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A new pandemic was recently declared by the World Health Organisation due to the SARS-CoV-2 virus. This virus is characterised by being highly transmissible, lethal, and affecting all age groups. This declaration led to the activation, in all countries, of emergency mechanisms to deal with this public health crisis that has exposed the weaknesses of the health systems and the deficit of beds in adult intensive care (UCIA) and paediatric intensive care units (PICU). Colombia has a reduced number of PICU beds compared to other low- and middle-income countries. For this reason, we must optimise resources, anticipate severe cases, and understand the behaviour of the disease caused by the SARS-CoV-2 virus (called COVID-19) in paediatrics, especially in severe forms of presentation in children. The severity and degree of involvement by the virus in all countries has been very similar, with a greater severity and frequency of infection in the adult population, particularly in people over 60 years of age, and with comorbidities (obesity, hypertension, diabetes, among others). However, severe cases requiring advanced interventions in intensive care have also been reported in the paediatric population, including a form of presentation with a large inflammatory response in children, called multi-systemic inflammatory syndrome (MIS-C). The Colombian Association of Critical Medicine and Intensive Care (AMCI) convened a multidisciplinary team of experts in paediatric critical medicine to establish a consensus statement of good clinical practice for the care of children with severe COVID-19 requiring care in intermediate care or paediatric intensive care. The objective of this consensus statement is to facilitate and standardise decision making in the most relevant aspects of care and to carry out a comprehensive approach to the paediatric patient based on the best available evidence and the opinion of experts in paediatric intensive care with at least 10 years of work experience in the area. Additionally, it was sought to involve those Paediatric Intensivists who have to directly care for children with COVID-19, and belong to reference or university hospitals and have a proven track record in research and teaching in paediatric critical care. This consensus statement will seek to update, as often as necessary, according to the change in the best available evidence, which will enable physicians who care for critical children with COVID-19 to provide comprehensive and adequate care according to the best available literature. © 2020 Asociación Colombiana de Medicina Crítica y Cuidado lntensivo
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Citizens of the twenty-first century use specific skills to solve real-life problem situations, propose interdisciplinary solutions, and sustainably solve their communities’ socio-scientific and technological problems, locally and globally. Science, technology, engineering, and mathematics (STEM) education is an integrated and interdisciplinary teaching-learning space. STEM careers are subject to gender gaps in terms of access to higher education, and only a quarter of female students follow a STEM career. Moreover, later in their professional careers, women often obtain lower salaries and income in the STEM professions. STEM education seeks to actively engage students by incorporating technologies into teaching-learning processes since, favoring searching, analysis, solution, and simulation of socio-scientific problems. The latter has become highly visible during the pandemic caused by COVID-19, particularly in emergency remote education measures. Information and communication technologies (ICT) plays a role in online education, either via the knowledge involved in school curricula or an understanding of how the pandemic has evolved. This is a triple task for professors since they must have the right skills to train citizens of the twenty-first century, build new stimulating learning spaces for their highly technologized students, and develop these skills in their students. This article reviews the concepts associated with digital and STEM skills by analyzing a case study, exploring the perception of students in terms of their development of these competencies, and the commitments required in the study plans made by a Professor of Chemistry in a Chilean state university. A mixed investigation was undertaken, considering three phases with different methodologies. The first phase consisted of a bibliographic study, comparing both the digital and STEM skills of several organizations in Chilean education (UNESCO, MINEDUC, and ISTE). ISTE was used as the basis of the applied questionnaire to establish coherence in the dimensions coming from different reference frames. A second phase refers to the