El problema de la compartimentación en contenidos teóricos y prácticos en el proceso de aprendizaje. Propuesta de diagramas arbóreos interactivos en las prácticas de Microbiología

[SPA] El estudio de la Microbiología a nivel de enseñanzas media y superior, se imparte clásicamente mediante clases magistrales teóricas y clases prácticas en el laboratorio. Esta compartimentación se ha visto agravada con la implantación de los Grados en los que los contenidos se distribuyen aún más entre una amplia variedad de actividades. El alumno debe sustituir la presencialidad por el trabajo personal, si bien los resultados observados son su preocupación por la materia objeto de evaluación de cada una de las partes y la dificultad en integrar y secuenciar los contenidos que asimila. Por otra parte, las condiciones de seguridad que requiere el trabajo con patógenos unido a la falta de tiempo, supone una reducción del programa práctico. En el presente estudio, financiado con un Proyecto de Innovación de la Universidad de Murcia suscrito con la CARM, se plantea como objetivo la resolución de este problema, común a ambos niveles de enseñanza, mediante diagramas arbóreos interactivos de fácil acceso. La finalidad es conseguir unos resultados en el proceso de enseñanza-aprendizaje de la Microbiología de la forma más parecida a la realidad, en las que el alumno debe tomar decisiones en base a los contenidos y destrezas adquiridos. [ENG] The study of Microbiology in secondary and higher education, was conventionally taught through theoretical lectures and practical laboratory classes. This compartmentalization has been exacerbated with the implementation of Grades in which content is distributed even more from a wide variety of activities. The student must replace presentiality for personal work, but the results observed are concerned about the subject matter of assessment of each of the parties and the difficulty in integrating and assimilating the content sequence. Moreover, the security that requires working with pathogens coupled with the lack of time, a reduction of practical program. In the present study, funded with Innovation Project of the University of Murcia signed with CARM, therefore seeks to solve this problem, common to both levels of education by interactive tree diagrams easily accessible. The aim is to achieve results in the teaching and learning of Microbiology shaped more like reality, in which the student must make decisions based on the content and skills acquired.Trabajo financiado por un proyecto dentro del PROGRAMA III: Centro de Formación y Desarrollo Profesional Universidad de Murcia (Proyectos conjuntos de investigación e innovación educativa 2013-14

Unidades didácticas de apoyo para prácticas de laboratorio: nuevos contenidos y usos para smartphones

[SPA] Esta comunicación describe fundamentalmente la parte de desarrollo de herramientas, realizado por profesoras y profesores de la Facultad de Bellas de Artes y de la Facultad de Veterinaria, ambas de la Universidad de Murcia. El trabajo se enmarca en el proyecto de Innovación docente “Realización de prácticas en Microbiología mediante la utilización de recursos audiovisuales y nuevas tecnologías” en el Marco del Programa III del Convenio de Cooperación en Materia de Formación Inicial y Permanente del Profesorado que ejerce en los Niveles Anteriores a la Universidad, suscrito por la Universidad de Murcia y la Comunidad Autónoma de la Región de Murcia. Esta comunicación está vinculada a la comunicación titulada “El problema de la compartimentación en contenidos teóricos y prácticos en el proceso de aprendizaje. Propuesta de diagramas arbóreos interactivos en las prácticas de Microbiología”, tratando cuestiones complementarias de un mismo proyecto. Nos centraremos en la explicación del funcionamiento de la web app que ha sido concebida para que estudiantes de Microbiología puedan mejorar y afirmar los conocimientos que se adquieren en las prácticas de laboratorio. Esta aplicación es accesible desde el navegador del ordenador (online y offline) y está adaptada para teléfonos móviles (online), incluyendo material multimedia (imágenes, texto, audios y vídeos). Este material ha sido grabado íntegramente en los laboratorios de Microbiología de la Facultad de Veterinaria con la colaboración de profesoras/es y alumnas/os. [ENG] This paper describes a part of the work of teachers from the Faculty of Fine Arts and the Faculty of Veterinary Science, both from the University of Murcia. This work has been created in the context of an innovation learning project titled "Performing Microbiology practices using audiovisual resources and new technologies". This communication is linked to the communication entitled "The problem of compartmentalization in theory and practice for learning contents. Interactive tree diagrams for Microbiology practices", both of them explain subjects of the same project. We will focus on explaining the web app that has been designed by the teachers from de Fine Arts faculty and that integrates content created by veterinary teachers The main goal of this app is to improve and affirm the knowledge acquired by students of microbiology in the labs (practice exercises). This app works for web (online and offline) and mobile phones (online) and includes multimedia material (images, text, audio and video). This material has been recorded entirely in the Microbiology Laboratories of the Faculty of Veterinary, in collaboration with teachers and students.Trabajo financiado por un proyecto dentro del PROGRAMA III: Centro de Formación y Desarrollo Profesional Universidad de Murcia (Proyectos conjuntos de investigación e innovación educativa 2013-14

Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

Introduction: Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors. Methods: Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit. Results: The median [p25–p75] time from discharge to follow-up was 3.57 [2.77–4.92] months. Median age was 60 [53–67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO < 80% and 24% having DLCO < 60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO < 60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions. Conclusion: Age and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities

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

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