Entorno de aprendizaje clínico

En este informe científico-técnico se presenta sintéticamente la temática y desarrollo de los proyectos desarrollados por la Red Entorno de Aprendizaje Clínico del Proyecto Redes de Investigación en Docencia Universitaria 2015-16, de la Universidad de Alicante. En los apartados del capítulo se recogen los objetivos, características de composición de la red, el modo de funcionamiento para desarrollo del trabajo cooperativo-colaborativo. Finalizamos con la exposición de las conclusiones, de las dificultades halladas y las propuestas de mejora en previsión de continuidad de la red en próximas ediciones

Reflexiones sobre la autoevaluación del estudiante en el Grado en Enfermería

En el marco europeo de educación superior ha recobrado interés la aplicación de sistemas como la autoevaluación del estudiante. Reflexionar sobre la formación de los estudiantes en autoevaluación, y su consideración o no en la calificación final, han sido temas de estudio en el ámbito de las ciencias de la salud. En el plan de estudios del Grado en Enfermería de la Universidad de Alicante, la autoevaluación del estudiante forma parte en el sistema general de evaluación con una ponderación variable entre las distintas asignaturas. En el marco de la asignatura Cuidados de Enfermería del Adulto II (27025) la autoevaluación del estudiante está ponderada con un 5% y se implementa a través de la cumplimentación del formulario de autoevaluación personal. Para el análisis de los datos emplearemos las técnicas descriptivas e inferenciales pertinentes. A partir de nuestros resultados y de la evidencia científica previa, presentaremos una propuesta adaptada a nuestro contexto

Novelties of the Sierra de Gredos bryoflora (Central System, Spain), with special remarks on the autonomous community of Extremadura

En este artículo se presentan numerosas novedades corológicas de interés, basadas en las colectas llevadas a cabo durante los años 2016 y 2017 en los pisos oro y crioromediteráneo de la sierra de Gredos, zonas que habían sido escasamente colectadas. Entre los resultados destacamos el hallazgo de Douinia ovata, desconocida de la región mediterránea española, y de Sciurohypnum reflexum y Tortula hoppeana, nuevos para el Sistema Central en su conjunto. Destacamos también 4 hepáticas y 24 musgos nuevos para la Comunidad Autónoma de Extremadura, así como otras no conocidas para la sierra de Gredos o las provincias de Ávila o Salamanca. Por último, se incluyen citas de nuevas poblaciones de briófitos muy raros en Gredos o el Sistema Central en su conjunt

Novedades para la brioflora de la Sierra de Gredos (Sistema Central, España), con especial énfasis en la comunidad de Extremadura

This study present new records of bryophytes based on the collections made along the years 2016 and 2017 in both oro and cryoromediterranean bioclimatic subzones of Gredos mountain range, which were scarcely collected. Among the findings, we highlight Douinia ovata, unknown up to date for the Mediterranean Region of Spain, and Sciuro-hypnum reflexum and Tortula hoppeana, both new to the Central System. Also, we highlight the finding of 4 liverworts and 24 mosses news to the Autonomous Community of Extremadura, some of which also unknown either for Gredos mountain range or Ávila or Salamanca provinces. Finally, records of new populations of very rare bryophytes in Gredos or the Iberian Central System are included.En este artículo se presentan numerosas novedades corológicas de interés, basadas en las colectas llevadas a cabo durante los años 2016 y 2017 en los pisos oro y crioromediteráneo de la sierra de Gredos, zonas que habían sido escasamente colectadas. Entre los resultados destacamos el hallazgo de Douinia ovata, desconocida de la región mediterránea española, y de Sciurohypnum reflexum y Tortula hoppeana, nuevos para el Sistema Central en su conjunto. Destacamos también 4 hepáticas y 24 musgos nuevos para la Comunidad Autónoma de Extremadura, así como otras no conocidas para la sierra de Gredos o las provincias de Ávila o Salamanca. Por último, se incluyen citas de nuevas poblaciones de briófitos muy raros en Gredos o el Sistema Central en su conjunt

Novedades para la brioflora de la Sierra de Gredos (Sistema Central, España), con especial énfasis en la comunidad de Extremadura.

En este artículo se presentan numerosas novedades corológicas de interés, basadas en las colectas llevadas a cabo durante los años 2016 y 2017 en los pisos oro y crioromediteráneo de la sierra de Gredos, zonas que habían sido escasamente colectadas. Entre los resultados destacamos el hallazgo de Douinia ovata, desconocida de la región mediterránea española, y de Sciuro-hypnum reflexum y Tortula hoppeana, nuevos para el Sistema Central en su conjunto. Destacamos también 4 hepáticas y 24 musgos nuevos para la Comunidad Autónoma de Extremadura, así como otras no conocidas para la sierra de Gredos o las provincias de Ávila o Salamanca. Por último, se incluyen citas de nuevas poblaciones de briófitos muy raros en Gredos o el Sistema Central en su conjunt

