Análisis comparados de sistemas de información en el estudio del impacto de la gripe en la atención hospitalaria

OBJECTIVES: The main objective of the study is to determine the impact of the improvement of an epidemiological surveillance system on the clinical and organisational outcomes of patients hospitalised with influenza. Secondary objectives are: to identify the key elements of an influenza surveillance system that provides value to patients and professionals; to assess the magnitude of nosocomial transmission of influenza in a hospital, through a surveillance system with active search for new cases; to analyse the frequency of complications in patients hospitalised with influenza, including cardiovascular events in the surveillance; and to determine the validity and usefulness of the RAE-CMBD, compared to an epidemiological surveillance system, in the characterisation of patients hospitalised with influenza. METHODS: Three options for universal influenza surveillance in hospitals were compared: 1) Maintain a case register with passive surveillance; 2) Opt for a real-time epidemiological surveillance system; and 3) Explore the use of a secondary data source, such as the RAE-CMBD. The results of the implementation of each of the alternatives were evaluated through 3 differentiated and harmonic designs: observational, descriptive and cross-sectional studies; a quasi-experimental before-after study; and a concordance study. In total, 96,184 discharges from a tertiary hospital between 1 January 2017 and 31 December 2019 were analysed, focusing on the 1,196 adults hospitalised with confirmed influenza during three seasons (2016/2017, 2017/2018 and 2018/2019). RESULTS: After implementation of the real-time influenza surveillance system, the percentage of patients with early diagnosis and isolation was significantly increased (13.7% vs. 68.2%, p<0.001), nosocomial transmission of the virus decreased from 17% to 9.2% (p=0.001) and the average length of stay of all patients hospitalised with influenza was reduced by 2 days (10±13 vs. 8±6, p<0.001). A cardiac event was a complication in 2.5% of patients hospitalised with influenza and was associated with vaccination (OR 0.32; 95%CI 0.13-0.83; p=0.02), ICU admission (OR 6.9; 95%CI 1.64-29.1; p=0.008) and multi-organ failure (OR 4.84; 95%CI 1.73-13.53; p=0.003). A near 100% match (97.74%) was achieved between both data sources, the surveillance system and the RAE-CMBD. Inter-observer agreement for the identification of influenza episodes was high (k = 0.828) and the RAE-CMBD showed a sensitivity of 79.87%, specificity of 99.72%, positive predictive value of 86.71% and negative of 99.54%. The risk-adjusted mortality ratio (RMAR) of patients with influenza was lower than that of patients without influenza: 0.667 (0.53-0.82) vs. 1.008 (0.98-1.04) and the risk-adjusted length of stay ratio (REAR) higher: 1.15 (1.12-1.18) vs. 1.00 (0.996-1.001). CONCLUSIONS: Active surveillance of patients hospitalised with influenza increases the safety of patients and professionals by reducing nosocomial transmission of the virus; improves effectiveness, as it increases the capacity to detect new cases and the quality of data; increases efficiency, as it contributes to the reduction of hospital stay; and allows answering clinical and epidemiological research hypotheses. Influenza causes major complications in more than one third of hospitalised patients. Although most of these are respiratory, cardiac events also stand out, with a high mortality rate. The surveillance system established has shown the protective role of vaccination in the development of a cardiac event after influenza. The validity of the RAE-CMBD was proved with the data from the epidemiological surveillance system, which multiplies the information and broadens the knowledge of the disease. However, it does not replace active surveillance of cases, due to its retrospective approach and insufficient capacity to detect nosocomial transmission.OBJETIVOS: