Valve surgery in active infective endocarditis: a simple score to predict in-hospital prognosis

Aims Surgery for infective endocarditis (IE) is associated with high mortality. Our objectives were to describe the experience with surgical treatment for IE in Spain, and to identify predictors of in-hospital mortality. Methods Prospective cohort of 1000 consecutive patients with IE. Data were collected in 26 Spanish hospitals. Results Surgery was performed in 437 patients (43.7%). Patients treated with surgery were younger and predominantly male. They presented fewer comorbid conditions and more often had negative blood cultures and heart failure. In-hospital mortality after surgery was lower than in the medical therapy group (24.3 vs 30.7%, p = 0.02). In patients treated with surgery, endocarditis involved a native valve in 267 patients (61.1%), a prosthetic valve in 122 (27.9%), and a pacemaker lead with no clear further valve involvement in 48 (11.0%). The most common aetiologies were Staphylococcus (186, 42.6%), Streptococcus (97, 22.2%), and Enterococcus (49, 11.2%). The main indications for surgery were heart failure and severe valve regurgitation. A risk score for in-hospital mortality was developed using 7 prognostic variables with a similar predictive value (OR between 1.7 and 2.3): PALSUSE: prosthetic valve, age ≥ 70, large intracardiac destruction, Staphylococcus spp, urgent surgery, sex [female], EuroSCORE ≥ 10. In-hospital mortality ranged from 0% in patients with a PALSUSE score of 0 to 45.4% in patients with PALSUSE score > 3. Conclusions The prognosis of IE surgery is highly variable. The PALSUSE score could help to identify patients with higher in-hospital mortality.

Enhancing student learning with case-based teaching and audience response systems in an interdisciplinary Food Science course

A growing body of research in higher education suggests that teachers should move away from traditional lecturing towards more active and student-focus education approaches. Several classroom techniques are available to engage students and achieve more effective teaching and better learning experiences. The purpose of this paper is to share an example of how two of them – case-based teaching, and the use of response technologies – were implemented into a graduate-level food science course. The paper focuses in particular on teaching sensory science and sensometrics, including several concrete examples used during the course, and discussing in each case some of the observed outcomes. Overall, it was observed that the particular initiatives were effective in engaging student participation and promoting a more active way of learning. Case-base teaching provided students with the opportunity to apply their knowledge and their analytical skills to complex, real-life scenarios relevant to the subject matter. The use of audience response systems further facilitated class discussion, and was extremely well received by the students, providing a more enjoyable classroom experience.