Reflexiones sobre la autoevaluación del estudiante en el Grado en Enfermería

En el marco europeo de educación superior ha recobrado interés la aplicación de sistemas como la autoevaluación del estudiante. Reflexionar sobre la formación de los estudiantes en autoevaluación, y su consideración o no en la calificación final, han sido temas de estudio en el ámbito de las ciencias de la salud. En el plan de estudios del Grado en Enfermería de la Universidad de Alicante, la autoevaluación del estudiante forma parte en el sistema general de evaluación con una ponderación variable entre las distintas asignaturas. En el marco de la asignatura Cuidados de Enfermería del Adulto II (27025) la autoevaluación del estudiante está ponderada con un 5% y se implementa a través de la cumplimentación del formulario de autoevaluación personal. Para el análisis de los datos emplearemos las técnicas descriptivas e inferenciales pertinentes. A partir de nuestros resultados y de la evidencia científica previa, presentaremos una propuesta adaptada a nuestro contexto

Global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy Study

Background: Surgical strategies are being adapted to face the COVID-19 pandemic. Recommendations on the management of acute appendicitis have been based on expert opinion, but very little evidence is available. This study addressed that dearth with a snapshot of worldwide approaches to appendicitis. Methods: The Association of Italian Surgeons in Europe designed an online survey to assess the current attitude of surgeons globally regarding the management of patients with acute appendicitis during the pandemic. Questions were divided into baseline information, hospital organization and screening, personal protective equipment, management and surgical approach, and patient presentation before versus during the pandemic. Results: Of 744 answers, 709 (from 66 countries) were complete and were included in the analysis. Most hospitals were treating both patients with and those without COVID. There was variation in screening indications and modality used, with chest X-ray plus molecular testing (PCR) being the commonest (19\ub78 per cent). Conservative management of complicated and uncomplicated appendicitis was used by 6\ub76 and 2\ub74 per cent respectively before, but 23\ub77 and 5\ub73 per cent, during the pandemic (both P < 0\ub7001). One-third changed their approach from laparoscopic to open surgery owing to the popular (but evidence-lacking) advice from expert groups during the initial phase of the pandemic. No agreement on how to filter surgical smoke plume during laparoscopy was identified. There was an overall reduction in the number of patients admitted with appendicitis and one-third felt that patients who did present had more severe appendicitis than they usually observe. Conclusion: Conservative management of mild appendicitis has been possible during the pandemic. The fact that some surgeons switched to open appendicectomy may reflect the poor guidelines that emanated in the early phase of SARS-CoV-2

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN

Weaning from mechanical ventilation in intensive care units across 50 countries (WEAN SAFE): a multicentre, prospective, observational cohort study

Background Current management practices and outcomes in weaning from invasive mechanical ventilation are poorly understood. We aimed to describe the epidemiology, management, timings, risk for failure, and outcomes of weaning in patients requiring at least 2 days of invasive mechanical ventilation. Methods WEAN SAFE was an international, multicentre, prospective, observational cohort study done in 481 intensive care units in 50 countries. Eligible participants were older than 16 years, admitted to a participating intensive care unit, and receiving mechanical ventilation for 2 calendar days or longer. We defined weaning initiation as the first attempt to separate a patient from the ventilator, successful weaning as no reintubation or death within 7 days of extubation, and weaning eligibility criteria based on positive end-expiratory pressure, fractional concentration of oxygen in inspired air, and vasopressors. The primary outcome was the proportion of patients successfully weaned at 90 days. Key secondary outcomes included weaning duration, timing of weaning events, factors associated with weaning delay and weaning failure, and hospital outcomes. This study is registered with ClinicalTrials.gov, NCT03255109. Findings Between Oct 4, 2017, and June 25, 2018, 10 232 patients were screened for eligibility, of whom 5869 were enrolled. 4523 (77·1%) patients underwent at least one separation attempt and 3817 (65·0%) patients were successfully weaned from ventilation at day 90. 237 (4·0%) patients were transferred before any separation attempt, 153 (2·6%) were transferred after at least one separation attempt and not successfully weaned, and 1662 (28·3%) died while invasively ventilated. The median time from fulfilling weaning eligibility criteria to first separation attempt was 1 day (IQR 0–4), and 1013 (22·4%) patients had a delay in initiating first separation of 5 or more days. Of the 4523 (77·1%) patients with separation attempts, 2927 (64·7%) had a short wean (≤1 day), 457 (10·1%) had intermediate weaning (2–6 days), 433 (9·6%) required prolonged weaning (≥7 days), and 706 (15·6%) had weaning failure. Higher sedation scores were independently associated with delayed initiation of weaning. Delayed initiation of weaning and higher sedation scores were independently associated with weaning failure. 1742 (31·8%) of 5479 patients died in the intensive care unit and 2095 (38·3%) of 5465 patients died in hospital. Interpretation In critically ill patients receiving at least 2 days of invasive mechanical ventilation, only 65% were weaned at 90 days. A better understanding of factors that delay the weaning process, such as delays in weaning initiation or excessive sedation levels, might improve weaning success rates