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Device-Associated Infection Rate and Mortality in Intensive Care Units of 9 Colombian Hospitals : Findings of the International Nosocomial Infection Control Consortium
Q2Q1ArtĂculo original349-356Objective.
To perform active targeted prospective surveillance to measure device-associated infection (DAI) rates, attributable mortality due to DAI, and the microbiological and antibiotic resistance profiles of infecting pathogens at 10 intensive care units (ICUs) in 9 hospitals in Colombia, all of which are members of the International Infection Control Consortium.
Methods.
We conducted prospective surveillance of healthcare-associated infection in 9 hospitals by using the definitions of the US Centers for Disease Control and Prevention National Nosocomial Surveillance System (NNIS). DAI rates were calculated as the number of infections per 100 ICU patients and per 1,000 device-days.
Results.
During the 3-year study, 2,172 patients hospitalized in an ICU for an aggregate duration of 14,603 days acquired 266 DAIs, for an overall DAI rate of 12.2%, or 18.2 DAIs per 1,000 patient-days. Central venous catheter (CVC)ârelated bloodstream infection (BSI) (47.4% of DAIs; 11.3 cases per 1,000 catheter-days) was the most common DAI, followed by ventilator-associated pneumonia (VAP) (32.3% of DAIs; 10.0 cases per 1,000 ventilator-days) and catheter-associated urinary tract infection (CAUTI) (20.3% of DAIs; 4.3 cases per 1,000 catheter-days). Overall, 65.4% of all Staphylococcus aureus infections were caused by methicillin-resistant strains; 40.0% of Enterobacteriaceae isolates were resistant to ceftriaxone and 28.3% were resistant to ceftazidime; and 40.0% of Pseudomonas aeruginosa isolates were resistant to fluoroquinolones, 50.0% were resistant to ceftazidime, 33.3% were resistant to piperacillin-tazobactam, and 19.0% were resistant to imipenem. The crude unadjusted attributable mortality was 16.9% among patients with VAP (relative risk [RR], 1.93; 95% confidence interval [CI], 1.24-3.00; P = .002); 18.5 among those with CVC-associated BSI (RR, 2.02; 95% CI, 1.42-2.87; P<.001); and 10.5% among those with CAUTI (RR, 1.58; 95% CI, 0.78-3.18; P = .19).
Conclusion.
The rates of DAI in the Colombian ICUs were lower than those published in some reports from other Latin American countries and were higher than those reported in US ICUs by the NNIS. These data show the need for more-effective infection control interventions in Colombia
España: Prestación de Servicios de Telecomunicaciones a través de las Redes Eléctricas y Competencia
Ponencia Presentada en el II Congreso Latinoamericano de Derecho InformĂĄtico. El objetivo de esta ponencia es el de definir las implicaciones en los sectores de las telecomunicaciones y la electricidad, derivadas de la prestaciĂłn de servicios de telecomunicaciones a travĂ©s de las redes elĂ©ctricas, desde le punto de vista de la competencia en un marco de liberalizaciĂłn, en particular la tecnologĂa denominada Powerline Communication, PLC y las condiciones generales de competencia que se derivan de la aplicaciĂłn de PLC, el aprovechamiento de las sinergias de los sectores de telecomunicaciones y energĂa, provenidos de la generaciĂłn de economĂas de escala, sus efectos dada su condiciĂłn de mercados conexos, el acceso a la red y el aprovechamiento de redes ya instaladas o en localidades de difĂcil despliegue
Escuela en acciĂłn infantil : revista de pedagogĂa de magisterio
Se presenta un nĂșmero monogrĂĄfico dedicado a la educaciĂłn cientĂfica. Consta de distintas experiencias cientĂficas de experimentaciĂłn llevadas a cabo en el aula de infantil y de un reportaje. Ăste resume la visita realizada por un grupo de alumnos al taller cientĂfico Cosmocaixa en el que desarrollan los sentidos ademĂĄs de aprender ciencia. Las experiencias son 7, la mayorĂa talleres, y tratan diversos temas de estudio y experimentaciĂłn como el estudio del entorno a travĂ©s de un erizo; la electricidad, la electrostĂĄtica, el magnetismo y el agua; la luz y la oscuridad; el nacimiento de un ser vivo en incubadora; las cualidades y usos del agua, la tierra, el aire, el calor, la luz y el sonido; el crecimiento de plantas en un invernadero; y el sonido. TambiĂ©n se incluye un breve artĂculo sobre la presentaciĂłn del menĂș del comedor escolar a travĂ©s de dibujos, fotografĂas y etiquetas.MadridES
Towards the elimination of hepatitis C: implementation of reflex testing in Andalusia.
