Autoavaluació de competències transversals a l'assignatura d'anestesiologia mitjançant l'ABP

L'EEES incideix en la necessitat de contemplar les competències transversals en la formació de pregrau. A l'assignatura optativa de pregrau d'Anestesiologia apliquem l'ABP des de l'any 2001, i ens qüestionem cóm són les competències basals dels estudiants i si les fomentem. Objectiu: Mesurar l'autoavaluació dels estudiants de les competències transversals i analitzar el seu grau de progressió al llarg del nostre curs. Mètode: Estudi prospectiu i descriptiu amb estudiants de cinquè. Es sol·licita consentiment informat. Segons el projecte "Tuning" s'ha dissenyat un qüestionari on cada estudiant autoavalua al primer i a l'últim dia del curs les seves competències instrumentals, interpersonals i sistèmiques. La valoració va del 0 (incapaç) al 5 (molt capaç). Resultats: Tots els estudiants (13 dones i 1 home; edat mitja 23,78 anys) que participat en l'estudi han experimentat un increment de les seves competències amb una mitjana de 0,9 punts. Les competències millor valorades han estat la capacitat en la presa de decisions, el compliment de compromisos adquirits, la habilitat per treballar de forma autònoma, sent la més valorada la motivació per la consecució d'objectius d'aprenentatge. Les més deficitàries han estat el coneixement d'anglès i les habilitats per a investigar. Les de major progressió han estat: l'habilitat en recerca d'informació, capacitat d'expressió i per dissenyar i gestionar treballs. Conclusió: Cal conèixer el perfil basal de l'estudiant i quines són les seves mancances competencials per a després dissenyar un enfocament de l'educació basada en competències. L'autoavaluació i l'ABP ens ajuda a fomentar les competències transversals de l'estudiant.According to the Bologna Declaration transversal competencies should be improved in undergraduate education. In our optional course of Anesthesiology we apply PBL since 2001 and now we ask ourselves what kind of transversal competencies our students have and if we can help students to improve them. Objective: To measure students' self-evaluation of their transversal competencies and to analyze their progression throughout our course. Method: Prospective, descriptive study with 5th year medical students. Informed consent was asked. As described in the "Tuning" project, we designed a self-evaluation questionnaire on their instrumental, interpersonal and systemic competencies to be filled in by every student on the first and last day of class. We used a Likert scale going from 0 (unable) to 5 (excellent) for this purpose. Results: All students (13 women and 1 man; mean age 23.78 years old) filled in the questionnaire and showed a mean increase of their competencies of 0.9. The best evaluated competencies were the capacity of taking decisions, the realization of acquired compromises and the ability to work in an independent way. The best evaluated one was the motivation for the prosecution of learning objectives. The English knowledge and the ability to investigate were very deficient. The competencies that showed the most progression throughout the course were: the ability of searching information, the capacity of oral and written expression and finally their work management capacity. Conclusion: It is important to know the baseline profile of our students in terms of deficiencies of transversal competencies to design a competence-based education. PBL and self-evaluation help us to improve transversal competencies in our classes

Rationale and study design of PROVHILO - a worldwide multicenter randomized controlled trial on protective ventilation during general anesthesia for open abdominal surgery

<p>Abstract</p> <p>Background</p> <p>Post-operative pulmonary complications add to the morbidity and mortality of surgical patients, in particular after general anesthesia >2 hours for abdominal surgery. Whether a protective mechanical ventilation strategy with higher levels of positive end-expiratory pressure (PEEP) and repeated recruitment maneuvers; the "open lung strategy", protects against post-operative pulmonary complications is uncertain. The present study aims at comparing a protective mechanical ventilation strategy with a conventional mechanical ventilation strategy during general anesthesia for abdominal non-laparoscopic surgery.</p> <p>Methods</p> <p>The PROtective Ventilation using HIgh versus LOw positive end-expiratory pressure ("PROVHILO") trial is a worldwide investigator-initiated multicenter randomized controlled two-arm study. Nine hundred patients scheduled for non-laparoscopic abdominal surgery at high or intermediate risk for post-operative pulmonary complications are randomized to mechanical ventilation with the level of PEEP at 12 cmH₂O with recruitment maneuvers (the lung-protective strategy) or mechanical ventilation with the level of PEEP at maximum 2 cmH₂O without recruitment maneuvers (the conventional strategy). The primary endpoint is any post-operative pulmonary complication.</p> <p>Discussion</p> <p>The PROVHILO trial is the first randomized controlled trial powered to investigate whether an open lung mechanical ventilation strategy in short-term mechanical ventilation prevents against postoperative pulmonary complications.</p> <p>Trial registration</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN70332574">ISRCTN70332574</a></p

An Integrated Approach for the Early Detection of Endometrial and Ovarian Cancers (Screenwide Study): Rationale, Study Design and Pilot Study

