciónExploración de estados glucémicos en pacientes infantiles con diabetes tipo 1. Antecedentes: la prevención de la hipoglucemia grave se basa en parte en anticipar con precisión su ocurrencia. El objetivo del estudio fue analizar el efecto de un procedimiento de feedback sobre el estado glucémico de pacientes infantiles con diabetes tipo 1, los síntomas asociados y las estimaciones del NGS. Método: durante 7 días, 17 participantes realizaron mediciones programadas de sangre capilar y otras cada vez que tenían sospecha de alteraciones en su NGS. Resultados: se han analizado 454 ensayos, con una media de 178mg/dl (DE= 36.4). De las estimaciones precisas, solo el 5,1% correspondían a estados de hipoglucemia, el 36,77% se situaron en zonas de consecuencias clínicamente peligrosas y fueron más precisos cuando el NGS estaba en niveles 240 mg/dl. Informaron síntomas de forma aleatoria, cometieron errores al vincularlos con el NGS y demandaron feedback de oportunidad creyéndose en estado de hipoglucemia, encontrándose en hiperglucemia. Conclusiones: los NGS mantuvieron una alta variabilidad, con mayor promedio de hipoglucemias que en su hábitat cotidiano y no presentaron un perfil de señales fiables indicadoras de su NGS. Se ratifica la tendencia a subestimar los valores cuando la glucemia se situaba en niveles hiperglucémicos.Universidad de Oviedo. Biblioteca de Psicología; Plaza Feijoo, s/n.; 33003 Oviedo; Tel. +34985104146; Fax +34985104126; [email protected]

Aplicación de un programa de mejora de la adherencia en pacientes hipertensos debutantes

Objetivo: Comprobar la eficacia de un programa para la mejora de la adherencia en pacientes hipertensos de reciente diagnóstico. Diseño: Estudio cuasi-experimental. Emplazamiento: Cuatro Centros de Atención Primaria de la provincia de Almería. Participantes: Ciento veinte sujetos entre 18 y 65 años que habían sido diagnosticados como hipertensos en un periodo inferior a 12 meses. Mediciones principales: Los participantes fueron divididos en tres grupos: grupo de intervención A que recibió una instrucción educativa, grupo de intervención B que recibió la instrucción educativa y un procedimiento de feedback; y grupo control C que recibió el tratamiento habitual. La adherencia se determinó en función del estilo de vida (patrones de alimentación, actividad física, tabaco, alcohol) y tratamiento farmacológico. Resultados: En el caso de la alimentación y actividad física, tras la intervención se observaron diferencias significativas entre los grupos de actuación (p < 0,05), encontrando mejores niveles de adherencia en los sujetos del grupo B con respecto a estas variables. También se observaron mejores patrones de adherencia al tratamiento farmacológico en dichos pacientes. No se hallaron resultados significativos con respecto al alcohol y tabaco. Conclusiones: En la población de estudio, los pacientes que recibieron la instrucción educativa y feedback tuvieron mejores niveles de adherencia que aquellos que solo recibieron la instrucción o el tratamiento habitual

Evaluation of urinary catheterization competency in nursing students using the flipped classroom approach

Urinary catheterization is a complex procedure. Traditional teaching in classroom, such as using a simulator, is not enough to guarantee the necessary learning outcomes. It is therefore necessary to implement new active learning approaches such as the flipped classroom. The aim of this study was to examine the effect of the use of the flipped classroom on the level of self-efficacy and the assessment of clinical competencies in nursing students performing the urinary catheterization procedure. A quasi-experimental study of a single group with pre-/post-testing measures. A convenience sample of 139 nursing students. A flipped classroom approach was implemented. Measurements were taken pre and post intervention. This study followed the consolidated criteria for quality of nonrandomized evaluations studies (TREND) checklist. Regarding self-efficacy, statistically significant differences were found between the pre-test and post-test (Z = −14.453; p < 0.05). With respect to knowledge level, statistically significant differences were found when comparing pre-/post-test results (Z = −14,480; p < 0.05). Furthermore, statistically significant differences were found on the ability scale depending on pre-/post-test (Z = −10.277; p < 0.005); in all cases, obtaining a higher score in the post-test. The flipped classroom could be an effective educational tool for the development of clinical skills, specifically urinary catheterization. This method has been shown to improve the knowledge, skills, and self-efficacy in urinary catheterization of nursing students

Magnet hospital attributes in nursing work environment and its relationship to nursing students' clinical learning environment and satisfaction.

Aims: To analyse nursing students’ perception of the Magnet hospital attributes of the work environment at the hospitals where they perform their clinical placement and the relationship of this factor to their clinical learning environment and supervision, satisfaction and intention to stay in those hospitals once graduated. Design: This study had a cross-sectional, correlational, design. Methods: Data were collected using self-reported questionnaires from 180 nursing students at a university in southeast Spain between September–October 2018. Nursing work environment and clinical learning environment were measured using the Practice Environment Scale of the Nursing Work Index and Clinical Learning Environment, Supervision and Nurse Teacher scale, respectively. Students’ satisfaction with the work environment and with the clinical learning process were measured using a four-point Likert scale developed by the researchers. Percentages, frequencies, mean, standard deviation, χ2 test, Mann–Whitney U test, Spearman and phi correlation were used to analyse the data. Results: Nursing students’ perception of greater Magnet-like features at work environment was associated with better clinical learning environment (Spearman rs = |0.22–0.54|; p < .01) and satisfaction with the work environment (Spearman rs = 0.18; p = .01) and with their learning process (Spearman rs = 0.21; p < .01). Greater intention to stay working in the hospital after graduation was significantly associated with greater satisfaction with the learning process (phi = 0.31; p < .01) and the work environment (phi = 0.23; p = .02). Conclusion: Magnet-like features at the work environment lead to superior clinical learning environment and higher students’ satisfaction, two factors that play a decisive role in their decision to stay at hospitals where they performed clinicals after graduation

The connection of the clinical learning environment and supervision of nursing students with student satisfaction and future intention to work in clinical placement hospitals.

Aims and objectives: To analyse nursing students’ perceptions of the clinical learning environment and supervision and the connection between their satisfaction and intention of staying in their placement hospitals. Background: Global nursing shortage necessitates strategies for the recruitment and retention of nurses. It is believed that nursing students’ clinical placement experiences can affect their learning outcomes, as well as influence their choice of future workplace. Design: Cross-sectional, correlational study. Methods: One hundred and eighty nursing students participated in the study. The data were collected in person using The Clinical Learning Environment, Supervision and Nurse Teacher scale tool. Students’ satisfaction with the clinical learning environment and learning process was measured using a 4-point Likert scale developed by the researchers. The STROBE checklist was used in this paper. Results: Nursing students perceived a favourable clinical learning environment and supervision in the hospitals where they undertook clinical placements, recording high levels of satisfaction and high levels of intention to stay and work there. The clinical learning environment and supervision established positive correlations with student satisfaction. Conclusions: This study promotes the development of knowledge and understanding of how student satisfaction and intention to stay and work in their placement hospitals relates to the quality of the clinical learning environment and supervision, which could be helpful to the management of healthcare facilities and faculties in improving nursing education and retention/recruitment strategies. Relevance to clinical practice: Nursing students represent the future of the nursing workforce, so managers of healthcare facilities and faculties should move towards promoting a clinical learning and supervisory environment where supervisors, tutors and staff are aware of their commitment to student education and promote optimal learning and positive experiences in order for students to feel satisfied and motivated to work in their placement hospitals