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1.
Journal of Pedagogical Research ; 6(5):54-88, 2022.
Article in English | Scopus | ID: covidwho-2218115

ABSTRACT

This mixed-methods study primarily explored how elementary educators exhibited TPACK in their virtual literacy instruction and the challenges they faced during the early months of the COVID-19 pandemic. Nine elementary-level educators participated in the study serving in the role of either general educator, special educator, or reading specialist. Data sources included a survey, email interviews, and teacher instructional materials. A hybrid thematic data analysis approach was utilized for the qualitative data, and basic descriptive statistical analysis was used for the survey data. TPACK and TPK were the most frequently coded domain among participants. TPACK was apparent across all areas of literacy instruction but less complex in the participants‘ phonics instruction. The greatest relationship between perceived ability and demonstration of TPACK occurred in the TPACK domain. Through the lens of TPACK, identified challenges of virtual literacy instruction were student technology access and skills, student motivation and engagement, and student learning and accountability;identified successes addressed student emotional well-being, educator collaboration, and new learning. © 2022, Duzce University, Faculty of Education. All rights reserved.

2.
Erj Open Research ; 9(1), 2023.
Article in English | MEDLINE | ID: covidwho-2214524

ABSTRACT

Background: Knowledge regarding the long-term impact of invasive mechanical ventilation on the inspiratory muscles and functional outcomes in COVID-19 survivors is limited.

3.
Revista de Neurologia ; 76(2):47-57, 2023.
Article in Spanish | MEDLINE | ID: covidwho-2206078

ABSTRACT

INTRODUCTION: The nationwide lockdown implemented in Spain in March 2020 in response to the 2019 coronavirus disease pandemic (COVID-19) could have had an effect on the clinical situation, disease management and access to care in patients with idiopathic intracranial hypertension.

4.
Journal of Global Health Reports ; 6(e2022032), 2022.
Article in English | CAB Abstracts | ID: covidwho-2205659

ABSTRACT

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted unevenly across nations and population groups. Older adults were considered a high-risk group because of their high susceptibility to infection and potential for clinical complications and death. Long periods of home confinement and social distancing foster changes in daily life that impact the mobility, health and quality of life of older adults. This study aims to assess the quality of life of older adults during the COVID-19 pandemic, adherence to prevention measures, self-perceived impaired mobility, relating to others, daily activities, eating habits and constipation-patterns.

5.
Gac Med Mex ; 158(6):355-361, 2022.
Article in English | PubMed | ID: covidwho-2205338

ABSTRACT

INTRODUCTION: The arrival of the pandemic caused by coronavirus disease (COVID-19) exponentially increased scientific production. OBJECTIVE: To analyze the influence of COVID-19-related scientific production on the impact factor values of Latin American medical journals. METHODS: Journals related to the Medicine categories included in Journal Citation Reports (JCR) were used. Impact factor data from the 2020 and 2021 editions were used to compare the citations received by documents related to COVID-19. RESULTS: A decrease in the impact factor values of the evaluated journals was observed when the citations received by works related to COVID-19 were eliminated. CONCLUSIONS: The volume of information published on COVID-19 and the citations received influenced the impact increase in 2021 JCR.

6.
Gaceta Medica de Mexico ; 158(6):365-371, 2022.
Article in Spanish | EMBASE | ID: covidwho-2205314

ABSTRACT

Introduction: The arrival of the pandemic caused by coronavirus disease (COVID-19) exponentially increased scientific production. Objective(s): To analyze the influence of COVID-19-related scientific production on the impact factor values of Latin American medical journals. Method(s): Journals related to the Medicine categories included in Journal Citation Reports (JCR) were used. Impact factor data from the 2020 and 2021 editions were used to compare the citations received by documents related to COVID-19. Result(s): A decrease in the impact factor values of the evaluated journals was observed when the citations received by works related to COVID-19 were eliminated. Conclusion(s): The volume of information published on COVID-19 and the citations received influenced the impact increase in 2021 JCR. Copyright © 2022 Academia Nacional de Medicina de Mexico, A.C.