analysis of the study plan programs associated with STEM, ICT, and chemistry teaching, through an Analysis Matrix of Aprioristic Categories. In a third phase, the development of digital skills in undergraduate Chemistry students and professors were evaluated through the Digital Competence Questionnaire of Higher Education Students. Based on UNESCO information, the STEM competencies address both the content and its application to problems related to STEM careers in a manner consistent with the training model for science and chemistry teachers. In the case of digital skills, UNESCO integrates international reference frameworks respecting each country’s laws, enabling them to adapt them. In Chile, MINEDUC focuses on teachers’ use of digital tools to improve the teaching-learning processes of students;and ISTE is focused on the skills of higher education. The analysis of the study programs shows that students’ digital skills do not meet the requirements of the Chilean Ministry of Education (MINEDUC). However, the programs enhance more complex cognitive levels when the curricula advance, promoting STEM skills. The digital competence questionnaire for higher education students (CDAES) survey showed a development proportional to the curricular pursuit of the students where, in the first year of the degree, the students declare positive answers in 60.5% of the items consulted. This trend increases in the second and third years (90.7% of positive answers) and the fourth and fifth years (93.0 and 95.4% of positive answers). It remains a challenge to develop skills to design, create or modify technological educational media that promote the use of digital and STEM skills. In conclusion, this research proposes digital and STEM skills for teacher training, discussing the relevance of their integration in STEM teaching and learning. The teacher training curriculum does not have an explicit association with digital and STEM skills, lthough it addresses the skills required by national and international benchmarks. However, the students indicate positive attitudes toward the digital skills developed progressively during their training as teachers. As future Chemistry teachers, they value the development of digital teaching skills that allow them to address the challenges that arise in the classroom and thus promote the appreciation of STEM careers, which helps form citizens with more sustainable intentions. Copyright © 2022 Elías, Pérez, Cassot, Carrasco, Tomljenovic and Zúñiga.
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STATEMENT OF PROBLEM/QUESTION: People who are experiencing homelessness in Los Angeles do not have access to reliable clean water to practice hand hygiene, have limited ability to socially distance due to shelter space limitations, and may not have the finances to obtain a protective mask or keep one clean if they have one in their possession, which compromises their ability to protect themselves during the COVID-19 pandemic. DESCRIPTION OF PROGRAM/INTERVENTION: Internal MedicinePediatrics residents of Los Angeles County + University of Southern California Medical Center (LAC+USC) created a health education program within interim housing and shelter sites affiliated with the Department of Health Services (DHS) Housing for Health organization to help decrease the risk for covid-19 outbreaks within the population of people experiencing homelessness. The primary intervention consisted of evidence-based health education sessions using powerpoint presentations, informed by an initial survey of common questions fielded by community stakeholders, then followed by open discussion between the resident physicians, shelter staff, and shelter clientele. MEASURES OF SUCCESS: Measuring the efficacy of the intervention included immediate verbal feedback from clients and staff after the health education, as well as pre- and post-surveys. Pre-surveys assessed staff's perception of their client population's understanding of COVID-19 and their adherence to public health recommendations (wearing masks, practicing frequent hand washing, practicing social distancing). After a minimum of one month, post-surveys were sent to staff to evaluate if there was an improvement in client understanding and adherence to public health recommendations. FINDINGS TO DATE: 10 total educational sessions were completed for clients and staff at DHS sites. Staff noted that 4 to 5 clients were: wearing masks 87.5% of the time prior to the intervention and 100% after, practicing good hand hygiene 62.5% of the time prior and 83.3% after, and practicing social distancing 62.5% of the time prior and 100% after. KEY LESSONS FOR DISSEMINATION: Health education interventions within shelter and interim-housing populations can be effective in behavioral modification for disease prevention of covid-19 infection.