El objetivo principal del trabajo es determinar el impacto de la mejora de un sistema de vigilancia epidemiológica en los resultados clínicos y organizativos de los pacientes hospitalizados con gripe. Como objetivos secundarios, encontramos: identificar los elementos clave de un sistema de vigilancia de gripe que aporte valor a los pacientes y profesionales; evaluar la magnitud de la transmisión nosocomial de gripe en un hospital de agudos, a través de un sistema de vigilancia con búsqueda activa de casos nuevos; analizar la frecuencia de complicaciones en los pacientes hospitalizados con gripe, incluyendo en la vigilancia los eventos cardiovasculares; y delimitar la validez y utilidad del RAE-CMBD, respecto a un sistema de vigilancia epidemiológica, en la caracterización de los pacientes hospitalizados con gripe. METODOLOGÍA: Se compararon tres opciones de vigilancia universal de gripe en hospitales: 1) Mantener un registro de casos con vigilancia pasiva; 2) Apostar por un sistema de vigilancia epidemiológica en tiempo real; y 3) Explorar la utilización de una fuente secundaria de datos, como el RAE-CMBD. Se evaluaron los resultados de la implementación de cada una de las alternativas a través de 3 diseños diferenciados y armónicos: estudios observacionales, descriptivos y transversales; estudio cuasi-experimental antes-después; y estudio de concordancia. En total, se analizaron las 96.184 altas de un hospital de tercer nivel entre el 1 de enero de 2017 y el 31 de diciembre de 2019, poniendo el foco en los 1.196 adultos hospitalizados con gripe confirmada durante tres temporadas (2016/2017, 2017/2018 y 2018/2019). RESULTADOS: Tras la implementación del sistema de vigilancia de gripe en tiempo real, se incrementó significativamente el porcentaje de pacientes con diagnóstico y aislamiento precoz (13,7% vs. 68,2%, p<0,001), disminuyó la transmisión nosocomial del virus del 17% al 9,2% (p=0,001) y se redujo en 2 días la estancia media de todos los pacientes hospitalizados con gripe (10±13 vs. 8±6, p<0,001). Un 2,5% de los pacientes hospitalizados con gripe presentaron como complicación un evento cardiaco, asociándose su aparición con la vacunación (OR 0,32; IC95% 0,13-0,83; p=0,02), el ingreso en UCI (OR 6,9; IC95% 1,64-29,1; p=0,008) y el fallo multiorgánico (OR 4,84; IC95% 1,73-13,53; p=0,003). Se logró un emparejamiento cercano al 100% (97,74%) entre las dos fuentes de datos utilizadas, el sistema de vigilancia y el RAE-CMBD. La concordancia interobservadores para la identificación de los episodios con gripe fue elevada (&#409; = 0,828) y el RAE-CMBD mostró una sensibilidad del 79,87%, especificidad del 99,72%, valor predictivo positivo del 86,71% y negativo del 99,54%. La razón de mortalidad ajustada por riesgo (RMAR) de los pacientes con gripe fue menor que la de los pacientes sin gripe: 0,667 (0,53&#8211;0,82) vs. 1,008 (0,98&#8211;1,04) y la razón de duración de la estancia ajustada por riesgo (REAR), mayor: 1,15 (1,12&#8211;1,18) vs. 1,00 (0,996&#8211;1,001). CONCLUSIONES: La vigilancia activa de los pacientes hospitalizados con gripe incrementa la seguridad de pacientes y profesionales al disminuir la transmisión nosocomial del virus; mejora la efectividad, puesto que aumenta la capacidad de detección de casos nuevos y la calidad de los datos; aumenta la eficiencia, ya que contribuye a la reducción de la estancia hospitalaria; y permite responder a hipótesis de investigación. El sistema de vigilancia implantado ha puesto de manifiesto el papel protector de la vacunación en el desarrollo de un evento cardiaco tras gripe. La demostración de la concordancia y validez del RAE-CMBD con los datos del sistema de vigilancia epidemiológico, multiplica la información y amplía el conocimiento de la enfermedad. No obstante, no sustituye a la vigilancia activa de casos, debido a su carácter retrospectivo y a la insuficiente capacidad de detección de la transmisión nosocomial.Escuela de DoctoradoDoctorado en Investigación en Ciencias de la Salu

