Compromiso por la calidad de las sociedades científicas en España

En este artículo se resumen los objetivos, la metodología y las primeras conclusiones del proyecto «Compromiso por la calidad de las sociedades científicas en España», coordinado por el Ministerio de Sanidad, Servicios Sociales e Igualdad, la Sociedad Española de Medicina Interna y el Instituto Aragonés de Ciencias de la Salud, en el que participan 48 sociedades científicas. Los objetivos de este proyecto son: disminuir la utilización de intervenciones médicas innecesarias, que son las que no han demostrado eficacia, tienen escasa o dudosa efectividad, o no son coste-efectivas; disminuir la variabilidad en la práctica clínica; difundir entre médicos y pacientes el compromiso con el uso adecuado de recursos sanitarios y, por último, promover la seguridad clínica. En el documento se incluyen 135 recomendaciones finales de «no hacer» elaboradas por 30 sociedades científicas españolas. This article summarises the objectives, methodology and initial conclusions of the project “Commitment to Quality of the Spanish Scientific Societies”, coordinated by the Ministry of Health, Social Services and Equality, the Spanish Society of Internal Medicine and the Aragon Institute of Health Sciences, in which 48 scientific societies participate. This project's objectives are to decrease the use of unnecessary medical interventions, which are those that have shown no efficacy, have little or questionable effectiveness or are not cost-effective; decrease variability in clinical practice; promote the commitment among physicians and patients to properly use healthcare resources; and to promote clinical safety. The document includes 135 final recommendations for what not to do, prepared by 30 Spanish scientific societies

State of emergency medicine in Spain

Spain has universal public health care coverage. Emergency care provisions are offered to patients in different modalities and levels according to the characteristics of the medical complaint: at primary care centers (PCC), in an extrahospital setting by emergency medical services (EMS) and at hospital emergency departments (ED). We have more than 3,000 PCCs, which are run by family doctors (general practitioners) and pediatricians. On average, there is 1 PCC for every 15,000 to 20,000 inhabitants, and every family doctor is in charge of 1,500 to 2,000 citizens, although less populated zones tend to have lower ratios. Doctors spend part of their duty time in providing emergency care to their own patients. While not fully devoted to emergency medicine (EM) practice, they do manage minor emergencies. However, Spanish EMSs contribute hugely to guarantee population coverage in all situations. These EMS are run by EM technicians (EMT), nurses and doctors, who usually work exclusively in the emergency arena. EDs dealt with more than 25 million consultations in 2008, which implies, on average, that one out of two Spaniards visited an ED during this time. They are usually equipped with a wide range of diagnostic tools, most including ultrasonography and computerized tomography scans. The academic and training background of doctors working in the ED varies: nearly half lack any structured specialty residence training, but many have done specific master or postgraduate studies within the EM field. The demand for emergency care has grown at an annual rate of over 4% during the last decade. This percentage, which was greater than the 2% population increase during the same period, has outpaced the growth in ED capacity. Therefore, Spanish EDs become overcrowded when the system exerts minimal stress. Despite the high EM caseload and the potential severity of the conditions, training in EM is still unregulated in Spain. However, in April 2009 the Spanish Minister of Health announced the imminent approval of an EM specialty, allowing the first EM resident to officially start in 2011. Spanish emergency physicians look forward to the final approval, which will complete the modernization of emergency health care provision in Spain

Real-Life Use of Ceftolozane/Tazobactam for the Treatment of Bloodstream Infection Due to Pseudomonas aeruginosa in Neutropenic Hematologic Patients: a Matched Control Study (ZENITH Study)

