The Spanish Acquired Hemophilia A (AHA) Registry is intended to update the status of AHA in Spain. One hundred and fifty-four patients were included and retrospectively followed-up for a median time of 12 months. Patients were predominantly male (56.3%), with median age at diagnosis of 74 years. AHA was more frequently idiopathic (44.1%) and autoimmune disorder-associated (31.7%). Thirty-four percent of patients were on antithrombotic therapy at diagnosis. Hemostatic treatment was used in 70% of patients. Recombinant activated factor VII was more frequently infused (60.3% vs 20.6% activated prothrombin complex concentrate). Only one patient did not achieve control of hemorrhage. Complete remission (CR) was achieved by 84.2% of cases after immunosuppressive therapy (IST). Steroids alone were less efficient than the other strategies (68.2% vs 87.2%, P = .049), while no differences existed among these (steroids/cyclophosphamide, 88.5%, vs steroids/calcineurin inhibitors, 81.2%, vs rituximab-based regimens, 87.5%). Female sex and high inhibitor levels influenced CR negatively. Thirty-six deaths (23.8%) were reported. Main causes of death were infection (15 patients, 9.9%) and hemorrhage (5 patients, 3.3%). All hemorrhage-related and half the infection-related deaths occurred within two months of diagnosis. Prior antithrombotic therapy was inversely associated with survival, irrespective of age. Median age of non-survivors was significantly higher (79 vs 73 years in survivors). Patients dying of infection were older than the other non-survivors (85 vs 78 years). In summary, fatal infection in the first months is common in our series. Antithrombotic therapy is associated with mortality. Particular care should be taken to avoid misdiagnosis.
Very few data exist on when a particular thrombopoietin-receptor agonist (TPO-RA) is favored in clinical practice for the treatment of patients with immune thrombocytopenia (ITP), about novel risk factors for vascular events (VE) with these drugs, nor about predictive factors for therapy free responses (TFR). We conducted an observational, retrospective, long-term follow-up multicenter study from November 2016 to January 2018 of 121 adult ITP patients initiating TPO-RA between January 2012 to December 2014. Data reflected that a platelet count ≤25 × 109/l at the time when the TPO-RA was initiated was associated with a 2.8 higher probability of receiving romiplostim vs. eltrombopag (P = 0.010). VE on TPO-RA was related to previous neoplasia in patients over 65 years (50% vs. 2.2%, P < 0.001), and to previous splenectomy in younger patients (100% vs. 33%, P = 0.001). Receiving romiplostim as first TPO-RA with no subsequent TPO-RA switching was associated with a 50% likelihood of TFR after 2.9 years of therapy (3.3 years in chronic ITP patients). These real-world data help deciphering some areas of uncertainty, and offer insight into some of the most relevant challenges of ITP which may help clinicians make appropriate treatment decisions in the management of adult ITP patients with TPO-RA.
The World Health Organization has warned that, in children, the second cause of death from unintentional injuries are falls. The objective of this study was to analyze the motor response of primary schoolchildren when a backwards fall occurs. These analyses occurred before and after interventions of the Safe Fall program, which aims to teach safe and protected ways of backward falling. A quasi-experimental research design was used, with a sample of 122 Spanish (Sevillian) schoolchildren in the 10–12 age bracket. The INFOSECA ad-hoc observation scale was used for data collection: this scale registers 5 essential physical reactions throughout the process of a safe and protected backwards fall. After that, a number of descriptive, correlational and contrast statistics were applied. The value used in the McNemar test to establish statistical significance was p < 0.05. Results showed that over 85% of students had developed the competence to correctly perform all five physical motions that allow for a safer backward fall. The teaching of safe and protected techniques for falling backwards in child population in Primary Education is possible through the implementation of the Safe Fall program in Physical Education classes, which can help making falls safer, diminishing the risk and severity of the injuries they cause.
IntroducciónEl Espacio Europeo de Educación Superior (EEES) plantea un modelo diferente para la formación universitaria, en el que se hace énfasis en la enseñanza por competencias centrada en el estudiante, siendo éste el responsable de su propio aprendizaje, y en la que destaca el papel del profesorado como orientador de dicho proceso. Se busca que el alumnado adquiera un compromiso activo sobre el qué y el cómo de lo que aprende; esto supone un cambio en la modalidad de la enseñanza y la utilización de nuevas metodologías docentes, más adaptadas a las necesidades actuales [1,2]. El cambio de modelo de enseñanza pretende que las competencias que se adquieran vayan más allá de la mera especialización técnica, para incluir, además, dimensiones relacionales y sociopolíticas. Es decir, el comportamiento técnico y metodológico ha de completarse con un comportamiento personal y social [3][4][5][6].La formación de las futuras enfermeras en el ámbito europeo se está configurando dentro de este marco. Todo docente sabe las dificultades para alcanzar estas competencias [7] debido a la masificaDocencia universitaria semipresencial. Experiencia en el uso de la plataforma virtual SWAD Manuel López-Morales, Matilde Celma-Vicente, M. Dolores Cano-Caballero Gálvez, Aurora Quero-Rufián, M. Ascensión Rodríguez-López Introducción. La innovación en la metodología docente universitaria es una exigencia del nuevo Espacio Europeo de Educación Superior. La utilización de las tecnologías de la información y la comunicación es una realidad de la sociedad actual, y especialmente del alumnado universitario. Materiales y métodos.Este artículo muestra la experiencia en el uso de la plataforma virtual de apoyo a la docencia, en la asignatura de Salud y Medio Ambiente en la Universidad de Granada.Resultados y conclusiones. La opinión de los alumnos es muy favorable hacia su uso. Su nivel de satisfacción es muy alto, aunque les supone una dedicación y esfuerzo mayores a los esperados. La plataforma virtual ofrece unas posibilidades académicas que permiten el acercamiento y adaptación a los nuevos perfiles de alumnado. Para el profesorado supone un cambio en sus principales actividades: la preparación y diseño de contenidos, las tutorías virtuales y la gestión de foros. Semi-presential university teaching. An experience in the use of SWAD virtual platformIntroduction. The new European Space of higher education demands innovation in the university teaching methodology. The use of the new information and communication technologies is a reality in our current society, especially among university students. The use of virtual platforms for teaching is more developed in post graduate lifelong learning than in university education.
In Figure 1, the y-axis label, "Proportion of patients that maintain TFR" was incorrectly given as "Patients that maintained TFR (%)". In Figure 2, the y-axis label, "Proportion of patients that achieve TFR" was incorrectly given as "Patients that achieved TFR (%)". The original Figures 1 and 2 and accompanying legends appear below.The original Article has been corrected.
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