undiagnosed hepatitis C virus (HCV) infection and/or inadequate access to care are barriers to the elimination of HCV. Reflex testing has proven to facilitate referral to care, treatment and viral elimination. In this study, a reflex testing program was implemented in Andalusia and its impact on access to care was evaluated. an observational, retrospective and prospective study was performed across diagnostic laboratories responsible for HCV diagnosis in southern Spain. After surveying the barriers to performing reflex testing, the number of patients that were not referred for care in 2016 was retrospectively studied (pre-reflex cohort). Subsequently, several measures were proposed to overcome the identified barriers. Finally, reflex testing was implemented and its impact evaluated. the pre-reflex cohort included information from 1,053 patients. Slightly more than half of the patients (n = 580; 55%) visited a specialist for treatment evaluation during a median period of 71 days (interquartile range = 35-134) since the date of diagnosis. The post-reflex cohort (September 2017 to March 2018) included 623 patients. Only 17% (n = 106) of the patients had not been referred for care or evaluated for treatment in a median period of 52 days (interquartile range = 28-86). in 2016, nearly half of new HCV diagnoses in southern Spain were not referred for care. Barriers to the implementation of reflex testing were overcome in our study. Moreover, this strategy was effectively implemented in 2017. Reflex testing contributed to improving referral for care. This program will contribute to the micro-elimination of hepatitis C in Spain
Device-Associated Infection Rate and Mortality in Intensive Care Units of 9 Colombian Hospitals: Findings of the International Nosocomial Infection Control Consortium
Memorias semana de la Facultad de EducaciĂłn. VII semana: historias, saberes y prĂĄcticas educativas innovadoras e incluyentes.
Las Memorias de la VII Semana de la EducaciĂłn âHistorias, saberes y prĂĄcticas
educativas innovadoras e incluyentesâ, publicadas por la Editorial de la
CorporaciĂłn Universitaria Minuto de Dios â UNIMINUTO, reĂșnen las ponencias
y resĂșmenes sobre esta temĂĄtica presentadas en un evento de realizaciĂłn
anual, cuyo propósito es socializar experiencias investigativas y académicas
de grupos, semilleros de investigaciĂłn y trabajos de grado entre estudiantes
y profesores de la Facultad de EducaciĂłn, y con profesores y estudiantes de
otras instituciones educativas que gentilmente compartieron experiencias en
el campo de la educaciĂłn, la pedagogĂa, el arte, la cultura y el deporte.
El principal interés de este encuentro radica en recoger la construcción
histĂłrica educativa de la CorporaciĂłn Universitaria Minuto de Dios â UNIMINUTO
con respecto a sus orĂgenes y construcciones acadĂ©micas; y las experiencias
histĂłricas de otras propuestas educativas a nivel de la educaciĂłn infantil, bĂĄsica,
media y superior con tejido cultural y social, desde un enfoque diferencial y
diverso en el cual todas las experiencias enriquecen la formaciĂłn de maestros
desde la innovación e inclusión en los diferentes contextos. En este encuentro participaron las universidades Antonio Nariño, de la
Amazonia, del Rosario, La Gran Colombia y PedagĂłgica Nacional, asĂ como
la CorporaciĂłn Escuela PedagĂłgica Experimental, el Centro Educativo de
Nuestra Señora de la Paz, el Instituto Colombo Sueco y varios docentes de la
SecretarĂa de EducaciĂłn Distrital de BogotĂĄ D. C
Cross-sectional association between non-soy legume consumption, serum uric acid and hyperuricemia: the PREDIMED-Plus study
[Purpose]: To assess the association between the consumption of non-soy legumes and different subtypes of non-soy legumes and serum uric acid (SUA) or hyperuricemia in elderly individuals with overweight or obesity and metabolic syndrome.