We sought to assess the characteristics and outcomes of neutropenic hematologic patients with Pseudomonas aeruginosa (PA) bloodstream infection (BSI) treated with ceftolozane-tazobactam (C/T). We conducted a multicenter, international, matched-cohort study of PA BSI episodes in neutropenic hematologic patients who received C/T. Controls were patients with PA BSI treated with other antibiotics. Risk factors for overall 7-day and 30-day case fatality rates were analyzed. We compared 44 cases with 88 controls. Overall, 91% of episodes were caused by multidrug-resistant (MDR) strains. An endogenous source was the most frequent BSI origin (35.6%), followed by pneumonia (25.8%). There were no significant differences in patient characteristics between groups. C/T was given empirically in 11 patients and as definitive therapy in 41 patients. Treatment with C/T was associated with less need for mechanical ventilation (13.6% versus 33.3%; P = 0.021) and reduced 7-day (6.8% versus 34.1%; P = 0.001) and 30-day (22.7% versus 48.9%; P = 0.005) mortality. In the multivariate analysis, pneumonia, profound neutropenia, and persistent BSI were independent risk factors for 30-day mortality, whereas lower mortality was found among patients treated with C/T (adjusted OR [aOR] of 0.19; confidence interval [CI] 95% of 0.07 to 0.55; P = 0.002). Therapy with C/T was associated with less need for mechanical ventilation and reduced 7-day and 30-day case fatality rates compared to alternative agents in neutropenic hematologic patients with PA BSI. IMPORTANCE Ceftolozane-tazobactam (C/T) has been shown to be a safe and effective alternative for the treatment of difficult to treat infections due to Pseudomonas aeruginosa (PA) in the general nonimmunocompromised population. However, the experience of this agent in immunosuppressed neutropenic patients is very limited. Our study is unique because it is focused on extremely immunosuppressed hematological patients with neutropenia and bloodstream infection (BSI) due to PA (mainly multidrug resistant [MDR]), a scenario which is often associated with very high mortality rates. In our study, we found that the use of C/T for the treatment of MDR PA BSI in hematological neutropenic patients was significantly associated with improved outcomes, and, in addition, it was found to be an independent risk factor associated with increased survival. To date, this is the largest series involving neutropenic hematologic patients with PA BSI treated with C/T

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

Effect of remote ischaemic conditioning on clinical outcomes in patients with acute myocardial infarction (CONDI-2/ERIC-PPCI): a single-blind randomised controlled trial.

BACKGROUND: Remote ischaemic conditioning with transient ischaemia and reperfusion applied to the arm has been shown to reduce myocardial infarct size in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). We investigated whether remote ischaemic conditioning could reduce the incidence of cardiac death and hospitalisation for heart failure at 12 months. METHODS: We did an international investigator-initiated, prospective, single-blind, randomised controlled trial (CONDI-2/ERIC-PPCI) at 33 centres across the UK, Denmark, Spain, and Serbia. Patients (age >18 years) with suspected STEMI and who were eligible for PPCI were randomly allocated (1:1, stratified by centre with a permuted block method) to receive standard treatment (including a sham simulated remote ischaemic conditioning intervention at UK sites only) or remote ischaemic conditioning treatment (intermittent ischaemia and reperfusion applied to the arm through four cycles of 5-min inflation and 5-min deflation of an automated cuff device) before PPCI. Investigators responsible for data collection and outcome assessment were masked to treatment allocation. The primary combined endpoint was cardiac death or hospitalisation for heart failure at 12 months in the intention-to-treat population. This trial is registered with ClinicalTrials.gov (NCT02342522) and is completed. FINDINGS: Between Nov 6, 2013, and March 31, 2018, 5401 patients were randomly allocated to either the control group (n=2701) or the remote ischaemic conditioning group (n=2700). After exclusion of patients upon hospital arrival or loss to follow-up, 2569 patients in the control group and 2546 in the intervention group were included in the intention-to-treat analysis. At 12 months post-PPCI, the Kaplan-Meier-estimated frequencies of cardiac death or hospitalisation for heart failure (the primary endpoint) were 220 (8·6%) patients in the control group and 239 (9·4%) in the remote ischaemic conditioning group (hazard ratio 1·10 [95% CI 0·91-1·32], p=0·32 for intervention versus control). No important unexpected adverse events or side effects of remote ischaemic conditioning were observed. INTERPRETATION: Remote ischaemic conditioning does not improve clinical outcomes (cardiac death or hospitalisation for heart failure) at 12 months in patients with STEMI undergoing PPCI. FUNDING: British Heart Foundation, University College London Hospitals/University College London Biomedical Research Centre, Danish Innovation Foundation, Novo Nordisk Foundation, TrygFonden

