Procedimiento de canalización y cuidados de la vía venosa periférica. FEMORA 2017

O programa FEMORA recompila procedementos estandarizados, con evidencia científica, para os profesionais do Sergas. Protocolizar os coidados confórmase como instrumento indispensable de soporte para a práctica clínica. Entre as súas numerosas vantaxes cabe destacar a redución na diversidade inapropiada da práctica clínica, o que propicia unha atención máis xusta e equitativa para os nosos pacientes. Este procedemento unifica, así mesmo, criterios de actuación que nos serven de punto de partida para unha avaliación da calidade do proceso asistencial.El programa FEMORA recopila procedimientos estandarizados, con evidencia científica, para los profesionales del Sergas. Protocolizar los cuidados se conforma como instrumento indispensable de soporte para la práctica clínica. Entre sus numerosas ventajas cabe destacar la reducción en la diversidad inapropiada de la práctica clínica, lo que propicia una atención más justa y equitativa a nuestros pacientes. Este procedimiento unifica, asimismo, criterios de actuación que nos sirven de punto de partida para una evaluación de la calidad del proceso asistencia

Educar para los nuevos Medios. Claves para el desarrollo de la competencia mediática en el entorno digital

Educar es una de las labores más complejas, intensas y, a la vez, más maravillosas que puede acometer una persona. Ser docente es una tarea ilusionante. En un mundo en el que la información es cada vez más importante por la rapidez con que se produce y consume, la variedad de recursos con que se difunde constituye un reto en el papel de los educadores y educadoras. La educación para la comunicación, a través de los nuevos medios, requiere de habilidades y estrategias específicas e implica prácticas innovadoras. Este texto ofrece claves para desarrollar la competencia mediática necesaria para entender, usar y comunicar en el entorno digital. Desde el concepto de competencia mediática y la escuela prosumidora se muestran experiencias y planteamientos en distintos niveles educativos y contextos curriculares que ofrecen pistas para educar a la ciudadanía. Esta alfabetización aúna la perspectiva de la experiencia de docente receptor y consumidor, atendiendo a la recepción crítica de la información, la selección y administración de la misma, el reconocimiento de valores e ideologías y la gestión emocional, junto a la elaboración y creación de contenidos

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

Spatiotemporal Characteristics of the Largest HIV-1 CRF02_AG Outbreak in Spain: Evidence for Onward Transmissions

Background and Aim: The circulating recombinant form 02_AG (CRF02_AG) is the predominant clade among the human immunodeficiency virus type-1 (HIV-1) non-Bs with a prevalence of 5.97% (95% Confidence Interval-CI: 5.41–6.57%) across Spain. Our aim was to estimate the levels of regional clustering for CRF02_AG and the spatiotemporal characteristics of the largest CRF02_AG subepidemic in Spain.Methods: We studied 396 CRF02_AG sequences obtained from HIV-1 diagnosed patients during 2000–2014 from 10 autonomous communities of Spain. Phylogenetic analysis was performed on the 391 CRF02_AG sequences along with all globally sampled CRF02_AG sequences (N = 3,302) as references. Phylodynamic and phylogeographic analysis was performed to the largest CRF02_AG monophyletic cluster by a Bayesian method in BEAST v1.8.0 and by reconstructing ancestral states using the criterion of parsimony in Mesquite v3.4, respectively.Results: The HIV-1 CRF02_AG prevalence differed across Spanish autonomous communities we sampled from (p &lt; 0.001). Phylogenetic analysis revealed that 52.7% of the CRF02_AG sequences formed 56 monophyletic clusters, with a range of 2–79 sequences. The CRF02_AG regional dispersal differed across Spain (p = 0.003), as suggested by monophyletic clustering. For the largest monophyletic cluster (subepidemic) (N = 79), 49.4% of the clustered sequences originated from Madrid, while most sequences (51.9%) had been obtained from men having sex with men (MSM). Molecular clock analysis suggested that the origin (tMRCA) of the CRF02_AG subepidemic was in 2002 (median estimate; 95% Highest Posterior Density-HPD interval: 1999–2004). Additionally, we found significant clustering within the CRF02_AG subepidemic according to the ethnic origin.Conclusion: CRF02_AG has been introduced as a result of multiple introductions in Spain, following regional dispersal in several cases. We showed that CRF02_AG transmissions were mostly due to regional dispersal in Spain. The hot-spot for the largest CRF02_AG regional subepidemic in Spain was in Madrid associated with MSM transmission risk group. The existence of subepidemics suggest that several spillovers occurred from Madrid to other areas. CRF02_AG sequences from Hispanics were clustered in a separate subclade suggesting no linkage between the local and Hispanic subepidemics