Screenwide is a case-control study (2017-2021) including women with incident endometrial and ovarian cancers (EC and OC), BRCA1/2 and MMR pathogenic variant carriers, and age-matched controls from three centers in Spain. Participants completed a personal interview on their sociodemographic factors, occupational exposure, medication, lifestyle, and medical history. We collected biological specimens, including blood samples, self-collected vaginal specimens, cervical pap-brush samples, uterine specimens, and, when available, tumor samples. The planned analyses included evaluation of the potential risk factors for EC/OC; evaluation of molecular biomarkers in minimally invasive samples; evaluation of the cost-effectiveness of molecular tests; and the generation of predictive scores to integrate different epidemiologic, clinical, and molecular factors. Overall, 182 EC, 69 OC, 98 BRCA pathogenic variant carriers, 104 MMR pathogenic variant carriers, and 385 controls were enrolled. The overall participation rate was 85.7%. The pilot study using 61 samples from nine EC cases and four controls showed that genetic variants at the variant allele fraction > 5% found in tumors (n = 61 variants across the nine tumors) were detected in paired endometrial aspirates, clinician-collected cervical samples, and vaginal self-samples with detection rates of 90% (55/61), 79% (48/61), and 72% (44/61) by duplex sequencing, respectively. Among the controls, only one somatic mutation was detected in a cervical sample. We enrolled more than 800 women to evaluate new early detection strategies. The preliminary data suggest that our methodological approach could be useful for the early detection of gynecological cancers

Intraoperative ventilator settings and their association with postoperative pulmonary complications in neurosurgical patients : post-hoc analysis of LAS VEGAS study

Background Limited information is available regarding intraoperative ventilator settings and the incidence of postoperative pulmonary complications (PPCs) in patients undergoing neurosurgical procedures. The aim of this post-hoc analysis of the 'Multicentre Local ASsessment of VEntilatory management during General Anaesthesia for Surgery' (LAS VEGAS) study was to examine the ventilator settings of patients undergoing neurosurgical procedures, and to explore the association between perioperative variables and the development of PPCs in neurosurgical patients. Methods Post-hoc analysis of LAS VEGAS study, restricted to patients undergoing neurosurgery. Patients were stratified into groups based on the type of surgery (brain and spine), the occurrence of PPCs and the assess respiratory risk in surgical patients in Catalonia (ARISCAT) score risk for PPCs. Results Seven hundred eighty-four patients were included in the analysis; 408 patients (52%) underwent spine surgery and 376 patients (48%) brain surgery. Median tidal volume (V-T) was 8 ml [Interquartile Range, IQR = 7.3-9] per predicted body weight; median positive end-expiratory pressure (PEEP) was 5 [3 to 5] cmH(2)0. Planned recruitment manoeuvres were used in the 6.9% of patients. No differences in ventilator settings were found among the sub-groups. PPCs occurred in 81 patients (10.3%). Duration of anaesthesia (odds ratio, 1.295 [95% confidence interval 1.067 to 1.572]; p = 0.009) and higher age for the brain group (odds ratio, 0.000 [0.000 to 0.189]; p = 0.031), but not intraoperative ventilator settings were independently associated with development of PPCs. Conclusions Neurosurgical patients are ventilated with low V-T and low PEEP, while recruitment manoeuvres are seldom applied. Intraoperative ventilator settings are not associated with PPCs

Хирургическое лечение холециститов и их осложнений

ЖЕЛЧНОКАМЕННАЯ БОЛЕЗНЬЖЕЛЧНЫХ ПУТЕЙ БОЛЕЗНИПЕЧЕНИ БОЛЕЗНИХИРУРГИЯ ЖЕЛЧНЫХ ПУТЕЙХИРУРГИЯ ПЕЧЕНИХОЛЕЦИСТИТКурс лекций включает в себя 8 лекций, посвященных анатомическим сведениям о желчевыводящих путях, этиопатогенезу острого и хронического холецистита. Освещены современные методы диагностики заболевания желчевыводящих путей, приведена клиническая картина различных форм острого холецистита, включая поражения желчевыводящих путей, хирургическая тактика, способы хирургических вмешательств, ошибки в хирургии желчевыводящих путей, постхолецистэктомический синдром

The Effectiveness of a Program of Physical Activity and Diet to Modify Cardiovascular Risk Factors in Patients with Severe Mental Illness (CAPiCOR Study)

Background: Patients with severe mental disorders have a higher prevalence of cardiovascular risk factors. Obesity and sedentarism are cardiovascular risk factors and their control reduces morbidity and mortality. Thus, interventions directed toward decreasing weight and/ or increasing the level of physical activity are necessary.Objectives: The aim of this study would be to evaluate the effectiveness of an educational intervention focused on diet and physical activity in order to change the amount of physical activity, Body Mass Index and waist circumference in these patients.Design: Randomized clinical trial with a control group with one-year follow-up.Setting: Outpatient Mental Health Teams of Barcelona and a residence for patients with severe mental disorders.Participants: Patients between 18 and 65 years of age diagnosed with schizophrenia, a schizoaffective disorder or bipolar disorder in treatment with antipsychotic medication and a low level of physical activity (240 patients in each randomized group).Intervention group: Physical activity group educational program of 24 sessions over 12 weeks and diet (16 sessions in the fist 8 weeks) carried out by nurses and physical activity specialists.Control group: Usual practice with regular checks and the usual treatment of their disease.Main outcome measures: Level of physical activity (IPAQ questionnaire), weight, Body Mass Index and waist circumference.Other outcomes: Cardiovascular risk, quality of life (SF-36 questionnaire), tobacco consumption, dietary habit (PREDIMED questionnaire), blood pressure and laboratory parameters (cholesterol, triglycerides, glucose).Evaluations will be masked and will be made at 0, 3, 6 and 12 months.Data analysis: Intention to treat analysis. Analysis of variance for repeated measures to adjust for differences attributable to the effect of the intervention for potential confounders (drug treatment, care level of intervention and mental status of the patient).Ethical aspects: The project has been evaluated and approved by the ethics committee (CEIC) of the Primary Healthcare-University Research Institute IDIAP Jordi Gol, with registration number P11/64.Trial registration: Clinicaltrials.gov NCT01729650