Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Systematic review on the efficacy of behavioral activation therapy in the management of adult patients with depression

Introduction: This work aimed to assess the approach of behavioral activation for the treatment of adult patients diagnosed with depressive disorder; the importance of this study in the clinical setting is significant since it allowed us to know the viability and acceptability of the treatment. Behavioral activation is the basis of this study. Materials and method: Systematic review, under the PRISMA methodology, the PICO tool was implemented to formulate the research question. Results: 42 articles were located, of which, upon complete reading, 23 met the inclusion criteria established for the review

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

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

Fundamentos enfermeros en el proceso de administración de medicamentos

Este libro compila el cuidado de enfermería en las diferentes etapas de la administración de medicamentos. De esta forma utiliza el proceso de atención de enfermería como una herramienta que permite, de manera sistemática, desarrollar el pensamiento crítico para la toma de decisiones. La fundamentación teórica y práctica contenida en estos 33 capítulos fortalece el proceso de administración de medicamentos en el marco de la seguridad y la calidad del cuidado; establece un lenguaje común y la aplicación de la evidencia científica. En su construcción contó con la participación interdisciplinaria de químicos farmacéuticos, bacteriólogos, médicos gastroenterólogos, nutricionistas y enfermeras especialistas en diferentes áreas del cuidado a nivel asistencial y docente. Esta obra resulta novedosa porque integra fundamentos teóricos de farmacología, algunos elementos de fisiología y el proceso de atención de enfermería. Lo anterior genera acciones en el marco de garantía de calidad en la seguridad del paciente y previene incidentes y eventos adversos relacionados con la administración de medicamentos por diferentes vías y en poblaciones adultas y pediátricas. Invitamos al lector a construir el conocimiento a través de la lectura de los diferentes capítulos, lo que le permitirá transformar su práctica cotidiana y contribuir a su éxito profesional.Bogot

Prosthetic Valve Candida spp. Endocarditis: New Insights Into Long-term Prognosis—The ESCAPE Study

International audienceBackground: Prosthetic valve endocarditis caused by Candida spp. (PVE-C) is rare and devastating, with international guidelines based on expert recommendations supporting the combination of surgery and subsequent azole treatment.Methods: We retrospectively analyzed PVE-C cases collected in Spain and France between 2001 and 2015, with a focus on management and outcome.Results: Forty-six cases were followed up for a median of 9 months. Twenty-two patients (48%) had a history of endocarditis, 30 cases (65%) were nosocomial or healthcare related, and 9 (20%) patients were intravenous drug users. "Induction" therapy consisted mainly of liposomal amphotericin B (L-amB)-based (n = 21) or echinocandin-based therapy (n = 13). Overall, 19 patients (41%) were operated on. Patients <66 years old and without cardiac failure were more likely to undergo cardiac surgery (adjusted odds ratios [aORs], 6.80 [95% confidence interval [CI], 1.59-29.13] and 10.92 [1.15-104.06], respectively). Surgery was not associated with better survival rates at 6 months. Patients who received L-amB alone had a better 6-month survival rate than those who received an echinocandin alone (aOR, 13.52; 95% CI, 1.03-838.10). "Maintenance" fluconazole therapy, prescribed in 21 patients for a median duration of 13 months (range, 2-84 months), led to minor adverse effects.Conclusion: L-amB induction treatment improves survival in patients with PVE-C. Medical treatment followed by long-term maintenance fluconazole may be the best treatment option for frail patients

Role of age and comorbidities in mortality of patients with infective endocarditis.

The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups: A total of 3120 patients with IE (1327  There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in th

Contemporary use of cefazolin for MSSA infective endocarditis: analysis of a national prospective cohort

Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P <0.01) and previous renal failure (57.9%, P <0.01). Patients treated with cloxacillin presented higher rates of septic shock (25%, P = 0.033) and new-onset or worsening renal failure (47.3%, P = 0.024) with significantly higher rates of in-hospital mortality (38.5%, P = 0.017). One-year IE-related mortality and rate of relapses were similar between treatment groups. None of the treatments were identified as risk or protective factors. Conclusion: Our results suggest that cefazolin is a valuable option for the treatment of MSSA IE, without differences in 1-year mortality or relapses compared with cloxacillin, and might be considered equally effective