Concepciones de enseñanza y aprendizaje de profesores de infantil, primaria y secundaria y la relación con las variables educativas

It has been established that teachers' conceptions of learning and teaching influence their instructional practices. Several authors maintain that these conceptions are based on certain implicit assumptions that give rise to different theories. Our view is that people have multiple alternative theories which they use depending on the context and the demands of the task. The main purpose of this study was to find out whether such representational plurality exists in teachers' conceptions and, if it does, whether this plurality can lead to the identification of different representational profiles. We were also interested in studying some of the teaching practice variables that might influence the nature of the representational profiles. Our results, obtained by means of a dilemma questionnaire answered by 1074 teachers from different educational levels and knowledge domains and with different ranges of experience, are consistent with the assumption of representational plurality, as they show that the same teacher may hold different conceptions that set up a conceptions profile. Moreover, the combination of the responses in each profile is not random. Teachers at the more advanced levels and with more teaching experience manifested more traditional conceptions. Furthermore, some knowledge domains were associated with certain conception profilesSe ha comprobado que las concepciones de aprendizaje y enseñanza de los profesores influyen en su práctica docente. Varios autores sostienen que estas concepciones se basan en ciertos supuestos implícitos que dan lugar a distintas teorías. Nuestra visión es que la gente dispone de multitud de teorías alternativas que pueden utilizar en función del contexto y las exigencias de la tarea. El objetivo principal del presente estudio es averiguar si esta pluralidad representativa existe en las concepciones de los profesores y, de ser así, si puede conducir a la identificación de distintos perfiles representacionales. Nos interesamos, asimismo, por el estudio de algunas de las variables de la práctica docente que pudieran influir en la naturaleza de dichos perfiles. Nuestros resultados - obtenidos mediante un cuestionario de dilemas realizado por 1074 profesores de distintos niveles educativos, ámbitos de conocimiento y experiencia- coinciden con la suposición de la pluralidad representativa, pues revelan que el mismo profesor podría forjar concepciones distintas que conforman un perfil de concepciones. Además, la combinación de respuestas en cada perfil no es aleatoria. Los profesores de niveles más altos y los más experimentados manifestaron unas concepciones más tradicionales. Igualmente, algunos campos de conocimiento se asociaron a perfiles de concepciones concretosThis research was funded under three projects of the National Program for Basic Research-Projects by the Spanish Ministry of Science and Innovation (EDU2009- 14278-C02-01EDUC) (EDU2010-21995-C02-01) and (EDU2013-46606-C2-1-R)

Re-evaluating sheet erosion rates in a popular trekking trail located at the Spanish Central System

Degradation of walking tracks, mainly due to sheet erosion associated with hiking activities, damages the natural and recreational value of protected natural areas. Senda Schmidt is a popular trail located on the northern slope of the Sierra de Guadarrama (Central Spanish System), that shows high denudation morphologies on account of accelerated soil-erosion processes basically caused by human influence (trampling by continuous trekking), resulted in exposed roots. Previous works have used dendrogeomorphological methods in this trail to estimate rates of sheet erosion based on the changing morphology of tree rings (from concentric to eccentric) when root is exposed. This study aims to evaluate soil erosion reconstructing the first year of root exposure by analyzing changes in wood anatomical parameters within growth rings. Additionally, different multivariate statistical approaches were used in order to determinate the influence of different environmental factors affecting the variation in velocity of the sheet erosion processes

Innovative Health and Social Integrated Care Model Effectiveness to Improve Quality Care for Chronic Patients: A Single Group Assignment Clinical Trial