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BACKGROUND AND AIMS: Renal recovery (RR) after AKI is a determinant outcome of future comorbidity and mortality in critical care patients. Related predictive factors remain uncertain. METHOD: We retrospectively analyzed patients admitted to ICU between January 2020 and February 2021 from our critical nephrology database. We analyzed adult patients with diagnosis of AKI (KDIGO criteria) treated with renal replacement therapy (RRT) during ICU hospitalization. We excluded patients with dialysis support previous to the admission. The main outcomes we evaluated were (1) RR (successful suspension of RRT without hyperkalemia, increase in serum creatinine (SCr), hypervolemia or acidemia after 1 week without RRT, with urine volume > 500 mL/d without diuretic treatment or > 2000 mL/d with diuretics). (2) Mortality during hospitalization. RESULTS: We found 1442 patients were admitted to ICU, 418 presented AKI (29.8%), of them, 178 patients (64% male) required RRT (AKI-RRTd) in ICU during follow-up, with mean age of 66 year old (52.8% >65 year). Main comorbidity and demographic data are in Table 1. Mean time in ICU was 19 days (RIC 11-35). The most frequent admission cause was non-surgical pathologies (93%), 53% of admitted patients had COVID-19 as main diagnosis (95 patients). There was need of vasoactive support in 73.6%, ventilatory support (82.6) and 67.2% of patients had fluid overload. The indication of dialysis was determined by a nephrologist: mainly oliguria, acidosis, hyperkalemia, fluid overload and increase SCr. Mean SCR at admission was 2.5 mg/dL. There were missing data in 48% of basal SCr (known SCr between 1 and 12 months prior to admission). Total mortality in AKI-RRTd was 70.8% (126 patients). In COVID patients, was 77.9% (74 patients). We found renal recovery in 63.4% of total survivors (33/52 patients). When analyzing COVID, there were 21 survivors, and we found renal recovery in 80.9% of patients. Patients who did not achieved renal recovery had longer ICU stay (median: 20 days, RIC: 4-26) and inhospitalization (median: 41 days, RIC: 29-58). Those patients were older, and had higher morbidity (diabetes), higher SCr at ICU admission and lower urine output. Their fluid balance was higher at 48 h after CRRT initiation (OR 3.05, 95% CI 1.39-6.65, P <.01). In COVID population without renal recovery, there were more urgent dialysis onset (OR 8.33, 95% confidence interval (95% CI) 1.04-66.2;P = .04), age > 65 year (OR 6.48, 95% CI 1.94-21.6;P < .01), positive fluid balance at 48 h after RRT (OR 3.25;95% CI 1.09-9.69;P = .03). The risk factors for mortality, were age > 65 year (OR 4.14, 95% CI 2.05- 8.35;P < .01), mechanical ventilation (OR 3.28, 95% CI 1.48-7.30;P < .01), haemodynamic support (OR 4.37, 95% CI 2.14-8.92;P < .01). Otherwise, lower SCr at admission (OR 0.82, 95% CI 0.71-0.93;P < .01) and at instauration of RRT (OR 0.75, 95% CI 0.065-0.88;P < .01) were associated to lower mortality. In COVID patients, fluid overload at RRT initiation (OR 10.83, 95% CI 1.37-85.36;P = .02), age > 65 year old (OR 8.85, 95% CI 2.68-29.1;P < .01) and FiO2 > 50% at RRT start (OR 2.77, 95% CI 1.02-7.50;P = .04) were associated to higher mortality. CONCLUSION: In ICU patients with AKI-RRT dependence, negative fluid balance at 48 h after RRT onset and in COVID patients, age < 65 year old, negative fluid balance at 48 h after RRT onset and non-urgent onset of RRT were related with renal recovery. (Table Presented).
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Introduction: There are successful reports of the use of telemedicine in nephrology (TN), which would facilitate the access of patients with chronic kidney diseases (CKD) from the primary health centers (PHCs) to the nephrologist. Since 2019, TN has been implemented in Chile as a public health policy with national coverage. The process and outcome indicators associated with the Chilean National TN Program among PHCs and reference nephrologists are described. Methods: Descriptive study of asynchronous telemedicine care performed from urban and rural PHCs (574) (municipal health centers) to 17 nephrologists from Hospital Digital, between January 01, 2019 and June 30, 2021. The percentage of the rural population in Chile is 12.1%. Teleconsultations are sent by the PHCs doctor through a digital platform that contains clinical information, laboratory tests and treatments. The nephrologist in a deferred time, responds in the same way and decides between the options: 1) Counter-refer the patient to PHCs requesting more information or with treatment recommendations;2) Refer to a hospital for more complex studies or treatments. The following were analyzed: 1. Distribution by age, sex and comorbidities;2. Response times;3. Prevalence of CKD by stages;4. Destination post evaluation TN;5. Level of