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Papers by MIRIAM JOCELYN SANCHEZ MOLINA
Alteridad, 2020
En la última década se está despertando un elevado interés por las ventajas que la aplicación de ... more En la última década se está despertando un elevado interés por las ventajas que la aplicación de una evaluación formativa parece tener en la docencia universitaria. El presente estudio tiene como finalidad analizar si la Evaluación Formativa y Compartida en la Formación Inicial del Profesorado ayuda al alumnado a obtener mejores resultados académicos. Para ello se realiza un estudio de caso con 37 alumnos de la asignatura de Expresión y Comunicación Corporal en la Educación Infantil de cuarto curso del Grado de Educación Infantil. El alumnado puede elegir entre tres vías de aprendizaje y evaluación: vía continua, vía mixta y vía final o no presencial. Tras el análisis de las actas oficiales de calificación, los resultados obtenidos muestran que la Evaluación Formativa y Compartida ha influido en su rendimiento académico, y el alumnado que ha optado por la vía de evaluación continua ha obtenido un mejor rendimiento académico. La mayoría del alumnado ha optado por esta vía de aprendiz...
las Juntas Electorales para tal objeto. En forma solemne se instala el Cabildo en la iglesia de l... more las Juntas Electorales para tal objeto. En forma solemne se instala el Cabildo en la iglesia de la Matriz, con asistencia de los electores. Por diversas circunstancias no se cumple con este mandato en otros lugares, según comunica el Corregidor a Quito, el 8 de noviembre del mismo año. La Constitución había sido promulgada con la más grande solemnidad y jurada en la misma Iglesia Mayor. Fue calificada de documento sabio y brillante. Dos años después el mismo Corregidor indica al Presidente, Gobernador y Capitán General, Toribio Montes, que habíase promulgado por bando la Cédula Real los Cabildos Constitucionales.
La Rehabilitación es el proceso global y continuo de duración limitada y con objetivos definidos ... more La Rehabilitación es el proceso global y continuo de duración limitada y con objetivos definidos encaminados a permitir que una persona con deficiencia alcance tanto un nivel físico como mental y social óptimo, dándole a la persona las herramientas necesarias para poder alcanzar un nivel de independencia y libertad importantes para llevar su vida
Page 1. Resum 3 Resum L'objectiu principal d'aquest projecte és el de caracteritzar l&#... more Page 1. Resum 3 Resum L'objectiu principal d'aquest projecte és el de caracteritzar l'emissivitat de flames d'incendis forestals mitjançant tècniques basades en termografia infraroja. L'estudi bibliogràfic d'aquest paràmetre mostra ...
European journal of internal medicine, Jun 1, 2018
Treatment of bacteriuria in the absence of symptoms is not indicated, taking into account the pot... more Treatment of bacteriuria in the absence of symptoms is not indicated, taking into account the potential complications of therapy, including the increasing incidence of Clostridium difficile infection and the risk of precipitating antibiotic resistance [1]. Previous studies among residents in chronic care facilities, have shown that antimicrobial initiation without meeting clinical criteria is common in patients with a suspected urinary tract infection [2]. The problem is even greater among patients with indwelling catheters because: 1) persons with a catheterized urinary tract acquire bacteriuria at the rate of 3-10% per day, when a closed drainage system is used [3], and 2) the population at risk of receiving a catheter-associated urinary tract infection (CAUTI) diagnosis is likely to be cognitive impaired, which can mask possible associated symptoms. The aim of our study was to determine the appropriateness of CAUTI diagnosis, among hospitalized patients initially diagnosed and treated as CAUTI. We conducted an observational retrospective study of all episodes diagnosed as CAUTI in patients ≥18 years old, who required hospitalization between 2010 and 2015. Charts were reviewed for the appropriateness of diagnosis, using established criteria reported by the International Clinical Practice Guidelines from the Infectious Diseases Society of America (IDSA) [4]. Each clinical record was also reviewed for the appropriateness of antibiotic selection, treatment duration and development of Clostridium difficile associated diarrhea (CDAD) within 3 months of treatment. We included relevant demographic information and cognition and functional status using the Cognitive Performance Scale and Activities of Daily Living Scale (Barthel Index), respectively. Empirical treatment was considered appropriate if it was according to the local hospital guidelines. These guidelines recommend combination of a third generation antipseudomonal cephalosporin plus ampicillin or similarly broad spectrum agent (e.g., piperacillin/tazobactam or a carbapenem). Based on available evidence and expert opinion, we defined appropriate treatment duration if it was prescribed for 7-14 days [4]. Descriptive estimates were calculated using Stata SE version 13.0. The variables were reported as frequencies (%) for categorical variables, means (standard deviation) or median [interquartile range, IQR], as appropriate. In order to assess possible associations between the appropriateness of CAUTI diagnosis and