Suelo y planta. Índices. Volumen 2

Effects of the landspreading of pig slurry on the yield and composition of capsi cum annuum. M. P. Bernal, A. Roig, J. Cegarra and R. Madrid.-- Características micromorfológicas de suelos de humedales en zonas semiáridas (Cuenca del Duero). J. Benayas, M. a T. de la Cruz y J. M. a Rey. Benayas.-- Aplicación de la técnica de porosimetría por intrusión de mercurio en el estudio de la porosidad de un conjunto de suelos del NW de España. E. Benito, A. Paz y R. Pini.-- Cambios físicos y químicos durante la maduración de Vitis vinífera, variedad Monastrell, en la D. O. Jumilla. G. Navarro, F. Pardo, P. Jiménez, J. Oliva y S. Navarro.-- Micorrizas vesículo - arbusculares en parcelas que se encuentran en sucesión- regeneración en Jos Andes tropicales. M. Montilla, R. A. Herrera y M. Monasterio.-- Efectos de los incendios forestales sobre el suelo. J. González, M. C. Fernández y G.P. Gimeno.-- Mineralogía de suelos formados sobre calizas en Galicia. M. T. Taboada, M. B. Silva y M. c. Villar.-- Efecto de tratamientos foliares con Ti (IV) sobre nutrición, producción y calidad de fruto en plantas de Capsicum annuum, L. F. Martínez-Sánchez, J. L. Giménez, M. Carvajal, A. Moreno, J. L. Fuentes y C. F. Alcaraz.-- Poder discriminante de las clasificaciones: aplicación a los suelos de la depresión Guadix- Baza (Granada). A. Iriarte, E. Barahona y C. Gil de Carrasco.-- Aspects of elm propagation by soft and hardwood cuttings. L. Mittempergher, G. Bartolini, F. Ferrini and M. Panicucci.-- Metales pesados en las escombreras de la mina Puentes (La Coruña): influencia de las condiciones Eh- pH. F. Macíass, M. T. Barral, C. Monterroso y R. M. Calvo.-- Incidencia del fósforo en la mineralización del nitrógeno orgánico de un lodo de depuradora en dos suelos calizos. Extracción mediante EUF. l. Verdú, l. Gómez, F. Burló y J, Mataix.-- Dinámica del proceso de sorción de fósforo en suelos. Definición de indicadores. T. Crisanto y P. P. Iturbe.-- Estudio de la adsorción de atrazina por polimeros modelos y por un ácido homico mediante la técnica de diálisis. M. Schiavon, J. M. Portal, F. Andreux y G. Bertin.-- Oxidos de hierro sintéticos y agregación en muestras de caolinita y cuarzo. M. Arias, M. T. Barraly F. Díaz-Fierros.-- Fertilization with NPK and humate NPK: Plant yield and nutrient dynamics. A. Benedetti, A. Figliolia, C. Izza, R. lndiati and S. Canali.-- Aplicación de un método de fraccionamiento de especies alumínicas a soluciones de suelos de Galicia. E. Alvarez y R. Calvo.-- Contenido y evolución de 9 elementos químicos en pimiento piquillo a lo largo de su desarrollo. R. Y. Cavero, A. Echeverría, F. Iribarren y M. L. López.-- Distribución del tamaño de poros, porosidad total y su variabilidad con la dedicación en el horizonte orgánico de un cambisol gleico. A. Paz y E. Benito.-- Caracterización de la textura superficial de granos de cuarzo en suelos con horizontes texturalmente contrastados. M. T. Martín Patino, R. J. Ballesta, V. Cala y A. Alvarez .-- Utilización de un lodo aerobio como sustitutivo de fertilizantes fosforados inorgánicos. M. Ayuso, T. Hernández, C. García y F. Costa.-- Movilidad de aldicarb y de carbofurano en columnas de suelo. A. Apaolaza, F. J. Arranz y E. Revilla.-- Degradación de clorofila en cloroplastos incubados en medio isotónico con la fracción celular extracloroplástica. J. Cuello, A. Lahora y B. Stibater.-- Especiación química de zinc y cadmio en suelos de cultivo. V. Cala, A. M. Alvarez, R. Vigil de la Villa y M. Gasea.-- Germination with alternate temperatures of weeds infesting irrigated vegetables. R. González Ponce, A. Herce and M. L. Salas.-- Evaluación de la fertilidad de los vertisoles de la provincia de Badajoz (España) mediante cultivos experimentales. Producción en materia seca y nutrientes del cultivo. A. García y A. López.-- Isozymes peroxidase in cytokinin treated seedlings of Corylus avellana L. C. Colinas, C. Díaz-Sala and R. Rodríguez.-- Respuestas de las plantas a la contaminación por metales pesados. J. Barceló y Ch. Poschenrieder.-- N, P and K balance in winter wheat in the pampean semiarid region of Argentina. R. A. Rosell, M. R. Landriscini and J. A. Galantini.-- Utilización de residuos urbanos como fertilizantes orgánicos. T. Hernández, C. García, F. Costa, J. A. Valero y M. Ayuso.-- Inducción de organogénesis en cotiledones de Pinus canariensis. C. Martínez Pulido.-- Hidróxidos de aluminio sintéticos y agregación en muestras de caolinita y cuarzo . . M. Arias, M. T. Barral y F. Díaz-Fierros.-- Producción de endoglucanasas por Glomus mosseae y su posible implicación en la colonización de raf<::es de cebolla. J. M. García-Garrido, l. García-Romera y J. A. Ocampo.