7.
Foro Internacional ; 63(1):85-132, 2023.
Article in Spanish | Web of Science | ID: covidwho-2205277

ABSTRACT

This article aims to explain the use of soft power by the People's Republic of China (PRC) by taking the so-called "panda diplomacy" and glob-al health diplomacy as examples. Using the deductive method and the sup-port of a theoretical apparatus based on the analysis of soft power by Chinese scholars, the authors discuss the strategies Beijing uses to "win the minds and hearts" of the international community and mitigate the perception of the "Chinese threat" generated by multiple factors, including the current pan-demic caused by sARs-Cov-2. The article concludes that through panda diplo-macy and global health diplomacy, the PRC has succeeded in these goals and is likely to continue to use its soft power to position itself as a great power in the 21st century.

8.
Revista Espanola De Ciencia Politica-Recp ; - (60):225-250, 2022.
Article in Spanish | Web of Science | ID: covidwho-2204895

ABSTRACT

The sustained growth of tourism activity for more than seven decades and its resilience to crisis led to the consolidation of a tourism policy arena in which public decision-makers and some interest groups from the tourism sector participated on a regular basis. In the context of this policy domain, the narrative on tourism and tourism policy also responded to a robust rhetoric which, regardless the circumstances, was already dealing with negative feedback that pointed out different problems related to the sustainability of the model such as overcrowded destinations or poor quality of jobs in the tourism sector among others. The effects of the health crisis caused by COVID-19 in the tourism sector were particularly significant mainly due to mobility restrictions. In order to cope with this situation much more active positions from both governments and interest groups were required. The article examines the impact on the stakeholder map as well as possible changes in the strategies adopted by the players involved. The research conclusions support the idea that stakeholders continue to perform their duties without any significant change, although a more relevant contribution is demanded during the difficult moments we are currently experiencing. This situation is pushing them to assume more proactive and open to dialogue positions.

9.
International Journal of Medical Sciences ; 20(1):1-10, 2023.
Article in English | EMBASE | ID: covidwho-2203043

ABSTRACT

Background: Short and long-term sequelae after admission to the intensive care unit (ICU) for coronavirus disease 2019 (COVID-19) are to be expected, which makes multidisciplinary care key in the support of physical and cognitive recovery. Objective(s): To describe, from a multidisciplinary perspective, the sequelae one month after hospital discharge among patients who required ICU admission for severe COVID-19 pneumonia. Method(s): A total of 104 patients completed the study in the multidisciplinary outpatient clinic. The tests performed included spirometry, measurement of respiratory muscle pressure, loss of body cell mass (BCM) and BCM index (BCMI), general joint and muscular mobility, the short physical performance battery (SPPB or Guralnik test), grip strength with hand dynamometer, the six-minute walk test (6-MWT), the functional assessment of chronic illness therapy-fatigue scale (FACIT-F), the European quality of life-5 dimensions (EQ-5D), the Barthel index and the Montreal cognitive assessment test (MoCA). While rehabilitation was not necessary for 23 patients, 38 patients attended group rehabilitation sessions and other 43 patients received home rehabilitation. Endpoints: The main sequelae detected in patients were fatigue (75.96%), dyspnoea (64.42%) and oxygen therapy on discharge (37.5%). The MoCA showed a mean score compatible with mild cognitive decline. The main impairment of joint mobility was limited shoulder (11.54%) and shoulder girdle (2.88%) mobility;whereas for muscle mobility, lower limb limitations (16.35%) were the main dysfunction. Distal neuropathy was present in 23.08% of patients, most frequently located in lower limbs (15.38%). Finally, 50% of patients reported moderate limitation in the EQ-5D, with a mean score of 60.62 points (SD 20.15) in perceived quality of life. Conclusion(s): Our findings support the need for a multidisciplinary and comprehensive evaluation of patients after ICU admission for COVID-19 because of the wide range of sequelae, which also mean that these patients need a long-term follow-up. Impact on clinical rehabilitation: This study provides data supporting the key role of rehabilitation during the follow-up of severe patients, thus facilitating their reintegration in society and a suitable adaptation to daily living. Copyright © The author(s).