Caso clínico de dermatitis periestomal y dehiscencia en una colostomía

Woman of 68 year old underwent surgery for malignant rectum tumor. It after 6 days from the first treatment, irritant contact dermatitis was observed at any of the components of the ostomy appliance and / or fecal material; and a small dehiscence in the stoma. The nurse performance was isolating the stoma by adjusting the device to prevent leaks (pasta and molding resins, changing device) and prevent infection, protect the peristomal skin (barrier films and powders stomata), seeking healing by second intention with dressings of healing in humid environment (hydrofiber hydrocolloid).Mujer de 68 años intervenida de tumor maligno de recto. Transcurridos 6 días desde la primera cura, se observó una dermatitis de contacto irritativa a alguno de los componentes del dispositivo de ostomía y/o del material fecal; así como una pequeña dehiscezncia en el estoma. La actuación enfermera fue aislar el estoma ajustando el dispositivo para evitar las fugas (pasta y resinas moldeadoras, cambios de dispositivo) y prevenir infecciones, proteger la piel periestomal (películas barrera y polvos para estomas), procurando la cicatrización por segunda intención con apósitos de cura en ambiente húmedo (hidrofibra de hidrocoloide)

Conflicts of interest and editorial ethics in clinical practice guidelines on care of ulcers and chronic wounds

Objetivo: evaluar la calidad ética editorial (independencia editorial) y ética profesional (declaración de conflictos de intereses) expresada en las Guías de Práctica Clínica (GPCs) sobre prevención y tratamiento de úlceras y heridas crónicas. Metodología: estudio observacional y revisión sistemática de GPCs nacionales e internacionales vigentes sobre úlceras vasculares de la pierna (UVP), úlceras de pie diabético (UPD), úlceras por presión (UPP) y úlceras neoplásicas (UN). Evaluación del dominio 6 (ítem nº22 y nº23) del Instrumento AGREE II (Appraisal of Guidelines Research and Evaluation). Revisión por 6 expertos y análisis intra-observador. Resultados: se analizaron 26 GPCs (12 sobre UPP, 7 sobre UPD, 6 sobre UVP y 1 sobre UN). El 80,7% de las GPCs fueron publicaciones internacionales. 10 GPC cumplieron totalmente con el Dominio 6 del AGREE II, 13 lo hicieron de forma parcial, y 3 no lo cumplieron. Referente al ítem 22 (ética editorial), el valor promedio alcanzado fue del 62,5%, mientras que para el ítem nº23 (ética profesional) se obtuvo un 83,92%. Conclusiones: el 73% de GPCs cumplieron satisfactoriamente el Dominio 6 del AGREE II; Aun así, GPC-UVP deberían elevar su estándar de calidad de ética editorial y profesional. El ítem 22 (independencia editorial) fue el que menos se cumple y el más difícil de valorar por los revisores, debiendo ser éste un apartado a mejorar en las futuras ediciones de GPCs.Objective: to evaluate the ethical quality publishing (editorial independence) and professional ethics (declaration of conflicts of interest) expressed in the Clinical Practice Guidelines (CPGs) on prevention and treatment of ulcers and chronic wounds. Methodology: observational study and systematic review of current national and international GPCs on vascular leg ulcers (VLU), diabetic foot ulcers (DFU), pressure ulcers (PU) and malignant ulcers (MU). Evaluation Domain 6 (item #22 and #23) AGREE II Instrument (Appraisal of Guidelines Research and Evaluation). Review by 6 experts and intra-observer analysis. Results: 26 CPGs were analyzed (12 on PU, 7 on DFU, 6 on VLU and 1 on MU). 80.7% of CPGs were international publications. 10 CPG fully complied with the Dominion 6 AGREE II, 13 did so partially, and 3 not comply. Relating to item 22 (editorial ethics), the average value achieved was 62.5%, while for item 23 (professional ethics) an 83.92% was obtained. Conclusions: 73% of CPGs comply successfully the Domain 6 AGREE II; Still, GPC-UVP should raise their standard of editorial quality and professional ethics. The item 22 (editorial independence) was the least fulfilled and the most difficult to assess by reviewers, it must be a section to improve in future editions of CPGs

NEWSHUB: Incubadora de contenidos formativos para la comunicación profesional de los resultados del Aprendizaje Basado en Proyectos (ABP).