-- Estudio comparado de la fracción mineral del suelo de cultivo· y de las heces' de Allolobophora molleri (Lumbricidae) Rosa, 1889.D. Trigo y D. J. Díaz Cosín.-- Determinación de la homogeneidad múltiple utilizando diferentes niveles de taxones en perfiles de suelos de la cuenca media y alta del río Motatán. Estados Mérida y Trujillo. Venezuela. J. Jaimes, J. Oballos y G. Ochoa.-- Adsorción - desorción de picloram por arcillas y óxidos. E. A. Ferreiro, S. G. de Bussetti.-- Influencia de la carga y el potencial hídrico durante la compactación sobre la resistencia a la tracción de unidades estructurales de suelo en estado seco. A. Paz y J. Guérif.-- Residuos orgánicos: Incidencia de su aplicación sobre la composición mineral del fruto del tomate, I. Gómez, J. Navarro-Pedreño y J. Mataix.-- Growth, cell wall elasticity and plasticity in Zea mays L. coleoptiles exposed to cadmium. B. Gunsé, M. Llugany, Ch. Poschenrieder and J. Barceló.-- Effects of high zinc and cadmium concentrations on the metallophyte Thlaspi caerulescens J. et C. Presl. (Brassicaceae). J. Módico, Ch. Poschenrieder, M. D. Vázquez and J. Barceló.--Determinación del grado ·de contaminación de los rlos mediante el estudio conjunto de la composición de sus aguas y sedimentos. A. Bustos, C. Ortega y I. Sastre.-- Influencia del grado de madurez de un residuo urbano sobre la germinación y disponibilidad de nitrógeno. M. Ayuso, T. Hernández, F. Costa, C. García y J. A. Pascual.-- Influencia del nitrógeno sobre el desarrollo in vitro del portainjerto de vid.--A. Villegas, C. Mozuelos, M. Cantos y A. Troncoso.-- Efecto del alpechín sobre la solubilización de metales pesados. M. Bejarano y L. Madrid.-- Aporte foliar de titanio a plantas de pimiento pimentonero. Influencia sobre el balance de nutrición en pericarpio de fruto. M. Carvajal, M. J. Frutos, J. L. Giménez, C. F. Alcaraz y F. Martínez-Sánchez.-- Effects of phosphate, sulfate and molibdate on the uptake and distribution of technetium-99 in bush bean plants. A. Bennássar, C. Cabot, J. Barceló y Ch. Poschenrieder.-- Uptake, translocation and efficiency of nutrients in Phaseolus vulgaris L. cv. contender exposed to aluminum. N. Massot, Ch. Poschenrieder and J. Barceló.-- Efecto del cadmio sobre Ü1. absorción y distribución de manganeso en distintas variedades de Lactuca. A. Gárate, I. Ramos y J. J. Lucena.-- Efecto residual de diferentes residuos orgánicos sobre un cultivo de cebada. F. Costa, T. Hernández, C. García, M. Ayuso, J. A. Pascual y A. Polo.-- Beneficial effects of low chromium III concentrations in iron deficient maize plants. Ch. Poschenrieder, M. D. Vázquez, A. Bonet and J. Barceló.-- Depresión en el rendimiento del maíz causado por altas concentraciones de N residual en el suelo. C. Pozo, C. Cruces, J. M. Ramos, y L. F. García del Moral.-- Selección y caracterización de una línea celular de limonero tolerante a estrés salino. A. Piquera y E. Hellín.-- Efectos del As en el comportamiento vegetal de Lycopersicum esculentum Mili. Relación del As en hojas y frutos con parámetros físicos. F. Burló, A. Carbonell y J. Mataix.--Niveles críticos y equilibrios óptimos de macronutrientes en la fertilización diferenciada de la vid. R. Sarmiento, J. L. García, M. C. Grande, M. C. Vil/alón, A. de Castro y C. Mozuelos.-- Niveles críticos y equilibrios óptimos de micronutrientes en la fertilización diferenciada de la vid. R. Sarmiento, J. L. García, M. C. Grande, M. C. Vil/alón, A. de Castro y C. Mozuelos.-- Efecto de un compost de lodo residual sobre el rendimiento y contenido de Cd y Ni en diversos cultivos. I. Walter, R. Miralles y M. Bigeriego.-- Estudio del eflujo neto de H+ por raíces aeropónicas estériles de plantulas de girasol (Helianthus annuus L.) bajo condiciones de toxicidad de B. F. Espinosa y M. C. Alvarez-Tinaut-- Efecodel riego con aguas residuales urbanas depuradas sobre la disponibilidad de metales pesados para la planta. A. Inglés, M. Gómez y R. Nogales.-- Diferential response of four maize (Zea mays L.) varieties to aluminum toxicity. P. Guevara, Ch. Poschenrieder and Barceló.-- Comparación de los efectos de molibdeno y vanadio en Phaseo/us vulgaris L.: Crecimiento, proteínas y actividades enzimáticas de la nitrato-reducción. D. Saco, M. Alvarez y S. Martín.-- Influencia de la fertirrigación N, P, K sobre diversos nutrientes totales y solubles. Su evolución temporal. J. L. Va/enzuela, A. del Río, A. Sánchez, l. López-Cantarero y L. Romero.-- Valoración de métodos de extracción de mercurio en suelos contaminados. J. J. Lucena, L. E. Hernández, S. Olmos y R. Carpena Ruiz.-- Relaciones entre contenidos totales de Zn, Pb, Cu y Cd en suelos y plantas. A. M. Moreno, L. Pérez y J. González.-- Effect of N-nutrition and irrigation water on Carob-Tree (Ceratonia si/iqua L.). Growth responses. P. Correia y M. A. Martins-LouçaoPeer reviewe