relevance of PHCs consultations. Results: In total, 12.705 asynchronous telemedicine visits were performed (2019: 50.8 %;2020: 31.9 %;2021:17.3%. During the Covid-19 pandemic, attention for TN was maintained although restricted by the health crisis in the public health network. The mean age was 65.9 (SD: 13.2) years;80% were older than 60 years;57%% women. CKD stages: S1 (8.5%%);S2 (16.2%);S3 (53.6%);S4 (17.9%) and S5 (3.7%). Comorbidities: diabetes 56%, hypertension 90.7%, dyslipidemia 65%, overweight 29.2% and obesity 38.7%. The average response time was 91 hrs. (range 1- 173). In total, 7.954 patients (62.6%) were referred to PHCs with recommendations, without requiring transfers to another center. In turn, 4.751 patients (37.4%) required face-to-face nephrological evaluation (58.1% high priority for CKD in stages 4-5). The relevance of the consultations according to the nephrologist's evaluation was considered high 23.1% and median 49.3%. Conclusions: The implementation of TN as a public policy has made it possible to facilitate expeditious access, evaluation and timely treatment of patients with CKD from urban and rural PHCs and prioritize face-to-face care by a nephrologist for those with greater risk or severity. Most of the patients evaluated (62.8%) were referred to PHCs, optimizing the limited space and high demand of face-to-face care per specialist. During the Covid-19 pandemic period, the use of TN was restricted but allowed continuity of control of patients with CKD and decongest PHCs and emergency care centers. Future studies should evaluate the impact of TN in the follow-up of patients screened with CKD, especially in stages 3-5, the decrease in travel-related CO2 emissions due to reduced displacement, the level of patient´s satisfaction/PHCs teams, and the evaluation effective cost of this care modality. No conflict of interest
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BACKGROUND AND AIMS: Acute Kidney Injury (AKI) has remarkable cardiovascular and mortality outcomes, both short and long term potentially preventable with adequate ICU support, thus, early diagnosis is mandatory. Full AKI diagnosis according to KDIGO criteria can result in delayed interventions at admission in ICU, giving potential benefits to alternatives in early diagnosis. Cruz and NEFROINT research group described a scale for prediction of severe AKI, based on risk factors and establishing creatinine cuts as markers of kidney distress.1 Our aim is to describe the predictive capacity of small changes in serum creatinine correlating with clinical risk factors in adult critical care patients. 1. Clin J Am Soc Nephrol (2014) 9, 663-672. METHOD: We retrospectively selected from our Critical Care Nephrology database adult patients admitted in any of our hospital's ICU between February to August 2020, excluding those at admission with diagnosis of AKI, serum creatinine > 2.5 mg/dl, or those receiving dialysis (acute or chronic) or kidney transplantation. We defined AKI according to KDIGO criteria. We calculated Cruz et al scale of prediction of severe AKI. The minimally acceptable criteria for this test was a sensitivity of 95%. A point estimate and confidence intervals of sensitivity and specificity were derived from a contingency table. RESULTS: From 1204 new ICU patients, according to selection criteria we found 372 patients (women 40.3%), with mean age of 60.9 years (range 18-98), mainly hospitalized for medical conditions. Mean values of APACHE II was 22.9. Hemodynamic support was required in 41.1% of patients and mechanical ventilation in 58.6% of patients. (Table 1). AKI KDIGO 2-3 was diagnosed in 65 (26.8%) of patients. Creatinine at admission was statistically different in patients that developed AKI (CI 0.95 -0.51 - 0.15 mg/dl, p=0.0004). Requirement of hemodynamic (p = 0.003) and ventilatory support (p = 0.009), sepsis (p = 0.003), and diagnosis of COVID-19 (p = 0.03) were more frequent in patients who developed AKI. Clinical risk for severe AKI was present in 356 patients (95.7%): 66,5% at very high risk, 9,8% at high risk and 19,2% at moderate risk. Patients without risk criteria were classified as low risk (4,3%). In patients with risk factors for AKI, and a significative increase in creatinine adjusted to risks, diagnostic performance for predicting diagnosis of KDIGO 2-3 AKI had a sensitivity, specificity, positive and negative predictive value of 89% (CI95% 79 - 95%), 58% (CI95% 52 - 64%), 0.31 (CI95% 0.25 - 0.39) and 0.96 (CI95% 0.92 - 0.98) respectively (Figure). Renal replacement therapy was required in 39 (60%) of patients with severe AKI (incidence 10.5%). (Table 2) CONCLUSION: Regardless of the risk stratification for AKI, the absence of significant early changes in serum creatinine rules out the possibility of progression to KDIGO 2-3 AKI in the first seven days after ICU admission.
