Clinical and Ecological Impact of an Educational Program to Optimize Antibiotic Treatments in Nursing Homes (PROA-SENIOR): A Cluster, Randomized, Controlled Trial and Interrupted Time-Series Analysis

[Background] Antimicrobial stewardship programs (ASPs) are recommended in nursing homes (NHs), although data are limited. We aimed to determine the clinical and ecological impact of an ASP for NHs.[Methods] We performed a cluster, randomized, controlled trial and a before–after study with interrupted time-series analyses in 14 NHs for 30 consecutive months from July 2018 to December 2020 in Andalusia, Spain. Seven facilities implemented an ASP with a bundle of 5 educational measures (general ASP) and 7 added 1-to-1 educational interviews (experimental ASP). The primary outcome was the overall use of antimicrobials, calculated monthly as defined daily doses (DDD) per 1000 resident days (DRD).[Results] The total mean antimicrobial consumption decreased by 31.2% (−16.72 DRD; P = .045) with respect to the preintervention period; the overall use of quinolones and amoxicillin–clavulanic acid dropped by 52.2% (P = .001) and 42.5% (P = .006), respectively; and the overall prevalence of multidrug-resistant organisms (MDROs) decreased from 24.7% to 17.4% (P = .012). During the intervention period, 12.5 educational interviews per doctor were performed in the experimental ASP group; no differences were found in the total mean antimicrobial use between groups (−14.62 DRD; P = .25). Two unexpected coronavirus disease 2019 waves affected the centers increasing the overall mean use of antimicrobials by 40% (51.56 DRD; P < .0001).[Conclusions] This study suggests that an ASP for NHs appears to be associated with a decrease in total consumption of antimicrobials and prevalence of MDROs. This trial did not find benefits associated with educational interviews, probably due to the coronavirus disease 2019 pandemic.[Clinical Trials Registration] NCT03543605.Peer reviewe

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Estrategia didáctica transversal "mis competencias aplico, con mis productos las explico" para potenciar competencias científicas

Today 's society demands competent individuals, a ble to face the new challenges of a globalized and changing world. In order to improve the quality of education, sorne interna! and externa! tests are applied, which evaluate the students' performance in their formation process. For this reason, it is required to design and implement new didactic strategies that guarantee the development of competences in students, where teachers foster learning environments that allow students to solve real problems in real contexts and achieve a good performance in a personal, social and laboring level. That's why it is desired to potentiate in the students of fourth and fifth grade, the development of such competences through the elaboration of cleaning products. The process was based on the explanation, communication and teamwork a reas of Natural Sciences, starting from a constructivist and transversal strategy that benefits significant learning. The mixed focus is used here, involving the participative action research, which boosts solving problems motivated by practica! activities. The obtained results show that when the contents of diverse subjects are articulated, the mobilization of knowledge and the development of competences for life are achieved.La sociedad actual cada día demanda contar con individuos competentes, capaces de afrontar los nuevos desafíos de un mundo globalizado y cambiante, con el objetivo de mejorar la calidad en la educación se aplican pruebas internas y externas que evalúan el desempeño de los estudiantes en su proceso de formación. Por esta razón se hace necesario trazar e efectuar nuevas estrategias didácticas que garanticen el progreso de competencias, donde los profesores propicien ambientes de aprendizaje, que les permitan resolver problemas reales en contextos reales y lograr en ellos un buen desempeño. Por lo que se pretende potenciar en estudiantes quinto grado, el desarrollo de las competencias específicas basadas en la explicación, la comunicación y el trabajo en equipo en el área de Naturales, a partir de una estrategia constructivista y transversal que favorezca el aprendizaje significativo, mediante la elaboración de productos de aseo. El enfoque empleado es de carácter mixto, utilizando la investigación acción participativa. Los resultados obtenidos muestran que al articular los contenidos de las diversas asignaturas, se logra la movilización de saberes y el perfeccionamiento de competencias para la vida, es decir los estudiantes son competentes para comprender, interactuar y transformar el mundo en el que viven

Huerto y jardín en la escuela

Se propone la organización de un huerto y un jardín en el entorno escolar con el objetivo de despertar el interés por la naturaleza. Se pretende, además, fomentar el trabajo en equipo y las habilidades de investigación de técnicas de estudio, aprender a respetar las plantas y propiciar la participación de los padres. Las actividades consisten en la distribución y preparación del terreno en parcelas, creación de un invernadero, elaboración de semilleros, labores de siembra y plantación, tareas de mantenimiento y conservación del huerto y el jardín, recolección de frutos, y salidas a otros jardines e invernaderos. La evaluación se lleva a cabo a través de la observación directa, continua y sistemática, y consta de tres fases: inicial, continua y sumativa.Madrid (Comunidad Autónoma). Consejería de Educación y CulturaMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

El teatro como juego y medio de expresión en la escuela

El proyecto surge al comprobar las posibilidades de expresión y comunicación de las actividades teatrales realizadas el año anterior en el Aula de Naturaleza. Los objetivos son desarrollar la expresión y comunicación; potenciar la creatividad; y compartir el trabajo realizando representaciones en distintos centros escolares de Getafe. Se divide el trabajo en juegos preparativos, la obra y el montaje. Mediante el juego se trabaja la psicomotricidad, la expresión lingüística, corporal, plástica y rítmico-musical. Después se estudian los personajes, el argumento, el espacio y el tiempo de las cinco obras seleccionadas y se empieza a ensayar. A la vez en los talleres de audiovisuales, de música, y de cosido y de telas, se diseña el escenario, los decorados, los trajes y demás aspectos técnicos. Se realizan dos obras por trimestre y se representan en distintos teatros de Getafe. Se evalúan las habilidades adquiridas, la motivación, la aportación creativa, la capacidad razonadora, la espontaneidad y la disciplina en el escenario. Cabe destacar que los alumnos con problemas de conducta se han integrado en el grupo.Madrid (Comunidad Autónoma). Consejería de EducaciónMadridMadrid (Comunidad Autónoma). Subdirección General de Formación del Profesorado. CRIF Las Acacias; General Ricardos 179 - 28025 Madrid; Tel. + 34915250893ES

