Baseline ECG and prognosis after transcatheter aortic valve implantation: the role of interatrial block

Background: The clinical significance of conduction disturbances after transcatheter aortic valve implantation has been described; however, little is known about the influence of baseline ECGs in the prognosis of these patients. Our aim was to study the influence of baseline ECG parameters, including interatrial block (IAB), in the prognosis of patients treated with transcatheter aortic valve implantation. Methods and Results: The BIT (Baseline Interatrial Block and Transcatheter Aortic Valve Implantation) registry included 2527 patients with aortic stenosis treated with transcatheter aortic valve implantation. A centralized analysis of baseline ECGs was performed. Patients were divided into 4 groups: normal P wave duration (<120 ms); partial IAB (P wave duration ≥120 ms, positive in the inferior leads); advanced IAB (P wave duration ≥120 ms, biphasic [+/-] morphology in the inferior leads); and nonsinus rhythm (atrial fibrillation/flutter and paced rhythm). The mean age of patients was 82.6±9.8 years and 1397 (55.3%) were women. A total of 960 patients (38.0%) had a normal P wave, 582 (23.0%) had partial IAB, 300 (11.9%) had advanced IAB, and 685 (27.1%) presented with nonsinus rhythm. Mean follow‐up duration was 465±171 days. Advanced IAB was the only independent predictor of all‐cause mortality (hazard ratio [HR], 1.48; 95% CI, 1.10-1.98 [P=0.010]) and of the composite end point (death/stroke/new atrial fibrillation) (HR, 1.51; 95% CI, 1.17-1.94 [P=0.001]). Conclusions: Baseline ECG characteristics influence the prognosis of patients with aortic stenosis treated with transcatheter aortic valve implantation. Advanced IAB is present in about an eighth of patients and is associated with all‐cause death and the composite end point of death, stroke, and new atrial fibrillation during follow‐up

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Temps d'educació

Resumen en castellano, francés e inglésEl autor valora las respuestas de la reforma a los problemas del sistema educativo refiriéndose al enfoque de los profesionales docentes. El papel de los docentes exige una mejor preparación y mayor capacidad del trabajo en equipo para gestionar de manera autónoma la propuesta curricular y educativa del centro. Se afirma que las exigencias de la reforma pueden resultar positivas para el profesorado y, en general, para la población escolar si se desarrollan las condiciones adecuadas.CataluñaES

Cuadernos de pedagogía

Se plantea que la escuela debe ayudar a los jóvenes a elegir un itinerario profesional acorde con sus potencialidades. No se debe sólo enseñar a usar unas técnicas, sino a analizar la situación socio-laboral caracterizada actualmente por la precariedad, la flexibilidad y la incorporación de las nuevas tecnologías. Se propone un sistema educativo y formativo que abarque tres niveles de formación: una educación de base, una educación profesional específica o especializada y una formación profesional continua. Se debería contribuir al desarrollo de competencias entendidas como un conjunto de conocimientos, habilidades y destrezas profesionales vinculadas al desempeño profesional, a los requerimientos del ejercicio laboral y a la nueva situación económica y social.Madrid (Comunidad Autónoma). Servicio de Formación del Profesorado. CRIF Las Acacias; Calle General Ricardos, 179; 28025 Madrid; Tel. +34915250893; Fax +34914660991; [email protected]

Per què es cremen els boscos?. Tercer cicle

La presente unidad se presenta estructurada en dos volúmenes: una guía didáctica para el profesorado, de la cual existen dos ejemplares, y un cuaderno de trabajo para el alumnadoUnidad didáctica en la que se aborda la problemática de los incendios forestales, la deforestación y el avance de la desertización, tanto en la Comunidad Valenciana como en el resto de España. Esta unidad abarca temas importantes desde el punto de vista de una educación en defensa de la vida y el medio ambiente, así como aspectos relativos al proceso de enseñanza-aprendizaje: interpretación de mapas de diferentes escalas, manejo del atlas, construcción de gráficos, interpretación de diagramas, etc. Finalmente, se propone la realización de una campaña publicitaria, mediante la cual el alumnado pueda sensibilizarse por el estudio y la mejor comprensión de esta problemática. El trabajo, integrado en el área de conocimiento del medio, se complementa con actividades pertenecientes al área de Lengua.ValenciaBiblioteca de Educación del Ministerio de Educación, Cultura y Deporte; Calle San Agustín 5 -3 Planta; 28014 Madrid; Tel. +34917748000; [email protected]

La Orientación educativa y profesional en la educación secundaria

Garantizar una educación armónica e individualizada es sin duda un requisito de calidad de la enseñanza. La orientación ofrece a los docentes la ayuda necesaria para conseguir estos objetivos y para guiar a los alumnos por aquellos itinerarios académicos y profesionales que más se ajusten a sus capacidades e intereses durante la etapa de Educación Secundaria. En este libro se analizan las tareas de los profesores, los tutores y los profesionales de la psicopedagogía en los procesos de orientación, dentro de un modelo coordinado de actuación en el centro docente. Se presentan pautas de actuación para cada uno de ellos y se ofrece la información necesaria para que los alumnos aprendan a tomar decisiones a lo largo de su escolaridad ante las opciones que se les abren tanto en la Educación Secundaria Obligatoria como en el Bachillerato y los ciclos Formativos de Formación Profesional. Es una obra que responde, por tanto, a los intereses del conjunto de los profesores que trabajan en los centros de Secundaria y que reflexiona sobre un aspecto de la tarea docente básico en este momento en el que integrar /a dimensión instructiva y formativa de la educación se considera la clave de una educación de calidad