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SummaryDespite current guidelines, venous thromboembolism (VTE) prophylaxis is underused. Computerized programs to encourage physicians to apply thromboprophylaxis have been shown to be effective in selected populations. Our aim was to analyze the impact of the implementation of a computer- alert system for VTE risk in all hospitalized patients of a teaching hospital. A computer program linked to the clinical record database was developed to assess all hospitalized patients’VTE risk daily. The physician responsible for patients at high risk was alerted, but remained free to order or withhold prophylaxis. Over 19,000 hospitalized, medical and surgical, adult patients between January to June 2005 (pre-intervention phase), January to June 2006 and January to June 2007 (postintervention phase), were included. During the first semesters of 2006 and 2007, an electronic alert was sent to 32.8% and 32.2% of all hospitalized patients, respectively. Appropriate prophylaxis among alerted patients was ordered in 89.7% (2006) and 88.5% (2007) of surgical patients, and in 49.2% (2006) and 64.4% (2007) of medical patients. A sustained reduction of VTE during hospitalization was achieved, Odds ratio (OR): 0.53, 95% confidence interval (CI) (0.25–1.10) and OR: 0.51, 95%CI (0.24–1.05) during the first semesters of 2006 and 2007 respectively, the impact being significant (p

ResumenLa metodología docente “service-learning”, como su nombre indica, combina en un proyecto único, un servicio a la comunidad con un aprendizaje académico relacionado con el curriculum del estudiante. En esta comunicación se presentan los resultados obtenidos en dos proyectos docentes que han utilizado este método para facilitar a los estudiantes de Grado la adquisición de conocimientos significativos y el desarrollo de habilidades personales y sociales difíciles de conseguir con las metodologías tradicionales. Estos proyectos han sido desarrollados por un grupo de profesores que imparten docencia en la Facultad de Ciencias Biológicas y Ambientales de la Universidad de León, en los Grados en Biología, Biotecnología y Ciencias Ambientales, durante los cursos 2014-15 y 2015-16. Con la introducción de la metodología docente “service-learning” se consigue que la Universidad se abra a la sociedad y alcance una conexión real con su entorno, avanzando en lo que se ha denominado la tercera misión de la universidad. El fin último de estos proyectos, es que tanto los estudiantes como los profesores universitarios conozcan las potencialidades de esta metodología y se planteen incorporarla institucionalmente, como ya se hace en otras Universidades americanas y europeas. Abstract Service-learning is a teaching and learning methodology that integrates community service with academic coursework, enhancing the students’ learning experience. This communication summarizes the results obtained in two teaching projects in which students applied course contents to community-based activities, incorporating learning and community action goals. These projects were designed by a group of university professors from the Faculty of Biological and Environmental Sciences of the University of León, and were carried out by a selected group of students from the Degrees in Biology, Biotechnology and Environmental Sciences, in collaboration with different community partners. The purpose of these teaching experiences was to provide the students with a hand-on experience that linked personal and social development, helping them to develop new skills difficult to acquire with traditional teaching methods. Moreover, service-learning projects enhance community-university relations improving institutional commitment with the society. Our final goal is to publicize the benefits of community engagement pedagogies like service-learning among students and professors and to set the path to integrate them into the existing curriculum of the University of Leon.

Summary. Objectives: The prevention of venous thromboembolism (VTE) is a priority for improved safety in hospitalised patients. Worldwide, there is growing concern over the undersuse of appropriate thromboprophylaxis. Computerised decision support improves the implementation of thromboprophylaxis and reduces inpatient VTE. However, an economic assessment of this approach has not yet been performed. Objectives: To evaluate the economic impact of an electronic alert (e-alert) system to prevent VTE in hospitalised patients over a 4 year period. Patients/methods: All hospitalised patients at a single institution during the first semesters of 2005–2009 (n = 32 280) were included. All cases of VTE developed during hospitalisation were followed and direct costs of diagnosis and management collected. Results: E-alerts achieved a sustained reduction of the incidence of in-hospital VTE, OR 0.50 (95% CI, 0.29–0.84), the impact being especially significant in medical patients, OR 0.44 (95% CI, 0.22–0.86). No increase in prophylaxis-related bleeding was observed. In our setting, the mean direct cost (during hospitalisation and after discharge) of an in-hospital VTE episode is €7058. Direct costs per single hospitalised patient were reduced after e-alerts from €21.6 to €11.8, while the increased use of thromboprophylaxis and the development of e-alerts meant €3 and €0.35 per patient, respectively. Thus, the implementation of e-alerts led to a net cost saving of €6.5 per hospitalised patient. Should all hospitalised patients in Spain be considered, total yearly savings would approach €30 million. Conclusions: E-alerts are useful and cost-effective tools for thromboprophylaxis strategy in hospitalised patients. Fewer thromboembolic complications and lower costs are achieved by its implementation.

BACKGROUND: Hospitalized patients are complex and institutions have to face the high cost of critical care and the limited resources of the ward. Intermediate care appears as an attractive strategy to provide rational care according to patient needs. It is an interesting scenario to expand co-management and teaching. STUDY DESIGN: Retrospective observational study. SETTING: Intermediate care unit (ImCU) of a single academic hospital. PATIENTS AND METHODS: 456 patients admitted from April 2006 to April 2010 were included in the study. Demographics, admission physiologic parameters and in-hospital mortality were recorded. We used the Simplified Acute Physiology Score II (SAPS II) as prognostic score system. Co-management with medical and surgical teams, and the number of training residents were evaluated. RESULTS: In-hospital mortality was 20.6%, whereas the expected mortality was 23.2% based on SAPS II score. The correlation between SAPS II predicted and observed death rates was accurate and statistically significant (Rho = 1.0, p < 0.001). Co-management was performed with several medical and surgical teams, with an increase in perioperative comanagement of 22.7% (p = 0.014). The number of training residents in ImCU increased from 4.3% to 30.4% (p = 0.002) CONCLUSIONS: An ImCU led by hospitalists showed encouraging results regarding patient survival and SAPS II is an useful tool for prognostic evaluation in this population. Intermediate care serves as an expansion of role for hospitalists; and clinicians, trainees and patients may benefit from co-management and teaching opportunities at this unique level of care. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine

Activation of the epidermal growth factor receptor (EGFR) has been shown to occur by ligand-dependent and ligand-independent mechanisms. Different molecular mechanisms have been found to be responsible for ligand-independent receptor transactivation. Here, we show that hyperosmolar concentrations of sorbitol activate the EGFR in human keratinocytes. Experiments using specific inhibitors of EGFR phosphorylation show that the increased amount of activated receptors is the result of a decreased rate of dephosphorylation. Furthermore, sorbitol treatment results in a strong activation of stress kinase p38. Treatment of the cells with SB203580, a known inhibitor of p38 alpha and beta kinases, results in impairment of receptor activation, indicating that the stress kinase is involved in receptor activation modulation. This is further reinforced by experiments showing that addition of Toxin B, known to be an inhibitor of the small Rho GTPases rac1, cdc42, and Rho A/B, to the cells results in a strong induction of EGFR activation. Our results point, therefore, to a mechanism by which osmotic shock activates EGFR through the small Rho GTPases-p38 stress kinase pathway.