Mamíferos continentales del Mioceno tardío a la actualidad en la Argentina: cincuenta años de estudios

Ameghiniana was created 50 years ago. During this lapse, the late Cenozoic paleomastozoology developed exponentially in Argentina. Many of the papers dealed with systematics. However, fossil mammals were also used for establish the chronological scale based on a biostratigraphic sequence of faunas mainly from the Pampean area. This scale proved valid for other South American areas. Besides, mammals were used as proxies for understanding the continental climatic evolution and, at the same time, biogeographic studies flourished. In recent years, many paleoecological and morphofunctional studies were carried out. Certainly, the last 50 years were the most productive time in Argentina since the pioneering work of Florentino Ameghino

Land mammal from the late miocene to recent in Argentina: Fifty years of research

Ameghiniana was created 50 years ago. During this lapse, the late Cenozoic paleomastozoology developed exponentially in Argentina. Many of the papers dealed with systematics. However, fossil mammals were also used for establish the chronological scale based on a biostratigraphic sequence of faunas mainly from the Pampean area. This scale proved valid for other South American areas. Besides, mammals were used as proxies for understanding the continental climatic evolution and, at the same time, biogeographic studies flourished. In recent years, many paleoecological and morphofunctional studies were carried out. Certainly, the last 50 years were the most productive time in Argentina since the pioneering work of Florentino Ameghino.Museo de La Plat

Land mammal from the late miocene to recent in Argentina: Fifty years of research

Ameghiniana was created 50 years ago. During this lapse, the late Cenozoic paleomastozoology developed exponentially in Argentina. Many of the papers dealed with systematics. However, fossil mammals were also used for establish the chronological scale based on a biostratigraphic sequence of faunas mainly from the Pampean area. This scale proved valid for other South American areas. Besides, mammals were used as proxies for understanding the continental climatic evolution and, at the same time, biogeographic studies flourished. In recent years, many paleoecological and morphofunctional studies were carried out. Certainly, the last 50 years were the most productive time in Argentina since the pioneering work of Florentino Ameghino.Museo de La Plat

Permanencia del conocimiento adquirido en los dos primeros años de la Licenciatura de Médico Cirujano.: ¿Persiste al evaluarlo en el cuarto año?

Introducción. Los alumnos generalmente profundizan en el conocimiento de acuerdo al tipo de preguntas con que son evaluados: si evalúan memoria se favorece un aprendizaje mecánico y repetitivo que permanece poco tiempo en la memoria; si son de comprensión o aplicación favorecerán aprendizajes significativos. Materiales y métodos. Estudio analítico, observacional transversal. Por jueces se seleccionaron preguntas obtenidas de exámenes de anatomía, psicología, fisiología y cirugía de los tres niveles de conocimiento. El mismo examen se aplicó al azar a 13 grupos de segundo año y a 13 grupos de cuarto. La calificación y el análisis se realizaron de manera electrónica. Se aplicó la U de Mann-Whitney para identificar diferencias y percentiles con rango intercuartílico para la dispersión. Resultados. Se contestaron 310 exámenes de segundo año y 247 de cuarto. La fiabilidad del examen fue de 0,9009 y 0,9102, respectivamente. Se identificaron diferencias significativas (p = 0,000) en el examen global y en las respuestas de cirugía y psicología, considerando aciertos y nivel de conocimiento (memoria y comprensión). No se encontraron diferencias en anatomía (p = 0,527) y fisiología (p = 0,203). La mediana de aciertos fue de 39 y 43, respectivamente. La dispersión de reactivos en el análisis global y por asignatura mantuvo un rango intercuartílico de 3-4. Conclusiones. Al ser evaluado, el alumno con conocimientos memorísticos pierde interés al no encontrar la aplicación y la integración del conocimiento básicos en la clínica

Aplicación de redes neuronales artificiales en el liderazgo asignado y el éxito académico en egresados de medicina