Background: Patients with chronic disease have become one of the major challenges for health and social protection systems in developed countries. Integrated care models (ICM) have demonstrably improved the quality of care of chronic patients. However, new models of integration need further evaluation of its effectiveness and outcomes. Methods: The ICM studied promoted coordination between the health and social sectors during a 6-month period, through an ad hoc developed application (app) that enabled a constant flow of communication between professionals from both sectors. Patients’ quality of life, treatment adherence, chronic patient experience and caregiver overload were assessed by questionnaires at baseline, at the end of the intervention and 6 months post-intervention. Results: The implementation of the new health and social ICM permitted new case detection and medical and social services offered to chronic patients. Furthermore, the quality of life and treatment adherence of patients and caregiver overload were significantly improved. These positive effects lasted at least 6 months after the intervention. Conclusions: Integrated care may facilitate access to care services, increase perceived patient quality of life and treatment adherence. Enhanced access to medical and social services from complex chronic patients may have important implications for caregivers and the care systems who are struggling to adapt to an expanding demand.   Resum Antecedents: Els pacients amb malalties cròniques representen un dels grans reptes per als sistemes de salut i protecció social als països desenvolupats. S’ha demostrat que l’atenció integrada millora la qualitat assistencial dels pacients crònics. Tanmateix, els resultats i l’efectivitat de nous models d’integració requereixen ser avaluats. Metodologia: El model d’atenció integrada d’estudi va promoure la coordinació entre els sectors sanitari i social durant un període de 6 mesos mitjançant una aplicació (app) desenvolupada ad hoc que permetia un flux constant de comunicació entre professionals d’ambdós sectors. La qualitat de vida dels pacients, l’adherència al tractament, l’experiència del pacient i la sobrecàrrega del cuidador es van avaluar mitjançant qüestionaris a l’inici, al final de la intervenció i 6 mesos després de la intervenció. Resultats: La implantació de l’atenció integrada social i sanitària va permetre la detecció de nous casos i un major accés dels pacients crònics als serveis mèdics i socials. A més, va millorar significativament la qualitat de vida i l’adherència al tractament dels pacients i la sobrecàrrega dels cuidadors. Aquests efectes positius van perdurar almenys 6 mesos després de la intervenció. Conclusions: L’atenció integrada pot facilitar l’accés als serveis assistencials, augmentar la qualitat de vida percebuda dels pacients i l’adherència al tractament. L’accés millorat als serveis mèdics i socials dels pacients crònics complexos pot tenir implicacions importants per als cuidadors i els sistemes assistencials que lluiten per adaptar-se a una demanda creixent.   Paraules Clau: Sistemes sanitaris integrats; malaltia crònica; qualitat de vida; implementació de programes; tecnologies de la informació i la comunicació (TIC

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Association Between Preexisting Versus Newly Identified Atrial Fibrillation and Outcomes of Patients With Acute Pulmonary Embolism

Background Atrial fibrillation (AF) may exist before or occur early in the course of pulmonary embolism (PE). We determined the PE outcomes based on the presence and timing of AF. Methods and Results Using the data from a multicenter PE registry, we identified 3 groups: (1) those with preexisting AF, (2) patients with new AF within 2 days from acute PE (incident AF), and (3) patients without AF. We assessed the 90-day and 1-year risk of mortality and stroke in patients with AF, compared with those without AF (reference group). Among 16 497 patients with PE, 792 had preexisting AF. These patients had increased odds of 90-day all-cause (odds ratio [OR], 2.81; 95% CI, 2.33-3.38) and PE-related mortality (OR, 2.38; 95% CI, 1.37-4.14) and increased 1-year hazard for ischemic stroke (hazard ratio, 5.48; 95% CI, 3.10-9.69) compared with those without AF. After multivariable adjustment, preexisting AF was associated with significantly increased odds of all-cause mortality (OR, 1.91; 95% CI, 1.57-2.32) but not PE-related mortality (OR, 1.50; 95% CI, 0.85-2.66). Among 16 497 patients with PE, 445 developed new incident AF within 2 days of acute PE. Incident AF was associated with increased odds of 90-day all-cause (OR, 2.28; 95% CI, 1.75-2.97) and PE-related (OR, 3.64; 95% CI, 2.01-6.59) mortality but not stroke. Findings were similar in multivariable analyses. Conclusions In patients with acute symptomatic PE, both preexisting AF and incident AF predict adverse clinical outcomes. The type of adverse outcomes may differ depending on the timing of AF onset.info:eu-repo/semantics/publishedVersio

Innovaciones y mejoras en el proyecto tutoría entre compañeros. Curso 2015-2016

Memoria ID-0137. Ayudas de la Universidad de Salamanca para la innovación docente, curso 2015-2016

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Influencia de niveles plasmáticos de hierro, cobre y zinc en ateroscleoris carotidea e isquemia cerebral

Tesis doctoral inédita leída en la Universidad Autónoma de Madrid. Facultad de Medicina. Departamento de Medicina. Fecha de lectura: 6 de Octubre de 200