10.
International Journal of Emerging Technologies in Learning ; 17(22):20-38, 2022.
Article in English | Scopus | ID: covidwho-2201274

ABSTRACT

In this work, we present a teaching experience based on emerging pedagogies and gamification to improve leadership skills and achieve efficient teamwork in scientific-technical areas of Engineering Projects. We designed the contents of a workshop and a virtual tool to create emotional contexts that improved the acquisition of soft skills. The combination of multi-sensory pedagogical strategies and hybrid inductive-deductive methodologies based on tests and team games, inspired by the story line of the classic film "The Seven Samurai” (Kurosawa, 1954), allowed us both to carry out, over a period of two academic years, an "on-the-ground” workshop-game, and a virtual tool to interact in the workshop, while under the COVID-19 restrictions. Despite the different formats and gamification elements used over the two academic years, the metrics for evaluating the efficiency of acquiring these soft skills produced very positive results and, on the whole, did not show significant differences. The cinematographic language and empathy with the story and the characters led the students to identify with and internalize the elements of efficient teamwork and leadership. Movies can provide simple but effective narrative lines on which to build games. Here, we present the contents and details of both workshops as a transferable experience, as well as making the open virtual tool available for the educative community. © 2022, International Journal of Emerging Technologies in Learning. All Rights Reserved.

11.
Frontiers in Psychology ; 13, 2022.
Article in English | Web of Science | ID: covidwho-2199179

ABSTRACT

The teaching-learning process of reading and writing has great relevance in the psycho-emotional and socio-psychological development of school-age children. This is an exercise in which they develop imagination, attention and memory capacity and through this process the management of emotions and sensitivity and capacity of apprehension of reality. The crisis derived from the COVID-19 pandemic transformed reality in an unprecedented way in the recent history of humanity and the educational context was shaken by all these changes. With confinement, the teaching-learning process of reading and writing, which is designed to take place in person, had to be developed in a hybrid or online way, which was a major challenge for teachers and families and, of course, also for children who were in the process of learning. One of the aspects that was blurred in this context was the role of the teacher, which in this case is one of the most important elements, to achieve adequate learning of reading and writing. On one hand, the teacher is in charge of helping to manage the emotions derived from the learning process itself and, on the other hand, he is a key figure so that this is not only technical learning but also contributes to the child's socio-emotional development. The aim of this study was to analyze the impact of the socio-psychological changes that have occurred in the educational context since the COVID-19 pandemic on the emotions linked to the teaching process, learning of reading and writing through a systematic review of the studies carried out on the subject, in order to provide recommendations for face-to-face learning in the post-COVID-19 era. A systematic review strategy was devised and the literature search was conducted. The search was conducted using ERIC, Dialnet, Scopus, WoS, EBSCO, and Google Scholar databases. This systematic review took place during the month of May 2022. The results show that given the scarce presence of empirical studies on the subject, the objective has only been partially met. However, a systematic review of the studies carried out on the subject. For the identification of recommendations in the development of face-to-face learning in the post-covid era, it has been possible to identify some ideas of interest for future curricular designs in primary school students who are immersed in learning to read and write.

12.
Diabetes Care ; 13:13, 2023.
Article in English | MEDLINE | ID: covidwho-2198234

ABSTRACT

OBJECTIVE: To describe the evolving impact of the coronavirus disease 2019 pandemic on the incidence and presentation of new-onset pediatric type 2 diabetes.

13.
J Adv Nurs ; 2022.
Article in English | Web of Science | ID: covidwho-2192712

ABSTRACT

AIMS: This article discusses possible barriers to help-seeking that Indigenous and Black women encountered when seeking help related to experiences of intimate partner violence during the COVID-19 pandemic. DESIGN: This article is focused on understanding the impact of the COVID-19 pandemic on populations at highest risk for intimate partner violence in its most severe forms. DATA SOURCES: Literature sources range from 2010 to 2022. The article is also informed by the experiences of scholars and advocates working with Indigenous and Black women experiencing intimate partner violence in Wisconsin. In our write-up, we draw on Indigenous feminism and Black feminist thought. IMPLICATIONS FOR NURSING: Help seeking is contextual. The context in which help seeking occurs or does not occur for Indigenous and Black women, due to the barriers we discuss is vital for nurses to understand in order to provide efficient and meaningful nursing care. CONCLUSION: Our goal is to center the nursing profession in a leadership position in addressing the complex and unique needs of Indigenous and Black women who experience the highest rates of intimate partner violence and also experience the greatest barriers to care and support. IMPACT: We seek to contribute theory-driven knowledge that informs the work of nurses who are often the first to encounter survivors of intimate partner violence within the clinical setting. Help-seeking is often hindered by factors such as geographic and jurisdictional, economic, and structural response barriers. This knowledge will enhance nurses' ability to lead and advocate for clinical practice and policies that minimize the barriers women experience following intimate partner violence, especially during pandemics, disasters, and other extraordinary circumstances. PUBLIC CONTRIBUTIONS: This article is based on the collaboration of community advocates, nurse scientists, and public health scholars, who work closely with Indigenous and Black survivors of violence and seek to meet their needs and offer them meaningful support.