Objetivo: Aplicar un modelo de análisis de redes neuronales artificiales (RNA) para identificar las variables que predicen el liderazgo asignado y el éxito académico en egresados de seis generaciones de la carrera de Medicina. Método: Estudio analítico, retrospectivo y comparativo. Participaron 1434 egresados. Se envió un cuestionario por correo electrónico que incluyó el consentimiento de participación voluntaria. Se realizó análisis estadístico multivariado mediante RNA del tipo perceptrón multicapa, árboles de decisión y análisis de impulsores. Resultados: Las RNA identificaron siete variables independientes que predijeron el éxito profesional y ocho para el liderazgo en los médicos egresados. Los árboles de decisión identificaron diferencias significativas en las variables desempeño profesional (p = 0.000), edad (p = 0.005) y actividades de educación continua (p = 0.034) relacionadas con el éxito profesional, y para el liderazgo las variables sexo (p = 0.000), promedio en el bachillerato (p = 0.042), realizar práctica clínica en el servicio social (p = 0.002) y actividades de educación continua (p = 0.011). Conclusiones: Las RNA identificaron las principales variables independientes predictoras del éxito profesional y el liderazgo de los egresados. El estudio abre dos líneas de investigación poco estudiadas con las técnicas de RNA en el área de la medicina

Specific entrustable professional activities for undergraduate medical internships: a method compatible with the academic curriculum

Abstract Background Competency-based education has been considered the most important pedagogical trend in Medicine in the last two decades. In clinical contexts, competencies are implemented through Entrustable Professional Activities (EPAs) which are observable and measurable. The aim of this paper is to describe the methodology used in the design of educational tools to assess students´ competencies in clinical practice during their undergraduate internship (UI). In this paper, we present the construction of specific APROCs (Actividades Profesionales Confiables) in Surgery (S), Gynecology and Obstetrics (GO) and Family Medicine (FM) rotations with three levels of performance. Methods The study considered a mixed method exploratory type design, a qualitative phase followed by a quantitative validation exercise. In the first stage data was obtained from three rotations (FM, GO and S) through focus groups about real and expected activities of medical interns. Triangulation with other sources was made to construct benchmarks. In the second stage, narrative descriptions with the three levels were validated by professors who teach the different subjects using the Delphi technique. Results The results may be described both curricular and methodological wise. From the curricular point of view, APROCs were identified in three UI rotations within clinical contexts in Mexico City, benchmarks were developed by levels and validated by experts’ consensus. In regard to methodological issues, this research contributed to the development of a strategy, following six steps, to build APROCs using mixed methods. Conclusions Developing benchmarks provides a regular and standardized language that helps to evaluate student’s performance and define educational strategies efficiently and accurately. The university academic program was aligned with APROCs in clinical contexts to assure the acquisition of competencies by students

Evolution over Time of Ventilatory Management and Outcome of Patients with Neurologic Disease∗

OBJECTIVES: To describe the changes in ventilator management over time in patients with neurologic disease at ICU admission and to estimate factors associated with 28-day hospital mortality. DESIGN: Secondary analysis of three prospective, observational, multicenter studies. SETTING: Cohort studies conducted in 2004, 2010, and 2016. PATIENTS: Adult patients who received mechanical ventilation for more than 12 hours. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Among the 20,929 patients enrolled, we included 4,152 (20%) mechanically ventilated patients due to different neurologic diseases. Hemorrhagic stroke and brain trauma were the most common pathologies associated with the need for mechanical ventilation. Although volume-cycled ventilation remained the preferred ventilation mode, there was a significant (p < 0.001) increment in the use of pressure support ventilation. The proportion of patients receiving a protective lung ventilation strategy was increased over time: 47% in 2004, 63% in 2010, and 65% in 2016 (p < 0.001), as well as the duration of protective ventilation strategies: 406 days per 1,000 mechanical ventilation days in 2004, 523 days per 1,000 mechanical ventilation days in 2010, and 585 days per 1,000 mechanical ventilation days in 2016 (p < 0.001). There were no differences in the length of stay in the ICU, mortality in the ICU, and mortality in hospital from 2004 to 2016. Independent risk factors for 28-day mortality were age greater than 75 years, Simplified Acute Physiology Score II greater than 50, the occurrence of organ dysfunction within first 48 hours after brain injury, and specific neurologic diseases such as hemorrhagic stroke, ischemic stroke, and brain trauma. CONCLUSIONS: More lung-protective ventilatory strategies have been implemented over years in neurologic patients with no effect on pulmonary complications or on survival. We found several prognostic factors on mortality such as advanced age, the severity of the disease, organ dysfunctions, and the etiology of neurologic disease