Desarrollo de una aplicación para difundir la Logopedia en familias con niños con Trastorno del Espectro Autista

El concepto de Autismo ha variado a lo largo de los años. Las personas con Trastorno del Espectro Autista necesitan una intervención basada en el lenguaje (que varía en función del grado de Autismo y del desarrollo intelectual y social de cada sujeto), así como del resto de sus manifestaciones clínicas, entre las que conviene emplear las Tecnologías de la Información y la Comunicación (TIC). Además, es preciso atender a la presencia de la familia en la intervención y no dejar en un segundo plano este aspecto, como ocurre con las TIC. Por ello, el presente trabajo pretende realizar una revisión bibliográfica sobre la intervención dirigida a familias con hijos/as con Trastorno del Espectro Autista empleando las TIC, así como desarrollar una aplicación para la intervención y difusión de la Logopedia en dichas familias. El método que se ha llevado a cabo ha sido la lectura de numerosos artículos, manuales, libros y páginas web, además del visionado de varios vídeos de profesionales de la logopedia. También se ha contactado con un desarrollador de aplicaciones para llevar a cabo el desarrollo de la aplicación. Los resultados obtenidos constatan que no se observan aplicaciones informáticas destinadas a las familias, que la relación familia-logopeda no se menciona y que la intervención logopédica en autismo se encuentra en un segundo plano. Por ende, se desarrolla una aplicación cuyos bloques principales tratan de informar a las familias sobre aspectos principales del autismo y la logopedia, sobre la interacción padre-hijo y sobre la organización de eventos familiares. Existe la necesidad de elaborar aplicaciones destinadas a las familias con hijos/as con Autismo. El desarrollo de la presente aplicación condensa la información que se considera más importante para niños con cualquier modalidad comunicativa.Grado en Logopedi

Materias propedéuticas: la mirada de los estudiantes que finalizaron el curso de Introducción a las Ciencias Agrarias y Forestales de La Plata

Desde el Curso de Introducción a las Ciencias Agrarias y Forestales, se realiza anualmente un relevamiento de la opinión y percepciones de los estudiantes acerca de la enseñanza al finalizar la cursada. Se utiliza un instrumento de evaluación con preguntas abiertas y cerradas, en relación al desarrollo de los teóricos y prácticos, las salidas a campo, las modalidades de trabajo en aula, el desempeño docente, las formas de evaluación de los alumnos. Los resultados que se muestran corresponden a las encuestas realizadas desde el año 2003 hasta el año 2011, con las valoraciones que hacen los estudiantes del proceso de enseñanza aprendizaje y que posibilita repensar la práctica docente. Las conclusiones preliminares reflejan por un lado el interés de los alumnos en los conocimientos abordados, el análisis que se realiza de la realidad del sector en las salidas a campo y en el aula, por el otro lado la necesidad de rediseñar el instrumento de evaluación utilizado para profundizar la riqueza explicativa que realizan los estudiantes.Eje temático 1: Problemáticas y alternativas de mejora de la enseñanza c - Los enfoques y experiencias en cátedras con orientación propedéuticaFacultad de Ciencias Agrarias y Forestale

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Guía de recursos en educación intercultural

Resumen basado en la publicaciónSe ofrece una Guía de informaciones y recursos interesantes sobre los libros de texto de la enseñanza del español como lengua extranjera; los recursos en Internet para la enseñanza del español como lengua extranjera; los materiales educativos para todo el alumnado; los planes de acogida y los recursos ofrecidos por el cine e información sobre las redes solidarias. La integración del alumnado inmigrante en las aulas requiere del desarrollo profesional de los docentes. El aprendizaje de la lengua vehicular de enseñanza como segunda lengua es un asunto de interés de muchas acciones formativas del profesorado en ejercicio. Además los planes de acogida e integración del alumnado inmigrante, las adaptaciones del currículum, las relaciones con las familias, etc. ocupan a los centros educativos que de manera creciente procuran soluciones cercanas y efectivas. Se estudian en el Capítulo 1 los manuales para la enseñanza del español como lengua extranjera; se recogen recursos de Internet según los niveles de enseñanza y áreas curriculares en los Capítulos 2, 3 4 y 5. En su final Capítulo 6, se ofrece un directorio de organizaciones solidarias que realizan trabajos educativos con el alumnado inmigrante.AsturiasUniversidad de Oviedo.Facultad de Ciencias de la Educación; Calle Aniceto Sela s. n.; 33005 Oviedo; +34985103215; 985103214;ES

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)

Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI) : a phase 3, placebo-controlled, randomised trial

Background: Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI), particularly those with previous stenting, are at high risk of ischaemic events. These patients are generally treated with aspirin. In this trial, we aimed to investigate if these patients would benefit from treatment with aspirin plus ticagrelor. Methods: The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase 3 randomised, double-blinded, placebo-controlled trial, done in 1315 sites in 42 countries. Patients were eligible if 50 years or older, with type 2 diabetes, receiving anti-hyperglycaemic drugs for at least 6 months, with stable coronary artery disease, and one of three other mutually non-exclusive criteria: a history of previous PCI or of coronary artery bypass grafting, or documentation of angiographic stenosis of 50% or more in at least one coronary artery. Eligible patients were randomly assigned (1:1) to either ticagrelor or placebo, by use of an interactive voice-response or web-response system. The THEMIS-PCI trial comprised a prespecified subgroup of patients with previous PCI. The primary efficacy outcome was a composite of cardiovascular death, myocardial infarction, or stroke (measured in the intention-to-treat population). Findings: Between Feb 17, 2014, and May 24, 2016, 11 154 patients (58% of the overall THEMIS trial) with a history of previous PCI were enrolled in the THEMIS-PCI trial. Median follow-up was 3·3 years (IQR 2·8–3·8). In the previous PCI group, fewer patients receiving ticagrelor had a primary efficacy outcome event than in the placebo group (404 [7·3%] of 5558 vs 480 [8·6%] of 5596; HR 0·85 [95% CI 0·74–0·97], p=0·013). The same effect was not observed in patients without PCI (p=0·76, p interaction=0·16). The proportion of patients with cardiovascular death was similar in both treatment groups (174 [3·1%] with ticagrelor vs 183 (3·3%) with placebo; HR 0·96 [95% CI 0·78–1·18], p=0·68), as well as all-cause death (282 [5·1%] vs 323 [5·8%]; 0·88 [0·75–1·03], p=0·11). TIMI major bleeding occurred in 111 (2·0%) of 5536 patients receiving ticagrelor and 62 (1·1%) of 5564 patients receiving placebo (HR 2·03 [95% CI 1·48–2·76], p<0·0001), and fatal bleeding in 6 (0·1%) of 5536 patients with ticagrelor and 6 (0·1%) of 5564 with placebo (1·13 [0·36–3·50], p=0·83). Intracranial haemorrhage occurred in 33 (0·6%) and 31 (0·6%) patients (1·21 [0·74–1·97], p=0·45). Ticagrelor improved net clinical benefit: 519/5558 (9·3%) versus 617/5596 (11·0%), HR=0·85, 95% CI 0·75–0·95, p=0·005, in contrast to patients without PCI where it did not, p interaction=0·012. Benefit was present irrespective of time from most recent PCI. Interpretation: In patients with diabetes, stable coronary artery disease, and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction, and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy, have high ischaemic risk, and low bleeding risk

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Delaying surgery for patients with a previous SARS-CoV-2 infection

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