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

Ten millennia of hepatitis B virus evolution

Hepatitis B virus (HBV) has been infecting humans for millennia and remains a global health problem, but its past diversity and dispersal routes are largely unknown. We generated HBV genomic data from 137 Eurasians and Native Americans dated between ~10,500 and ~400 years ago. We date the most recent common ancestor of all HBV lineages to between ~20,000 and 12,000 years ago, with the virus present in European and South American hunter-gatherers during the early Holocene. After the European Neolithic transition, Mesolithic HBV strains were replaced by a lineage likely disseminated by early farmers that prevailed throughout western Eurasia for ~4000 years, declining around the end of the 2nd millennium BCE. The only remnant of this prehistoric HBV diversity is the rare genotype G, which appears to have reemerged during the HIV pandemic

Dímelo cantando

Se acompaña de un casete con las canciones que aparecen en este materialMaterial didáctico dirigido a profesores de Educación Infantil, que contiene una serie de canciones con propuestas de trabajo. Todas las canciones, llevan implícita una actividad cotidiana que realizan los niños. Se espera de ellos que logren aprender esas rutinas del día a día.MadridES

Desarrollamos el curriculo con las TIC

Se usan las nuevas tecnologías de la información y comunicación, TIC, para el desarrollo del currículo del centro mediante la creación de nuevas unidades didácticas, contenidos y actividades. Se plantean objetivos como buscar estrategias y procedimientos de trabajo propios y compartidos para el uso de las TIC en el centro; obtener conocimientos propios y válidos de las herramientas utilizadas para poder realizar tales materiales; trabajar asiduamente con soportes tecnológicos novedosos como cámaras de vídeo, pizarra digital o videoproyector que permitan investigar y actuar en el entorno del centro; y reflexionar sobre el impacto que genera el uso de las TIC en el proceso de enseñanza y aprendizaje. Para llevarlo a cabo, en primer lugar se forma al profesorado para que conozcan lo básico tanto del software como del hardware; poco a poco, los profesores elaboran sus recursos para las clases y finalmente lo ponen en práctica con los alumnos. Se incluye un CD-ROM con los materiales elaborados.Madrid (Comunidad Autónoma). Consejería de Educación. Dirección General de Ordenación AcadémicaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

De la mano de los libros

Este proyecto consiste en crear una biblioteca de centro para resaltar la importancia de los libros, la lectura y la escritura en el desarrollo intelectual y emocional del alumno. Por tanto, los objetivos son fomentar el hábito de la lectura como recurso para la obtención de información y la adquisición de aprendizajes, así como recurso para el ocio y el tiempo libre; valorar el libro como un bien común y de provecho que debe tener un uso correcto y evitar su deterioro; iniciar a los alumnos de cursos superiores en la catalogación de libros; dar a conocer y respetar las normas básicas para el uso correcto de la biblioteca; favorecer el análisis crítico de los textos y desarrollar valores como la solidaridad, la igualdad o la paz; transmitir la importancia de la compresión lectora y sensibilizar en la importancia de la escritura como transmisora de ideas, pensamientos y creencias. La actividad se desarrolla desde lo más elemental, buscar un espacio donde ubicar la biblioteca, seleccionar, adquirir y colocar la colección de ejemplares, además de poner en práctica actividades propias de este entorno como encuentros con autores de libros, exposiciones de trabajos, lecturas públicas, celebración del día del Libro y talleres de escritura. El proceso de evaluación es cualitativo y se lleva a cabo en reuniones de profesores algunas de las cuestiones a plantear son la adecuación del espacio seleccionado, funcionalidad del mobiliario y de la ordenación de fondos, utilidad de las actividades seleccionadas e interés de los alumnos. Se aporta un CD-ROM como anexo que contiene fotografías..Madrid (Comunidad Autónoma). Consejería de Educación. Dirección General de Mejora de la Calidad de la EnseñanzaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

Mortality after surgery in Europe: a 7 day cohort study

Background: Clinical outcomes after major surgery are poorly described at the national level. Evidence of heterogeneity between hospitals and health-care systems suggests potential to improve care for patients but this potential remains unconfirmed. The European Surgical Outcomes Study was an international study designed to assess outcomes after non-cardiac surgery in Europe.Methods: We did this 7 day cohort study between April 4 and April 11, 2011. We collected data describing consecutive patients aged 16 years and older undergoing inpatient non-cardiac surgery in 498 hospitals across 28 European nations. Patients were followed up for a maximum of 60 days. The primary endpoint was in-hospital mortality. Secondary outcome measures were duration of hospital stay and admission to critical care. We used χ² and Fisher’s exact tests to compare categorical variables and the t test or the Mann-Whitney U test to compare continuous variables. Significance was set at p<0·05. We constructed multilevel logistic regression models to adjust for the differences in mortality rates between countries.Findings: We included 46 539 patients, of whom 1855 (4%) died before hospital discharge. 3599 (8%) patients were admitted to critical care after surgery with a median length of stay of 1·2 days (IQR 0·9–3·6). 1358 (73%) patients who died were not admitted to critical care at any stage after surgery. Crude mortality rates varied widely between countries (from 1·2% [95% CI 0·0–3·0] for Iceland to 21·5% [16·9–26·2] for Latvia). After adjustment for confounding variables, important differences remained between countries when compared with the UK, the country with the largest dataset (OR range from 0·44 [95% CI 0·19 1·05; p=0·06] for Finland to 6·92 [2·37–20·27; p=0·0004] for Poland).Interpretation: The mortality rate for patients undergoing inpatient non-cardiac surgery was higher than anticipated. Variations in mortality between countries suggest the need for national and international strategies to improve care for this group of patients.Funding: European Society of Intensive Care Medicine, European Society of Anaesthesiology