Effects of cobalt-chromium everolimus eluting stents or bare metal stent on fatal and non-fatal cardiovascular events: patient level meta-analysis

Objectives: To examine the safety and effectiveness of cobalt-chromium everolimus eluting stents compared with bare metal stents. Design: Individual patient data meta-analysis of randomised controlled trials. Cox proportional regression models stratified by trial, containing random effects, were used to assess the impact of stent type on outcomes. Hazard ratios with 95% confidence interval for outcomes were reported. Data sources and study selection: Medline, Embase, the Cochrane Central Register of Controlled Trials. Randomised controlled trials that compared cobalt-chromium everolimus eluting stents with bare metal stents were selected. The principal investigators whose trials met the inclusion criteria provided data for individual patients. Primary outcomes: The primary outcome was cardiac mortality. Secondary endpoints were myocardial infarction, definite stent thrombosis, definite or probable stent thrombosis, target vessel revascularisation, and all cause death. Results: The search yielded five randomised controlled trials, comprising 4896 participants. Compared with patients receiving bare metal stents, participants receiving cobalt-chromium everolimus eluting stents had a significant reduction of cardiac mortality (hazard ratio 0.67, 95% confidence interval 0.49 to 0.91; P=0.01), myocardial infarction (0.71, 0.55 to 0.92; P=0.01), definite stent thrombosis (0.41, 0.22 to 0.76; P=0.005), definite or probable stent thrombosis (0.48, 0.31 to 0.73; P<0.001), and target vessel revascularisation (0.29, 0.20 to 0.41; P<0.001) at a median follow-up of 720 days. There was no significant difference in all cause death between groups (0.83, 0.65 to 1.06; P=0.14). Findings remained unchanged at multivariable regression after adjustment for the acuity of clinical syndrome (for instance, acute coronary syndrome v stable coronary artery disease), diabetes mellitus, female sex, use of glycoprotein IIb/IIIa inhibitors, and up to one year v longer duration treatment with dual antiplatelets. Conclusions: This meta-analysis offers evidence that compared with bare metal stents the use of cobalt-chromium everolimus eluting stents improves global cardiovascular outcomes including cardiac survival, myocardial infarction, and overall stent thrombosis.

La promoción del pensamiento crítico en el Aprendizaje Basado en Problemas (ABP). Un análisis a partir de los instrumentos de medición

[spa] La literatura científica sobre el Aprendizaje Basado en Problemas (ABP) ha dedicado una atención creciente a la cuestión del pensamiento crítico a lo largo de las dos últimas décadas. Los trabajos de investigación que se han llevado a cabo en los distintos contextos disciplinares de la educación superior presentan definiciones e instrumentos de medición del pensamiento crítico dispares. El presente artículo parte de dicha apreciación y trata de revisar sistemáticamente los mencionados trabajos con un doble objetivo: por un lado, esbozar una clasificación de los instrumentos de medición del pensamiento crítico de estudiantes de ABP y, por el otro, mostrar una panorámica de las evidencias hasta ahora obtenidas; todo ello con la finalidad de animar a profesores, estudiosos y autoridades académicas a seguir avanzando en esta línea de investigación. [eng] Critical thinking has received growing attention from scientific literature on Problem-Based Learning (PBL)during the last two decades. The research carried out in different disciplinary contexts of higher education presents disparate definitions and measuring instruments of critical thinking. This article aims to review systematically the mentioned literature with a dual purpose: on the one hand, to outline a classification of instruments measuring PBL students' critical thinking, on the other, to show an overview of the evidence so far obtained; all of this with the ultimate purpose of encouraging teachers, scholars and academical authorities to proceed further in this line of research.