Multimedia metodológica para perfeccionar el proceso de enseñanza aprendizaje en las carreras de ciencias médicas

Fundamento: A raíz de las transformaciones necesarias en el sector de la salud se requiere de una mejor organización del proceso de enseñanza  aprendizaje para garantizar la calidad de la formación de los futuros egresados. Objetivo: Evaluar la utilidad de la multimedia metodológica para  perfeccionar la planificación, ejecución y control  del proceso de enseñanza aprendizaje de las  ciencias médicas. Metodología: Investigación de desarrollo tecnológico que tiene tres fases: la fase de diagnóstico (la identificación de  necesidades de aprendizaje mediante el grupo focal); la fase de diseño, la cual contiene una sección superior con las imágenes de la Universidad Médica, una sección central que registra los contenidos fundamentales de la multimedia y una sección  lateral  con las temáticas fundamentales; y la fase de evaluación con  la entrevista al azar a 762 profesores de los 24  departamentos docentes de la provincia Sancti Spíritus. Resultados: El 100 % de los entrevistados refirió que la multimedia facilita acceder a las principales  normativas para el trabajo docente metodológico, más del 95 % que ayuda a una correcta planificación y control, además, que contribuye a la auto preparación y actualización pedagógica. Conclusiones: La multimedia metodológica resultó de gran utilidad para perfeccionar la planificación, ejecución y control del proceso de enseñanza aprendizaje  por su nivel de generalización y actualización. DeCS:  MULTIMEDIA; MATERIALES DE ENSEÑANZA; MEDIOS AUDIOVISUALES. Palabras clave: Multimedia metodológica, proceso de enseñanza-aprendizaje; materiales de enseñanza, medios audiovisuales

Percepción de la calidad de vida en pacientes adultos mayores con diabetes mellitus tipo II

Introducción: la calidad de vida es un parámetro dependiente de la autopercepción que tenga cada individuo. Objetivo: evaluar la percepción de la calidad de vida por pacientes adultos mayores con padecimiento de diabetes mellitus tipo II. Métodos: se realizó un estudio cualitativo del tipo investigación-acción participativa en 37 adultos mayores del área de salud 11, Policlínico Universitario «René Vallejo Ortiz», Manzanillo, noviembre 2016 - junio 2017. La calidad de vida se midió utilizando el cuestionario de WHOQOL-BREF realizando una visita pormenorizada a las viviendas. Resultados: predominó el sexo femenino (75.68 %) con una media de edad de 71.24 años. El 27,03 % de los adultos mayores eran divorciados o viudos, 62.16 % convivían en familias extensas, 59.46 % convivían en familias funcionales mientras que 51.35 % convivían en familias con ingresos económicos medios. La comorbilidad fue prevalente a expensas de la hipertensión arterial (67.47 %). El tiempo medio de evolución de la enfermedad fue de 11.37 años. La calidad de vida fue autopercibida como deficiente en el 67.57 % de los adultos mayores a expensas de la satisfacción con su salud (75.68 %). La dependencia de sustancias médicas resultó ser el dominio de mayor puntuación y el que mayor incidencia tuvo en el resultado final de la percepción de la calidad de vida. Conclusiones: se hace necesario una estrategia coordinada entre los distintos sectores de la sociedad que busquen una mayor calidad de vida en adultos mayores con enfermedades crónicas como la diabetes mellitus tipo II

Safety of hospital discharge before return of bowel function after elective colorectal surgery

© 2020 BJS Society Ltd Published by John Wiley & Sons LtdBackground: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function. Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien–Dindo classification system. Results: A total of 3288 patients were included in the analysis, of whom 301 (9·2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4–7) and 7 (6–8) days respectively (P < 0·001). There were no significant differences in rates of readmission between these groups (6·6 versus 8·0 per cent; P = 0·499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0·90, 95 per cent c.i. 0·55 to 1·46; P = 0·659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34·7 versus 39·5 per cent; major 3·3 versus 3·4 per cent; P = 0·110). Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Safety of hospital discharge before return of bowel function after elective colorectal surgery

Background: Ileus is common after colorectal surgery and is associated with an increased risk of postoperative complications. Identifying features of normal bowel recovery and the appropriateness for hospital discharge is challenging. This study explored the safety of hospital discharge before the return of bowel function.Methods: A prospective, multicentre cohort study was undertaken across an international collaborative network. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The main outcome of interest was readmission to hospital within 30 days of surgery. The impact of discharge timing according to the return of bowel function was explored using multivariable regression analysis. Other outcomes were postoperative complications within 30 days of surgery, measured using the Clavien-Dindo classification system.Results: A total of 3288 patients were included in the analysis, of whom 301 (9.2 per cent) were discharged before the return of bowel function. The median duration of hospital stay for patients discharged before and after return of bowel function was 5 (i.q.r. 4-7) and 7 (6-8) days respectively (P &lt; 0.001). There were no significant differences in rates of readmission between these groups (6.6 versus 8.0 per cent; P = 0.499), and this remained the case after multivariable adjustment for baseline differences (odds ratio 0.90, 95 per cent c.i. 0.55 to 1.46; P = 0.659). Rates of postoperative complications were also similar in those discharged before versus after return of bowel function (minor: 34.7 versus 39.5 per cent; major 3.3 versus 3.4 per cent; P = 0.110).Conclusion: Discharge before return of bowel function after elective colorectal surgery appears to be safe in appropriately selected patients

Timing of nasogastric tube insertion and the risk of postoperative pneumonia: an international, prospective cohort study

Aim: Aspiration is a common cause of pneumonia in patients with postoperative ileus. Insertion of a nasogastric tube (NGT) is often performed, but this can be distressing. The aim of this study was to determine whether the timing of NGT insertion after surgery (before versus after vomiting) was associated with reduced rates of pneumonia in patients undergoing elective colorectal surgery. Method: This was a preplanned secondary analysis of a multicentre, prospective cohort study. Patients undergoing elective colorectal surgery between January 2018 and April 2018 were eligible. Those receiving a NGT were divided into three groups, based on the timing of the insertion: routine NGT (inserted at the time of surgery), prophylactic NGT (inserted after surgery but before vomiting) and reactive NGT (inserted after surgery and after vomiting). The primary outcome was the development of pneumonia within 30 days of surgery, which was compared between the prophylactic and reactive NGT groups using multivariable regression analysis. Results: A total of 4715 patients were included in the analysis and 1536 (32.6%) received a NGT. These were classified as routine in 926 (60.3%), reactive in 461 (30.0%) and prophylactic in 149 (9.7%). Two hundred patients (4.2%) developed pneumonia (no NGT 2.7%; routine NGT 5.2%; reactive NGT 10.6%; prophylactic NGT 11.4%). After adjustment for confounding factors, no significant difference in pneumonia rates was detected between the prophylactic and reactive NGT groups (odds ratio 1.03, 95% CI 0.56–1.87, P = 0.932). Conclusion: In patients who required the insertion of a NGT after surgery, prophylactic insertion was not associated with fewer cases of pneumonia within 30 days of surgery compared with reactive insertion

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background: Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods: The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results: A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion: Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)