other study variables, we performed the Chi-square or Fisher's exact test for categorical variables and the Student t-test or Mann-Whitney test for quantitative variables. A probability < 0.05 was considered as statistically significant. A total of 222 episodes among 190 patients were reviewed, 153 (81%) were men, with a mean (SD) age of 76.4 (12.3) years and a median [IQR] length of stay of 7 [4-12] days. In 46% of cases, patients had some degree of cognitive impairment and 36% required extensive assistance based on their Barthel Index of Activities of Daily Living Scale. Most episodes (65%) were diagnosed among patients with long-term catheterization. In 30 episodes (14%), patients did not meet de IDSA criteria of CAUTI, none of them developed CDAD. The alternative definite diagnostics of these episodes were: other source of infection (N = 12; 40%), catheter associated pyuria without symptoms (N = 6; 20%), nonspecific signs/ symptoms with other more plausible explanation (N = 8; 27%) and catheter blockage or hematuria related to catheter manipulation (N = 4; 13%). Empirical treatment was considered inappropriate in 36 of 214 episodes (17%). The median [IQR] duration of treatment was 14 days [11-16] days. In 41% of cases duration of treatment was longer than the recommended course (> 14 days). In seven episodes (3%), patients developed CDAD, which was related with a longer hospital stay (median days: 15 vs 7; p = 0.01). The differences of study variables between groups are shown in the Table 1. Patients in the group of inappropriate diagnostic of CAUTI were older (82.7 ± 9.6 vs. 75.4 ± 12.4 years, p = 0.006), more functionally dependent (90% vs. 62%, p = 0.004) and less likely to be prescribed an appropriate empirical antibiotic treatment (68% vs. 85%, p = 0.02). This study shows our experience in a single universitary teaching hospital with respect to the diagnosis and management of CAUTI. We found a 14% of overdiagnostic and treatment of CAUTI, being it more frequent among older and more disabled hospitalized patients, which represents the majority of our patient population nowadays. Besides, our data showed a relation between misdiagnose of CAUTI and choosing an inappropriate empirical antibiotic treatment, whose duration was longer than indicated in almost half of the episodes. Diagnosing CAUTI without considering a thorough investigation for other causes of fever may lead not only to a delay in the diagnosis of the real source of infection in some cases but also to the initiation of inappropriate therapies (included unnecessary broad spectrum antibiotics) in others. Of special concern is the diagnosis of CAUTI based on the sole criterion of an altered mental status. In some of our patients, the only symptom
Alteridad, 2020
En la última década se está despertando un elevado interés por las ventajas que la aplicación de ... more En la última década se está despertando un elevado interés por las ventajas que la aplicación de una evaluación formativa parece tener en la docencia universitaria. El presente estudio tiene como finalidad analizar si la Evaluación Formativa y Compartida en la Formación Inicial del Profesorado ayuda al alumnado a obtener mejores resultados académicos. Para ello se realiza un estudio de caso con 37 alumnos de la asignatura de Expresión y Comunicación Corporal en la Educación Infantil de cuarto curso del Grado de Educación Infantil. El alumnado puede elegir entre tres vías de aprendizaje y evaluación: vía continua, vía mixta y vía final o no presencial. Tras el análisis de las actas oficiales de calificación, los resultados obtenidos muestran que la Evaluación Formativa y Compartida ha influido en su rendimiento académico, y el alumnado que ha optado por la vía de evaluación continua ha obtenido un mejor rendimiento académico. La mayoría del alumnado ha optado por esta vía de aprendiz...
las Juntas Electorales para tal objeto. En forma solemne se instala el Cabildo en la iglesia de l... more las Juntas Electorales para tal objeto. En forma solemne se instala el Cabildo en la iglesia de la Matriz, con asistencia de los electores. Por diversas circunstancias no se cumple con este mandato en otros lugares, según comunica el Corregidor a Quito, el 8 de noviembre del mismo año. La Constitución había sido promulgada con la más grande solemnidad y jurada en la misma Iglesia Mayor. Fue calificada de documento sabio y brillante. Dos años después el mismo Corregidor indica al Presidente, Gobernador y Capitán General, Toribio Montes, que habíase promulgado por bando la Cédula Real los Cabildos Constitucionales.
La Rehabilitación es el proceso global y continuo de duración limitada y con objetivos definidos ... more La Rehabilitación es el proceso global y continuo de duración limitada y con objetivos definidos encaminados a permitir que una persona con deficiencia alcance tanto un nivel físico como mental y social óptimo, dándole a la persona las herramientas necesarias para poder alcanzar un nivel de independencia y libertad importantes para llevar su vida
Page 1. Resum 3 Resum L'objectiu principal d'aquest projecte és el de caracteritzar l&#... more Page 1. Resum 3 Resum L'objectiu principal d'aquest projecte és el de caracteritzar l'emissivitat de flames d'incendis forestals mitjançant tècniques basades en termografia infraroja. L'estudi bibliogràfic d'aquest paràmetre mostra ...
