Increased 30-Day Mortality in Very Old ICU Patients with COVID-19 Compared to Patients with Respiratory Failure without COVID-19

Purpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without COVID-19 with a focus on LLST. Methods: Patients 80 years or older with acute respiratory failure were recruited from the VIP2 and COVIP studies. Baseline patient characteristics, interventions in intensive care unit (ICU) and outcomes (30-day survival) were recorded. COVID patients were matched to non-COVID patients based on the following factors: age (± 2 years), Sequential Organ Failure Assessment (SOFA) score (± 2 points), clinical frailty scale (± 1 point), gender and region on a 1:2 ratio. Specific ICU procedures and LLST were compared between the cohorts by means of cumulative incidence curves taking into account the competing risk of discharge and death. Results: 693 COVID patients were compared to 1393 non-COVID patients. COVID patients were younger, less frail, less severely ill with lower SOFA score, but were treated more often with invasive mechanical ventilation (MV) and had a lower 30-day survival. 404 COVID patients could be matched to 666 non-COVID patients. For COVID patients, withholding and withdrawing of LST were more frequent than for non-COVID and the 30-day survival was almost half compared to non-COVID patients. Conclusion: Very old COVID patients have a different trajectory than non-COVID patients. Whether this finding is due to a decision policy with more active treatment limitation or to an inherent higher risk of death due to COVID-19 is unclear.info:eu-repo/semantics/publishedVersio

Relationship between the Clinical Frailty Scale and short-term mortality in patients ≥ 80 years old acutely admitted to the ICU: a prospective cohort study.

BACKGROUND: The Clinical Frailty Scale (CFS) is frequently used to measure frailty in critically ill adults. There is wide variation in the approach to analysing the relationship between the CFS score and mortality after admission to the ICU. This study aimed to evaluate the influence of modelling approach on the association between the CFS score and short-term mortality and quantify the prognostic value of frailty in this context. METHODS: We analysed data from two multicentre prospective cohort studies which enrolled intensive care unit patients ≥ 80 years old in 26 countries. The primary outcome was mortality within 30-days from admission to the ICU. Logistic regression models for both ICU and 30-day mortality included the CFS score as either a categorical, continuous or dichotomous variable and were adjusted for patient's age, sex, reason for admission to the ICU, and admission Sequential Organ Failure Assessment score. RESULTS: The median age in the sample of 7487 consecutive patients was 84 years (IQR 81-87). The highest fraction of new prognostic information from frailty in the context of 30-day mortality was observed when the CFS score was treated as either a categorical variable using all original levels of frailty or a nonlinear continuous variable and was equal to 9% using these modelling approaches (p < 0.001). The relationship between the CFS score and mortality was nonlinear (p < 0.01). CONCLUSION: Knowledge about a patient's frailty status adds a substantial amount of new prognostic information at the moment of admission to the ICU. Arbitrary simplification of the CFS score into fewer groups than originally intended leads to a loss of information and should be avoided. Trial registration NCT03134807 (VIP1), NCT03370692 (VIP2)

Aproximación al trabajo social en España Development of social work in Spain

<abstract language="por">Este artigo aborda a evolução e desenvolvimento do serviço social como disciplina e profissão na Espanha. Depois de um breve panorama histórico que contextualiza a situação atual, focaliza-se a análise no grupo profissional, suas características sociodemográficas e atividades profissionais. A formação dos assistentes sociais na Espanha e sua produção científica completam a radiografia da situação atual da profissão.<br>This text approaches the evolution and development of the Social Work as a discipline and profession in Spain. After a brief historical review that puts into context the current situation, we focus the professional group, the social and demographic characteristics and the professional activities. The Spanish social workers' background and their scientific production complete the setting of the current situation of the profession

Memoria del CP Emilia Pardo Bazán. Curso 1986-87 : integración mediante un diseño curricular por talleres

Intentar crear un espacio didáctico integrado, adaptado al individuo y que le permita desarrollar sus aptitudes y se estimule el proceso de enseñanza-aprendizaje prestando especial interés a la integración de niños necesitados de Educación Especial. Alumnos del CP Emilia Pardo Bazán. N=250 sujetos de Preescolar y EGB de ellos 20 provienen de la Educación Especial. Partiendo de una serie de conceptos pedagógicos y didácticos se diseña un currículum adaptado y una serie de talleres. La evaluación se realiza al principio (observación sistemática), durante y después del curso (informe final). En el caso de los alumnos de EE se complementa con estudios socimétricos. Simultáneamente, un equipo multiprofesional efectúa diagnósticos individuales. El proyecto se completa con una reorganización de las estructuras del Centro y contactos con los padres. Hojas de registro donde se recoge la consecución de objetivos por cada niño. Protocolo de observación sistemática. Pruebas sociométricas. Pruebas diagnósticas. Entrevistas clínicas con las familias. Comentarios cualitativos de la experiencia. Se observa que los objetivos generales son adecuados. La metodología empleada es muy flexible y otorga protagonismo al niño. Esto evita la necesidad de un currículum paralelo. Por otro lado, se produce una valoración global de las adquisiciones del niño no sólo referidas al proceso de enseñanza-aprendizaje, sino también en aspectos sociales y personales. Los profesores consideran muy positiva la organización propuesta.. Aún sin citar datos numéricos, concluyen valorando muy positivamente la experiencia. El trabajo remarca los aspectos más problemáticos encontrados (horarios, coordinación, temporalización y Formación del Profesorado).MadridES

Factors associated with perioperative mortality in children and adolescents operated for tetralogy of Fallot: A sub-Saharan experience

BACKGROUND: Patients with tetralogy of Fallot are now surviving to adulthood with timely surgical intervention. However, many patients in low-income countries have no access to surgical intervention. This paper reports the surgical access and perioperative mortality in a sub-Saharan center that was mainly dependent on visiting teams. METHODS: We reviewed records of patients operated from January 2009 to December 2014. We examined perioperative outcomes, primarily focusing on factors associated with perioperative mortality. RESULTS: During this period, 62 patients underwent surgery. Fifty-seven (91.9%) underwent primary repair, while 5 (6.5%) underwent palliative shunt surgery. Of the five patients with shunt surgery, four ultimately underwent total repair. Eight (12.9%) patients died during the perioperative period. Factors associated with perioperative mortality include repeated preoperative phlebotomy procedures (P \u3c .001), repeated runs and long cardiopulmonary bypass time (P \u3c .001), and aortic cross-clamp time (P \u3c .001), narrow pulmonary artery (PA) valve annulus diameter (P = .022), narrow distal main PA diameter (P = .039), narrow left branch PA diameter (P = .049), and narrow right PA diameter (P = .039). Of these factors, cardiopulmonary bypass time/aortic cross-clamp time and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality. CONCLUSION: In this series of consecutive patients operated by a variety of humanitarian surgical teams, cardiopulmonary bypass time/aortic cross-clamp time, and pulmonary valve annulus diameter less than three SD were independently associated with perioperative mortality risk. As some of these factors are modifiable, we suggest that they should be considered during patient selection and at the time of surgical intervention