La magia del agua

El objetivo del proyecto consiste en valorar y conocer uno de los principales recursos naturales del hombre, el agua, para concienciar a la comunidad escolar de su buen uso. El trabajo se desarrolla desde distintos ámbitos: el origen, el hogar, la salud, el deporte, la industria, el transporte, la historia, la religión, el arte, el campo, el ocio y el futuro. Para llevar a cabo se organizan talleres y grupos de trabajo rotativos entre todos los cursos del centro, basados en el teatro, en la lectura y en la redacción de textos y poemas. Los alumnos adquieren destrezas de aprendizaje relacionadas con la capacidad cognitiva en procesos de atención, percepción y comunicación, además de desarrollar su capacidad creativa a la hora de redactar los textos. Los resultados se proyectan en la mejora del trabajo en equipo, la mejor expresión de sentimientos e ideas, el desarrollo del análisis personal y del entorno, en definitiva, mejoran en las cuatro habilidades lingüísticas: hablar, escuchar, leer y escribir. En los anexos aportan un taller de teatro, un taller de plástica y el noticiero del agua; también se incluye la información con un CD-ROM de la memoria del proyecto..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

Diagnostic yield of chest and thumb ECG after cryptogenic stroke, Transient ECG Assessment in Stroke Evaluation (TEASE): an observational trial

Objective In stroke survivors, atrial fibrillation (AF) is typically evaluated solely by short-term ECG monitoring in the stroke unit. Prolonged continuous ECG monitoring or insertable cardiac monitors require substantial resources. Chest and thumb ECG could provide an alternative means of AF detection, which in turn could allow prompt anticoagulation to prevent recurrent stroke. The objective of this study was to assess the yield of newly diagnosed AF during 28 days of chest and thumb ECG monitoring two times per day in cryptogenic stroke.Methods This study, Transient ECG Assessment in Stroke Evaluation, included patients who had a stroke from Region Gävleborg, Sweden, between 2017 and 2019. Patients with a recent ischaemic stroke without documented AF (or other reasons for anticoagulation) before or during ECG evaluation in the stroke unit were evaluated using the Coala Heart Monitor connected to a smartphone application for remote monitoring.Results The prespecified number of 100 patients (mean age 67.6±10.8 years; 60% men) was analysed. In nine patients (9%, number needed to screen 11) AF but no other significant atrial arrhythmias (&gt;30 s) was diagnosed. The mean CHA2DS2-VASc score was similar among patients with AF and no AF (4.9±1.1 vs 4.3±1.3; p=0.224) and patients with AF were older (74.3±9.0 vs 66.9±10.8; p=0.049). Patients performed on average 90.1%±15.0% of scheduled transmissions.Conclusion In evaluation of cryptogenic stroke, 9% of patients had AF detected using chest and thumb ECG two times per day during 1 month. In many stroke survivors, this is a feasible approach and they will be potentially protected from recurrent stroke by anticoagulation treatment.Trial registration number NCT03301662

Prevalence and genotype distribution of cervical human papilomavirus infection in the pre-vaccination era: a population-based study in the Canary Islands

Objective National Spanish studies show that prevalence of cervical human papillomavirus (HPV) infection in the female population is increasingly frequent, with an overall estimate of 14% in women aged 18–65 years. The objective of this study is to know the prevalence and distribution of HPV types in the female population of the Canary Islands prior to the introduction of HPV vaccines and to investigate the associated clinical and sociodemographic factors.Methods Based on the Primary Health Care database, a sample of adult women (aged 18–65 years) of Gran Canaria (GC) and Tenerife (TF) stratified into nine age groups was carried out between 2002 and 2007. Women were contacted by postal letter and telephone call and were visited in their primary care centre. A clinical-epidemiological survey was completed and cervical samples were taken for cytological study and HPV detection. HPV prevalence and its 95% CI were estimated, and multivariate analyses were performed using logistic regression to identify factors associated with the infection.Results 6010 women participated in the study, 3847 from GC and 2163 from TF. The overall prevalence of HPV infection was 13.6% (CI 12.8%–14.5%) and 11.1% (CI 10.3%–11.9%) for high-risk types. The most frequent HPV type was 16 followed by types 51, 53, 31, 42 and 59. HPV types included in the nonavalent vaccine were detected in 54.1% of infected women. Factors associated with an increased risk of infection were: young ages (18–29 years), the number of sexual partners throughout life, not being married, being a smoker, and having had previous cervical lesions or genital warts.Conclusions It is confirmed that prevalence of HPV infection in the female population of the Canary Islands is high, but similar to that of Spain, HPV 16 being the most frequent genotype. The determinants of infection are consistent with those of other populations

VII Jornadas de Innovación Educativa de la Universidad de La Laguna: imaginar y comprender la innovación en la Universidad

The change of structure and process of the organizations of the current society has generated a great impact in the new way of working. Work teams coordination ensures that a team functions as a unitary whole; is identified as a key process to understand work team effectiveness. This paper presents a brief introduction of the recent research on Work teams in organizations and raises relevant issues about their implications for Pedagogy studies. This paper aims, first, to analyze the potential of team based organizations. And secondly, to examine the effects in pedagogy studies. Coordination is a process that involves the use of strategies and patterns of behavior aimed to integrate actions, knowledge and goals of interdependent members. The tasks have increased its difficulty, doing that individual resolution is very difficult or impossibleUniversidad de La Lagun