14.
Crit Care Explor ; 5(1), 2023.
Article in English | PubMed Central | ID: covidwho-2190845

ABSTRACT

Vascular dysfunction and capillary leak are common in critically ill COVID-19 patients, but identification of endothelial pathways involved in COVID-19 pathogenesis has been limited. Angiopoietin-like 4 (ANGPTL4) is a protein secreted in response to hypoxic and nutrient-poor conditions that has a variety of biological effects including vascular injury and capillary leak.OBJECTIVES:: To assess the role of ANGPTL4 in COVID-19–related outcomes. DESIGN, SETTING, AND PARTICIPANTS:: Two hundred twenty-five COVID-19 ICU patients were enrolled from April 2020 to May 2021 in a prospective, multicenter cohort study from three different medical centers, University of Washington, University of Southern California and New York University. MAIN OUTCOMES AND MEASURES:: Plasma ANGPTL4 was measured on days 1, 7, and 14 after ICU admission. We used previously published tissue proteomic data and lung single nucleus RNA (snRNA) sequencing data from specimens collected from COVID-19 patients to determine the tissues and cells that produce ANGPTL4. RESULTS:: Higher plasma ANGPTL4 concentrations were significantly associated with worse hospital mortality (adjusted odds ratio per log2 increase, 1.53;95% CI, 1.17–2.00;p = 0.002). Higher ANGPTL4 concentrations were also associated with higher proportions of venous thromboembolism and acute respiratory distress syndrome. Longitudinal ANGPTL4 concentrations were significantly different during the first 2 weeks of hospitalization in patients who subsequently died compared with survivors (p for interaction = 8.1 × 10–5). Proteomics analysis demonstrated abundance of ANGPTL4 in lung tissue compared with other organs in COVID-19. ANGPTL4 single-nuclear RNA gene expression was significantly increased in pulmonary alveolar type 2 epithelial cells and fibroblasts in COVID-19 lung tissue compared with controls. CONCLUSIONS AND RELEVANCE:: ANGPTL4 is expressed in pulmonary epithelial cells and fibroblasts and is associated with clinical prognosis in critically ill COVID-19 patients.

15.
Open Forum Infectious Diseases ; 9(Supplement 2):S226, 2022.
Article in English | EMBASE | ID: covidwho-2189640

ABSTRACT

Background. In March 2020 our Institution was designated a COVID-19 unit, since the start of 2021 conventional medical attention has been reinstalled and it became a hybrid hospital. Our objective was to compare the outcome of patients with Invasive Aspergillosis (IA) without COVID-19 during the COVID-19 pandemic, compared with past controls from a historical cohort, and describe their clinical characteristics. As a secondary objective, we described the characteristics of other Invasive Fungal Infections (IFI) in a similar patient group. Methods. Retrospective and descriptive study. The information was obtained from the electronic file. For IFI diagnosis, the EORTC/MSG criteria for proven and probable infection were considered, including the AspiCU modified criteria. The main outcome was death at 6 weeks, time from symptom onset to diagnosis/treatment, and having received antifungal treatment as secondary outcomes. Outcomes were compared to historical IA controls (2:1) from a pre-COVID-19 cohort. The study was approved by the local research and ethics committee. Results. From March 2020 to December 2021, 50 IFIs were diagnosed in non-COVID-19 patients, of which 27 (54%) were Invasive Aspergillosis, 10 (20%) Cryptococcosis, 8(16%) histoplasmosis, 4 (8%) mucormycosis, and 1 (2%) Fusariosis. The median age was 44 years (IQR 33-58) and 67% were men. Forty three percent (22/51) had immunosuppression and 35% (18/51) had hematological malignancy, the median time from symptom onset to IFI diagnosis was 30 days (IQR 11-90) and 38% died within 6 weeks. During the pandemic, in Invasive Aspergillosis non COVID-19 patients, the median number of days from symptom onset to start antifungal was 21 (IQR 6-68) vs 5 (IQR 3-10) of IA historic controls (p=0.0005), 81.5% (22/ 27) vs 93% (50/54) received antifungal treatment (OR 0.88 , 95% CI 0.72-1.0, p=0.13), and IA cases had a mortality of 44% (12/27) vs 41% (22/54) in the historical cohort (p=0.75). We show the IA characteristics in Table 1. GM: Galactomannan antigen Conclusion. During the COVID-19 pandemic, patients with IA withouth COVID-19 were diagnosed significantly later. Also, a trend towards increased mortality and lower proportion of antifungal treatment was observed. It is likely a consequence of hospital reconversion during the start of the pandemic.