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BACKGROUND AND AIMS: Clinical outcomes of Acute Kidney Injury (AKI) in ICU mainly depend on opportune preventive strategies. Thus, early identification of AKI is mandatory, and alternative diagnostic strategies become plausible: one of them, Renal Angina Index (RAI), described by Matsuura1, predicts the development of AKI KDIGO 2-3, at 7th day after admission to the intensive care unit according to a cut-off point >6 on a scale with a 'creatinine score' (determined by the difference in serum creatinine between that at ICU admission and the first 24 hours in the ICU) and the impact of the patients medical history. 1Kidney Int Rep (2018) 3, 677-683. Our aim is to describe predictive capacity of the Renal Angina Index (RAI) in adult critical care patients in our population. METHOD: We retrospectively selected from our Critical Care Nephrology database adult patients admitted in any of our hospitals ICU between February to August 2020, excluding those at admission with diagnosis of AKI, serum creatinine > 2.5 mg/dl, or those receiving dialysis (acute or chronic) or kidney transplantation. We defined AKI according to KDIGO criteria. The RAI score was defined as the worst condition score multiplied by the creatinine score. The performance of the RAI score was assessed by Receiver Operating Characteristic (ROC) analysis power to detect a difference of 0.2 between the area under the curve (AUC), under the null hypothesis of AUC = 0.5 (no diagnostic accuracy). The optimal cut point was estimated with the Youden method. RESULTS: From 1204 new ICU patients, we included 372 patients (women 40.3%), with mean age 60.9 (18-98) (table 1). Main indication for ICU admission was medical conditions. Mean APACHE II was 22.9, hemodinamic support was required in 41,1% patients, mechanical ventilation in 58.6% patients and diabetes mellitus was present in 21.5% patients. AKI KDIGO 2-3 developed in 26.8% of patients. Mean creatinine at admission was statistically different in patients with AKI (CI 0.95 - 0.51 - -0.15 mg/dl, p=0.0004). The requirement of hemodynamic (p = 0.003) and ventilatory support (p = 0.009), sepsis (p = 0.003), and COVID-19 (p = 0.03) were more frequent in patients who developed AKI. Renal replacement therapy was required in 39 (60%) of patients with severe AKI (incidence 10,5%). RAI cutt-off point determined by Youden method in the overall sample was 24, being significantly higher in patients who developed AKI (16.54 Vs 7.47, CI 0.95 -13.5-4.99, p <0.001). A cut-off point of 24 was required for the Best predictive capacity for severe AKI, with sensitivity, specificity, positive and negative likelihood ratio of 34%, 94%, 5.5 and 0.7 respectively. CONCLUSION: In our population, RAI score requires a cutoff point much higher than that originally described to predict the development of severe AKI. Losing its discriminatory capacity.
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The objective of this article is to present some initiatives developed in South American countries, aimed at supporting and strengthening family farming in the context of the pandemic generated by COVID-19. These initiatives are taken into account because, specifically, they are related to the use and appropriation of digital platforms, such as digital social networks, instant messaging systems and web pages. It is considered that these experiences can be approached from the perspective that claims the processes of social appropriation of information and communication technologies (ICT) since, in a context of crisis and complexity such as that generated by COVID-19, Actors of different nature such as family farmers, small farmers, university extension centers, governments, multilateral organizations, among others, have used ICT devices in their production processes, promoting synergies that aim at the socio-economic sustainability of groups on the stage raised, they could be considered as vulnerable. This work is based on a research design divided into two phases: exploratory-descriptive, supported by a search in secondary sources to approach the subject and, theoretical-reflexive, for the analysis of the findings. The results are preliminary, but it is considered that they provide relevant indications for the study within the field of social studies of science as well as for the analysis of techno-scientific policies, always rescuing a non-deterministic perspective on a subject as complex as the one presented.