UAVs mission planning with imposition of flight level through fast marching square

Many proposed activities to be carried out by unmanned aerial vehicles (UAVs) in urban environments require a control over the altitude for different purposes. Energy saving and minimization of costs are some of these objectives. This work presents a method to impose a flight level in a mission planning carried out by a UAV in a 3D urban environment. The planning avoids all obstacles encountered in the environment and maintains a fixed flight level in the majority of the trajectory. The method used as planner is the Fast Marching Square (FM2) method, which includes two adjustment parameters. Depending on the values of these parameters, it is possible to introduce into the planning an altitude constraint, as well as to modify the smoothness of the trajectory and the safety margins from the obstacles. Several simulated experiments have been carried out in different situations obtaining very good results.The research leading to these results has received funding from the RoboCity2030-III-CM project (Robótica aplicada a la mejora de la calidad de vida de los ciudadanos, fase III; S2013/MIT-2748), funded by Programas de Actividades I+D en la Comunidad de Madrid and cofunded by Structural Funds of the EU

La experiencia vital como marco de referencia de las concepciones sobre el Derecho y la Justicia. Figuras ejemplares de la Filosofía del Derecho

El artículo resume el proyecto de innovación educativa llevado a cabo en el área de Filosofía del Derecho durante el curso académico 2017/2018. Un proyecto con el que se pretendió complementar la enseñanza-aprendizaje poniendo el foco en los sujetos concretos, en las "figuras ejemplares" que han articulado la Filosofía del Derecho como disciplina. Esta primera edición del proyecto estuvo dedicada a las figuras de Cicerón, Francisco de Vitoria, Bartolomé de las Casas, Ginés de Sepúlveda y Gustav Radbruch.Unidad de Innovación Docente, Universidad de CádizEl texto del artículo comprende tres páginas y un anexo con el modelo de encuesta aplicada a los/as alumnos/as

Real-time surveillance systems: Applicability for the control of influenza in acute care

Producción CientíficaThe high morbidity and mortality caused by influenza viruses translate into a great impact on specialized health care. Apart from the annual vaccination, the relevance of other measures to prevent and control this infection is unknown. The objective of our research was to determine the importance of a real-time surveillance system to establish early extended transmission precautions

Chondroid Tumors: Review of Salient Imaging Features and Update on the WHO Classification

Chondrogenic tumors are typically well recognized on radiographs, but differentiation between benign and malignant cartilaginous lesions can be difficult both for the radiologist and for the pathologist. Diagnosis is based on a combination of clinical, radiological and histological findings. While treatment of benign lesions does not require surgery, the only curative treatment for chondrosarcoma is resection. This article (1) emphasizes the update of the WHO classification and its diagnostic and clinical effects; (2) describes the imaging features of the various types of cartilaginous tumors, highlighting findings that can help differentiate benign from malignant lesions; (3) presents differential diagnoses; and (4) provides pathologic correlation. We attempt to offer valuable clues in the approach to this vast entit

A promising antifungal and antiamoebic effect of silver nanorings, a novel type of AgNP

This research was funded by Instituto de Desarrollo Económico del Principado de Asturias, Spain (IDEPA) [IDE/2019/000366]

Antibacterial effect of silver nanorings

This work was supported for the most part by funds from the Ministry of Economy and Employment of the Government of the Principality of Asturias (Spain) dedicated to the financing of consolidated research groups, grant FC-15-GRUPIN14–141

Oxygen Saturation on Admission Is a Predictive Biomarker for PD-L1 Expression on Circulating Monocytes and Impaired Immune Response in Patients With Sepsis

Sepsis is a pathology in which patients suffer from a proinflammatory response and a dysregulated immune response, including T cell exhaustion. A number of therapeutic strategies to treat human sepsis, which are different from antimicrobial and fluid resuscitation treatments, have failed in clinical trials, and solid biomarkers for sepsis are still lacking. Herein, we classified 85 patients with sepsis into two groups according to their blood oxygen saturation (SaO2): group I (SaO2 ≤ 92%, n = 42) and group II (SaO2 &gt; 92%, n = 43). Blood samples were taken before any treatment, and the immune response after ex vivo LPS challenge was analyzed, as well as basal expression of PD-L1 on monocytes and levels of sPD-L1 in sera. The patients were followed up for 1 month. Taking into account reinfection and exitus frequency, a significantly poorer evolution was observed in patients from group I. The analysis of HLA-DR expression on monocytes, T cell proliferation and cytokine profile after ex vivo LPS stimulation confirmed an impaired immune response in group I. In addition, these patients showed both, high levels of PD-L1 on monocytes and sPD-L1 in serum, resulting in a down-regulation of the adaptive response. A blocking assay using an anti-PD-1 antibody reverted the impaired response. Our data indicated that SaO2 levels on admission have emerged as a potential signature for immune status, including PD-L1 expression. An anti-PD-1 therapy could restore the T cell response in hypoxemic sepsis patients with SaO2 ≤ 92% and high PD-L1 levels

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