Timing and characteristics of venous thromboembolism after noncancer surgery

International audienc

Comparative clinical prognosis of massive and non‐massive pulmonary embolism: A registry‐based cohort study

International audienc

Science with the Cherenkov Telescope Array

213 pages, including references and glossary. Version 2: credits and references updated, some figures updated, and author list updatedInternational audienceThe Cherenkov Telescope Array, CTA, will be the major global observatory for very high energy gamma-ray astronomy over the next decade and beyond. The scientific potential of CTA is extremely broad: from understanding the role of relativistic cosmic particles to the search for dark matter. CTA is an explorer of the extreme universe, probing environments from the immediate neighbourhood of black holes to cosmic voids on the largest scales. Covering a huge range in photon energy from 20 GeV to 300 TeV, CTA will improve on all aspects of performance with respect to current instruments. The observatory will operate arrays on sites in both hemispheres to provide full sky coverage and will hence maximize the potential for the rarest phenomena such as very nearby supernovae, gamma-ray bursts or gravitational wave transients. With 99 telescopes on the southern site and 19 telescopes on the northern site, flexible operation will be possible, with sub-arrays available for specific tasks. CTA will have important synergies with many of the new generation of major astronomical and astroparticle observatories. Multi-wavelength and multi-messenger approaches combining CTA data with those from other instruments will lead to a deeper understanding of the broad-band non-thermal properties of target sources. The CTA Observatory will be operated as an open, proposal-driven observatory, with all data available on a public archive after a pre-defined proprietary period. Scientists from institutions worldwide have combined together to form the CTA Consortium. This Consortium has prepared a proposal for a Core Programme of highly motivated observations. The programme, encompassing approximately 40% of the available observing time over the first ten years of CTA operation, is made up of individual Key Science Projects (KSPs), which are presented in this document