European journal of internal medicine, Jun 1, 2018
Treatment of bacteriuria in the absence of symptoms is not indicated, taking into account the pot... more Treatment of bacteriuria in the absence of symptoms is not indicated, taking into account the potential complications of therapy, including the increasing incidence of Clostridium difficile infection and the risk of precipitating antibiotic resistance [1]. Previous studies among residents in chronic care facilities, have shown that antimicrobial initiation without meeting clinical criteria is common in patients with a suspected urinary tract infection [2]. The problem is even greater among patients with indwelling catheters because: 1) persons with a catheterized urinary tract acquire bacteriuria at the rate of 3-10% per day, when a closed drainage system is used [3], and 2) the population at risk of receiving a catheter-associated urinary tract infection (CAUTI) diagnosis is likely to be cognitive impaired, which can mask possible associated symptoms. The aim of our study was to determine the appropriateness of CAUTI diagnosis, among hospitalized patients initially diagnosed and treated as CAUTI. We conducted an observational retrospective study of all episodes diagnosed as CAUTI in patients ≥18 years old, who required hospitalization between 2010 and 2015. Charts were reviewed for the appropriateness of diagnosis, using established criteria reported by the International Clinical Practice Guidelines from the Infectious Diseases Society of America (IDSA) [4]. Each clinical record was also reviewed for the appropriateness of antibiotic selection, treatment duration and development of Clostridium difficile associated diarrhea (CDAD) within 3 months of treatment. We included relevant demographic information and cognition and functional status using the Cognitive Performance Scale and Activities of Daily Living Scale (Barthel Index), respectively. Empirical treatment was considered appropriate if it was according to the local hospital guidelines. These guidelines recommend combination of a third generation antipseudomonal cephalosporin plus ampicillin or similarly broad spectrum agent (e.g., piperacillin/tazobactam or a carbapenem). Based on available evidence and expert opinion, we defined appropriate treatment duration if it was prescribed for 7-14 days [4]. Descriptive estimates were calculated using Stata SE version 13.0. The variables were reported as frequencies (%) for categorical variables, means (standard deviation) or median [interquartile range, IQR], as appropriate. In order to assess possible associations between the appropriateness of CAUTI diagnosis and other study variables, we performed the Chi-square or Fisher's exact test for categorical variables and the Student t-test or Mann-Whitney test for quantitative variables. A probability < 0.05 was considered as statistically significant. A total of 222 episodes among 190 patients were reviewed, 153 (81%) were men, with a mean (SD) age of 76.4 (12.3) years and a median [IQR] length of stay of 7 [4-12] days. In 46% of cases, patients had some degree of cognitive impairment and 36% required extensive assistance based on their Barthel Index of Activities of Daily Living Scale. Most episodes (65%) were diagnosed among patients with long-term catheterization. In 30 episodes (14%), patients did not meet de IDSA criteria of CAUTI, none of them developed CDAD. The alternative definite diagnostics of these episodes were: other source of infection (N = 12; 40%), catheter associated pyuria without symptoms (N = 6; 20%), nonspecific signs/ symptoms with other more plausible explanation (N = 8; 27%) and catheter blockage or hematuria related to catheter manipulation (N = 4; 13%). Empirical treatment was considered inappropriate in 36 of 214 episodes (17%). The median [IQR] duration of treatment was 14 days [11-16] days. In 41% of cases duration of treatment was longer than the recommended course (> 14 days). In seven episodes (3%), patients developed CDAD, which was related with a longer hospital stay (median days: 15 vs 7; p = 0.01). The differences of study variables between groups are shown in the Table 1. Patients in the group of inappropriate diagnostic of CAUTI were older (82.7 ± 9.6 vs. 75.4 ± 12.4 years, p = 0.006), more functionally dependent (90% vs. 62%, p = 0.004) and less likely to be prescribed an appropriate empirical antibiotic treatment (68% vs. 85%, p = 0.02). This study shows our experience in a single universitary teaching hospital with respect to the diagnosis and management of CAUTI. We found a 14% of overdiagnostic and treatment of CAUTI, being it more frequent among older and more disabled hospitalized patients, which represents the majority of our patient population nowadays. Besides, our data showed a relation between misdiagnose of CAUTI and choosing an inappropriate empirical antibiotic treatment, whose duration was longer than indicated in almost half of the episodes. Diagnosing CAUTI without considering a thorough investigation for other causes of fever may lead not only to a delay in the diagnosis of the real source of infection in some cases but also to the initiation of inappropriate therapies (included unnecessary broad spectrum antibiotics) in others. Of special concern is the diagnosis of CAUTI based on the sole criterion of an altered mental status. In some of our patients, the only symptom