33 research outputs found

    Herramienta integral y de bajo coste para el desarrollo de prácticas remotas para las asignaturas de Ciencias e Ingeniería

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    Los laboratorios remotos, en los que los alumnos interactúan con los dispositivos reales a través de Internet, incrementa el tiempo de uso de dichos dispositivos por parte de los alumnos y el número de pruebas que pueden realizar durante las experiencias. Sin embargo, para implementarlos, los docentes habitualmente tienen que saber utilizar una serie de tecnologías diferentes, que dificultan su puesta en marcha y mantenimiento. Para paliar estos problemas, en este Proyecto de Innovación y Mejora de la Calidad Docente (PIMCD) se ha desarrollado una nueva metodología desde la que se centraliza la puesta en marcha de todo el laboratorio desde una única herramienta (Easy JavaScript Simulations, EJsS), que sirve tanto para gestionar el código mediante el que se interactúa con los dispositivos, el servidor que da acceso remoto a la práctica, y la interfaz gráfica con la que los alumnos interactúan con los dispositivos. Además, es importante resaltar que es una metodología de bajo coste, ya que desde el punto de vista del proceso de conversión de un laboratorio presencial ya existente en uno remoto, solo necesita una Raspberry PI para desplegar todo el software del laboratorio. Además, en este proyecto también se presentan un conjunto de experiencias desarrolladas con las mismas, que ya están siendo utilizadas por los alumnos en diferentes asignaturas de Ingeniería Electrónica de Comunicaciones y un nuevo laboratorio remoto de Robótica que se pondrá en marcha el curso que viene

    Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

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    Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

    Effects of hospital facilities on patient outcomes after cancer surgery: an international, prospective, observational study

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    Background Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide.Methods A multimethods analysis was performed as part of the GlobalSurg 3 study-a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital.Findings Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3.85 [95% CI 2.58-5.75]; p<0.0001), with excess mortality predominantly explained by a limited capacity to rescue following the development of major complications (63.0% vs 82.7%; OR 0.35 [0.23-0.53]; p<0.0001). Across LMICs, improvements in hospital facilities would prevent one to three deaths for every 100 patients undergoing surgery for cancer.Interpretation Hospitals with higher levels of infrastructure and resources have better outcomes after cancer surgery, independent of country income. Without urgent strengthening of hospital infrastructure and resources, the reductions in cancer-associated mortality associated with improved access will not be realised

    Integración de técnicas de Learning Analytics en la evaluación y mejora de las prácticas de laboratorio de las asignaturas de Ciencias e Ingeniería

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    Las prácticas de laboratorio desarrolladas en el grupo ISCAR en los últimos años se encuadran dentro de tres tipos: virtual, presencial y remoto. Es conveniente disponer de las tres versiones de una práctica, ya que esto permite abordar una estrategia de aprendizaje que en líneas generales consta de tres fases. En la fase (1), el alumno tiene acceso a la versión virtual de la práctica, de forma que pueda familiarizarse con el sistema, la tarea a realizar y la interfaz de la aplicación. En la fase (2), el alumno realiza la práctica presencial en el laboratorio. Puesto que el alumno ya conoce el uso de la herramienta y puede centrarse en la tarea que debe realizar, se espera que el aprovechamiento del tiempo de laboratorio sea óptimo. En la fase (3), el alumno tiene acceso a la versión remota, donde puede dedicar tiempo para completar las tareas no terminadas en el laboratorio o para ampliar conocimientos mediante la realización de otras tareas más avanzadas o de mayor dificultad. Por otra parte, el uso de herramientas software interactivas permite facilitar la recogida de una gran cantidad de información sobre la actividad del alumno durante la realización de la práctica, aprovechando el soporte que para llevar a cabo estas labores proporcionan las herramientas software EJsS y Moodle LMS, ya que su uso combinado permite registrar los datos de interacción de los alumnos, y facilita el desarrollo de las simulaciones e interfaces gráficas de los laboratorios virtuales y remotos en los que se realizarán las prácticas. Finalmente, estos datos son procesados y analizados para detectar relaciones significativas entre el modo de realizar las prácticas de los alumnos y las calificaciones que obtienen, descubrir posibles mejoras en la forma de presentar la información a los alumnos, o determinar posibles dificultades que puedan encontrar con el uso de la interfaz de la aplicación. Por tanto, este proyecto tiene como objetivos 1) la homogeneización de las prácticas de laboratorio de las asignaturas del área de Ingeniería de Sistemas y Automática (ISA), mediante la generación de tres versiones: virtual, presencial y remota; y 2) el estudio y mejora de los procesos de aprendizaje de los alumnos de las prácticas de laboratorio mediante herramientas y técnicas de Learning Analytics

    Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

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    Background: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit

    Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient—2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery

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    Outcomes in Newly Diagnosed Atrial Fibrillation and History of Acute Coronary Syndromes: Insights from GARFIELD-AF

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    BACKGROUND: Many patients with atrial fibrillation have concomitant coronary artery disease with or without acute coronary syndromes and are in need of additional antithrombotic therapy. There are few data on the long-term clinical outcome of atrial fibrillation patients with a history of acute coronary syndrome. This is a 2-year study of atrial fibrillation patients with or without a history of acute coronary syndromes

    Vitamin K antagonist control in patients with atrial fibrillation in Asia compared with other regions of the world: Real-world data from the GARFIELD-AF registry

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    Objective: To compare the distribution of international normalized ratios (INRs) in patients receiving vitamin K antagonist (VKA) for newly diagnosed atrial fibrillation in Eastern and Southeastern Asia and in other regions of the world (ORW) represented in the ongoing, global observational study GARFIELD-AF
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