16.
Open Forum Infectious Diseases ; 9(Supplement 2):S189-S190, 2022.
Article in English | EMBASE | ID: covidwho-2189600

ABSTRACT

Background. Post-COVID-19 syndrome occurs usually 3 months from the onset of COVID-19 with symptoms that last for at least 2 months and cannot be explained by an alternative diagnosis (WHO definition, 2021). Our objective was to describe the prevalence, type, and duration of symptoms and their impact on the quality of life of patients hospitalized for COVID-19. Methods. A cross-sectional descriptive study was done, digital informed consent was obtained. Patients with a history of hospitalization for COVID-19 between March 2020 and October 2021 were invited to answer electronically an adaptation of the questionnaire for the identification of post-COVID-19 syndrome and the instrument EuroQol-5D (quality of life). Both were performed at 3, 6, 9 and 12 months after the initial evaluation for COVID-19. Results. We included 246 patients, of whom 76% (187/246) met the definition of post-COVID-19 syndrome, 54% were men, with a median age of 50 years (IQR 41-63). Sixty-three percent (117/187) of post-COVID-19 syndrome patients described a worse health status (OR 9.2, 95% CI 4.1-22.6, p=< 0.0001). The median time to symptoms onset after hospital discharge was 1 day (IQR 1-20), and the median duration of symptoms was 150 days (IQR 90-225). The most frequent symptoms were dyspnea 75% (141), arthralgia 71% (132), fatigue 68% (127), hair loss 60% (112), myalgia 53% (99), sleep disturbances 52% (97), dizziness 47% (88), and palpitations 41% (76) (Figure 1). Regarding quality of life, the post-COVID-19 syndrome patients presented a lower visual analog scale of the EQ-5D versus the group without syndrome (80mm [IQR 70-90] vs. 89.5mm [IQR 75-90], p=0.05). All five dimensions of the quality of life were affected in the post-COVID-19 syndrome group;and dimensions of pain/ discomfort, usual activities, and anxiety/depression showed a statistical difference (Fig 2). Euroqol (EQ)-5D:Specific instrument to describe and value health-related quality of life. Conclusion. Post-COVID-19 syndrome occurred in 76% of hospitalized patients, with prolonged duration and quality of life impairment. Dyspnea was the most frequent symptom. Timely diagnostic and therapeutic intervention is required.

17.
European Geriatric Medicine ; 13(Supplement 1):S46-S47, 2022.
Article in English | EMBASE | ID: covidwho-2175428

ABSTRACT

Background: Lockdown and limited social interactions during the COVID-19 pandemic led to a higher risk to functional loss in older people. Despite the growing body of studies about loneliness, its relationship with intrinsic capacity (IC) remains unclear. Aim(s): To explore the association between loneliness and IC. Method(s): Prospective cohort study. Setting(s): Primary care centers and outpatient clinics from five rural and urban territories in Catalonia (Spain). Participant(s): 200 community dwelling people aged 70 or more with Barthel >= 90, without dementia or advanced chronic conditions. Outcome(s): IC was assessed using ICOPE screening tool. Loneliness was assessed with De Jong-Gierveld scale and dichotomized (not affected vs affected). The association between loneliness and IC was assessed using stepwise logistic regression. Result(s): 70% of participants showed decline in at least one of the five domains of IC (mean 2.1). Excluding the sensory domains these figures drop to 52% and 1.8 respectively. Frequency of decreased IC was 54% (sensory), 28% (mobility), 24% (psychological), 11% (vitality) and 31% (cognition). 65/200 participants (32%) showed loneliness (61 moderate, 3 severe, 1 very severe). People affected by loneliness had a greater decline of IC in the psychological (OR:4.52, p<0.001) and mobility domains (OR:3.55, p<0.001). Conclusion(s): Baseline data from a longitudinal cohort study shows that loneliness is associated with losses in psychological and mobility domains of IC. Further research is needed to understand casual pathways of this association.