[Methods]:A cross-sectional analysis was conducted in the framework of the PREDIMED-Plus study. We included 6329 participants with information on non-soy legume consumption and SUA levels. Non-soy legume consumption was estimated using a semi-quantitative food frequency questionnaire. Linear regression models and Cox regression models were used to assess the associations between tertiles of non-soy legume consumption, different subtypes of non-soy legume consumption and SUA levels or hyperuricemia prevalence, respectively.[Results]: Individuals in the highest tertile (T3) of total non-soy legume, lentil and pea consumption, had 0.14 mg/dL, 0.19 mg/dL and 0.12 mg/dL lower SUA levels, respectively, compared to those in the lowest tertile (T1), which was considered the reference one. Chickpea and dry bean consumption showed no association. In multivariable models, participants located in the top tertile of total non-soy legumes [prevalence ratio (PR): 0.89; 95% CI 0.82â0.97; p trendâ=â0.01, lentils (PR: 0.89; 95% CI 0.82â0.97; p trendâ=â0.01), dry beans (PR: 0.91; 95% C: 0.84â0.99; p trendâ=â0.03) and peas (PR: 0.89; 95% CI 0.82â0.97; p trendâ=â0.01)] presented a lower prevalence of hyperuricemia (vs. the bottom tertile). Chickpea consumption was not associated with hyperuricemia prevalence.[Conclusions]: In this study of elderly subjects with metabolic syndrome, we observed that despite being a purine-rich food, non-soy legumes were inversely associated with SUA levels and hyperuricemia prevalence.The PREDIMED-Plus trial was supported by the official funding agency for biomedical research of the Spanish government, ISCIII, through the Fondo de InvestigaciĂłn para la Salud (FIS), which is co-funded by the European Regional Development Fund (four coordinated FIS projects led by J.S.-S. and J.Vid., including the following projects: PI13/00673, PI13/00492, PI13/00272, PI13/01123, PI13/00462, PI13/00233, PI13/02184, PI13/00728, PI13/01090, PI13/01056, PI14/01722, PI14/00636, PI14/00618, PI14/00696, PI14/01206, PI14/01919, PI14/00853, PI14/01374, PI14/00972, PI14/00728, PI14/01471, PI16/00473, PI16/00662, PI16/01873, PI16/01094, PI16/00501, PI16/00533, PI16/00381, PI16/00366, PI16/01522, PI16/01120, PI17/00764, PI17/01183, PI17/00855, PI17/01347, PI17/00525, PI17/01827, PI17/00532, PI17/00215, PI17/01441, PI17/00508, PI17/01732, and PI17/00926), the Especial Action Project entitled: ImplementaciĂłn y evaluaciĂłn de una intervenciĂłn intensiva sobre la actividad fĂsica Cohorte PREDIMED-Plus grant to J.S.-S., the European Research Council (Advanced Research Grant 2013â2018, 340918) to M.Ă.M.-G., the Recercaixa Grant to J.S.-S. (2013ACUP00194), Grants from the ConsejerĂa de Salud de la Junta de AndalucĂa (PI0458/2013, PS0358/2016, and PI0137/2018), a Grant from the Generalitat Valenciana (PROMETEO/2017/017), a SEMERGEN Grant, and funds from the European Regional Development Fund (CB06/03). O.C. is supported by ISCIII Grant JR17/00022. M Rosa Bernal-Lopez was supported by âMiguel Servet Type Iâ program (CP15/00028) from the ISCIII-Madrid (Spain), cofinanced by the Fondo Europeo de Desarrollo Regional-FEDE
CompilaciĂłn de Proyectos de Investigacion de 1984-2002
Instituto Politecnico Nacional. UPIICS
Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries
Background
Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks.
Methods
The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned.
Results
A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31).
Conclusion
Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)