NEWSHUB es un espacio de encuentro académico y profesional. Su principal función es cubrir necesidades específicas de formación tanto para el profesorado como para el alumnado en materia de comunicación. La finalidad es facilitar que se diseñen actividades de aprendizaje basado en proyectos orientadas a generar productos comunicativos de calidad profesional, que sirvan a un tiempo como herramienta eficiente de aprendizaje en el entorno académico además de recurso destacado en el portfolio del alumnado para la búsqueda de empleo o la formalización de proyectos emprendedores. Asímismo, nuestro grupo es una incubadora de proyectos en el que rediseñamos actividades y prácticas de clase para que se ajusten a una aplicación eficaz de la metodología de aprendizaje basado en proyectos. Ofrecemos asesoría y acompañamiento a docentes y estudiantes para que desarrollen su actividad académica integrando estrategias y procesos de calidad propios del ámbito profesional. Como plataforma de formación ponemos contenidos formativos sobre comunicación eficiente a disposición de la comunidad educativa e investigadora y del sector de la orientación laboral y el fomento del emprendimiento. Ofrecemos recursos educativos abiertos a través de una plataforma web modular, interoperable y accesible, que alberga contenidos digitales de producción propia y un banco de buenas prácticas. Intentamos servir como plataforma de coaching digital. Con la irrupción de la Inteligencia Artificial los profesores tenemos que adaptar nuestra manera de enseñar y de aprender entendiendo e incorporando las nuevas tecnologías en nuestra docencia. Para ello acompañaremos a los docentes y contaremos con la opinión directa de los alumnos/as que participan en nuestro proyecto. Además, dada el área de Tecnología de la Información que comparten la mayor parte de los profesores que formamos NEWSHUB creemos necesario ayudar mediante esta plataforma a nuestros compañeros en su formación tecnológica mediante la impartición de seminarios, cursos y talleres prácticos que actualicen los conocimientos tecnológicos y doten de nuevas herramientas a los profesores en su labor docente. NEWSHUB conecta asignaturas, docentes y estudiantes para que los resultados de los distintos procesos de enseñanza-aprendizaje se optimicen para el cumplimiento de los objetivos clave del proyecto: aplicar eficazmente metodologías abiertas en el aula; alimentar el porfolio y el currículum en la búsqueda de empleo y el fomento del emprendimiento; y generar recursos educativos y modelos de buenas prácticas para formar en una comunicación eficiente. También permite crear un puente entre profesores/as, alumnos/as y materias de otras facultades e incluso de otros países. La virtualización permite deslocalizar y ponernos en contacto para intercambiar experiencias, programas y recursos educativos proporcionando una visión más rica y abierta en diferentes contextos culturales y de diversidad.Depto. de Periodismo y Nuevos MediosFac. de Ciencias de la InformaciónFALSEsubmitte

COVID-19 in hospitalized HIV-positive and HIV-negative patients : A matched study

CatedresObjectives: We compared the characteristics and clinical outcomes of hospitalized individuals with COVID-19 with [people with HIV (PWH)] and without (non-PWH) HIV co-infection in Spain during the first wave of the pandemic. Methods: This was a retrospective matched cohort study. People with HIV were identified by reviewing clinical records and laboratory registries of 10 922 patients in active-follow-up within the Spanish HIV Research Network (CoRIS) up to 30 June 2020. Each hospitalized PWH was matched with five non-PWH of the same age and sex randomly selected from COVID-19@Spain, a multicentre cohort of 4035 patients hospitalized with confirmed COVID-19. The main outcome was all-cause in-hospital mortality. Results: Forty-five PWH with PCR-confirmed COVID-19 were identified in CoRIS, 21 of whom were hospitalized. A total of 105 age/sex-matched controls were selected from the COVID-19@Spain cohort. The median age in both groups was 53 (Q1-Q3, 46-56) years, and 90.5% were men. In PWH, 19.1% were injecting drug users, 95.2% were on antiretroviral therapy, 94.4% had HIV-RNA < 50 copies/mL, and the median (Q1-Q3) CD4 count was 595 (349-798) cells/μL. No statistically significant differences were found between PWH and non-PWH in number of comorbidities, presenting signs and symptoms, laboratory parameters, radiology findings and severity scores on admission. Corticosteroids were administered to 33.3% and 27.4% of PWH and non-PWH, respectively (P = 0.580). Deaths during admission were documented in two (9.5%) PWH and 12 (11.4%) non-PWH (P = 0.800). Conclusions: Our findings suggest that well-controlled HIV infection does not modify the clinical presentation or worsen clinical outcomes of COVID-19 hospitalization

How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort

CatedresBackground: To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45-60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS). Methods: Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression. Results: Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45-50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38-6.55 and 2.63; 1.44-4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13-4.14) and urogenital symptoms (2.54; 1.42-4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74-13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups. Conclusions: Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women