18.
EAI/Springer Innovations in Communication and Computing ; : 191-204, 2023.
Article in English | Scopus | ID: covidwho-2173688

ABSTRACT

From an increasingly early age, girls and boys handle technology, and digital education must become an essential part of the training of young people. The European Union has recognized that it is urgent to strengthen training in digital competence throughout Europe so that Member States can recover from the crisis caused by the Covid-19 pandemic, in addition to building the foundations for a more ecological and digital Europe. In line with European policies, Spain has designed a national plan for digital skills, providing a strategic framework aligned with the 2030 agenda and the Sustainable Development Goals (SDGs). From the private sector, digital education initiatives have also been proposed. Thus, the Vodafone Spain Foundation has designed and is carrying out an educational program for the development of digital competence. In this educational program, gamification is part of both the training activities and the evaluation process, and in both cases, it is understood as a strategy aimed to promote engagement to the training process. This chapter presents the educational program DigiCraft for the development of digital competence and the evaluation process designed to verify their acquisition, in which the game has a fundamental pedagogical role. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

19.
Medicina intensiva ; 2022.
Article in English | EuropePMC | ID: covidwho-2169630

ABSTRACT

Graphical Objective To describe the sequelae one month after hospital discharge in patients who required admission to Intensive Care for severe COVID 19 pneumonia and to analyze the differences between those who received therapy exclusively with high-flow oxygen therapy compared to those who required invasive mechanical ventilation. Design Cohort, prospective and observational study. Setting Post-intensive care multidisciplinary program. Patients or participants Patients who survived admission to the intensive care unit (ICU) for severe COVID 19 pneumonia from April 2020 to October 2021. Interventions Inclusion in the post-ICU multidisciplinary program. Main variables of interest Motor, sensory, psychological/psychiatric, respiratory and nutritional sequelae after hospital admission. Results 104 patients were included. 48 patients received high-flow nasal oxygen therapy (ONAF) and 56 invasive mechanical ventilation (IMV). The main sequelae found were distal neuropathy (33.9% IMV vs 10.4% ONAF);brachial plexopathy (10.7% IMV vs 0% ONAF);decrease in grip strength: right hand 20.67 kg (+/- 8.27) in VMI vs 31.8 kg (+/- 11.59) in ONAF and left hand 19.39 kg (+/- 8.45) in VMI vs 30.26 kg (+/- 12.74) in ONAF;and limited muscle balance in the lower limbs (28.6% VMI vs 8.6% ONAF). The differences observed between both groups did not reach statistical significance in the multivariable study. Conclusions The results obtained after the multivariate study suggest that there are no differences in the perceived physical sequelae one month after hospital discharge depending on the respiratory therapy used, whether it was high-flow nasal oxygen therapy or prolonged mechanical ventilation, although more studies are needed to be able to draw conclusions.

20.
Medicina intensiva ; 45(2):104-121, 2020.
Article in Spanish | EuropePMC | ID: covidwho-2168078

ABSTRACT

La infección por el virus SARS-CoV-2, denominada COVID-19 (COronaVIrus Disease 19), fue detectada inicialmente en China en diciembre 2019, y posteriormente se ha diseminado rápidamente por todo el mundo, hasta el punto de que el 11 de marzo la Organización Mundial de la Salud declaró que el brote podría definirse como pandemia. La COVID-19 presenta un cuadro que oscila desde episodios leves seudogripales a otros graves e incluso potencialmente mortales debido, sobre todo, a insuficiencia respiratoria aguda. Es frecuente el ingreso de estos pacientes en nuestros servicios de Medicina Intensiva en relación con un síndrome de distrés respiratorio agudo. La falta de un tratamiento con evidencia científica ha llevado al empleo de diferentes pautas terapéuticas, en muchas ocasiones, con modificaciones rápidas de los protocolos. Recientes revisiones en revistas de prestigio han destacado la falta de terapias probadas y la necesidad de ensayo clínicos que permitan establecer pautas de tratamiento claras y objetivas. Este documento tiene por objeto ofrecer una actualización de la terapia que se está aplicando en la actualidad, y una ayuda en la asistencia diaria, sin pretender sustituir los protocolos adoptados en cada centro.

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