Assoliment dels objectius docents mitjançant l'aprenentatge basat en problemes (ABP) en l'assignatura de pregrau d'anestesiologia, reanimació i terapèutica del dolor

Comprovar l'assoliment dels objectius docents de l'assignatura optativa d'Anestesiologia, Reanimació i Terapèutica del Dolor en pregrau basada en l'AB

Retenció i assimilació de coneixements en l'assignatura de Pregrau d'anestesiologia, reanimació i terapèutica del dolor després d'un any mitjançant l'aprenentatge basat en problemes

Introducció: L'aprenentatge basat en problemes (ABP) implica als estudiants en un procés educatiu en el que es desenvolupa la seva capacitat per a resoldre problemes i assolir una educació autònoma necessària per a confrontar-se amb èxit als reptes de la vida professional. Presentem la nostra experiència docent dels últims 6 anys basada en l'ABP en l'assignatura optativa d'Anestesiologia, Reanimació i Terapèutica del Dolor en l'Hospital Germans Trias i Pujol, Badalona. Objectiu: Comprovar el grau de retenció i assimilació dels coneixements anestèsics adquirits pels alumnes mitjançant l'ABP després d'un any. Material i mètode: Un cop definits i repartits els objectius docents de l'assignatura en 12 sessions, els 12 tutors vam dissenyar una avaluació tipus test a realitzar pels mateixos estudiants de forma anònima i voluntària al finalitzar el curs i un any més tard. Resultats: El test final de curs fou realitzat per tots els alumnes (19 dones i 5 homes) amb una edat mitja de 23,5 anys. Un any després el test fou complimentat per 10 dones i 4 homes del mateix grup. La nota global del test al finalitzar l'assignatura fou de 7,2 i la de l'any següent fou de 7,96 que supera a l'inicial en 0,76 punts. Conclusió: L'ABP sembla contribuir a una millor retenció i assimilació de coneixements a llarg termini; és una forma eficaç i vàlida per a impartir educació mèdica en un programa coherent i integrat oferint avantatges sobre els mètodes d'ensenyament tradicionals i representa la nostra aportació al intent d'adaptar el currículum a la innovació metodològica exigida des d'Europa a partir de l'any 2010 dins del marc de l'Espai Europeu d'Educació Superior.Problem based learning (PBL) makes the student be part of an educational process where he may develop his solving problems-capacity and gain self-education in order to face with success professional life in the future. We present our 6-years PBL experience on Anesthesiology-teaching as an optional course in the University Hospital Germans Trias i Pujol in Badalona. Objective: To evaluate the retention and assimilation levels of anesthesiological knowledge acquired by the students with PBL after one year. Material and methods: Educational objectives were defined and included in 12 PBL-cases. At the end of the teaching programme the students were asked to undergo a voluntary and anonymous test (100 true/false sentences) in order to evaluate the understanding and assimilation levels of theoretical knowledge acquired with the PBL method. The same test was repeated with the same students one year later. Results: Immediately after the course the test was filled in by all the students (19 women and 5 men) with an average age of 23.5 years. One year later 10 women and 4 men of the same group filled in the test. The final score of the test after the course was 7.2 and the score one year later was 7.96, that means a score increase of 0.76. Conclusion: PBL seems to contribute to a better retention and assimilation of knowledge as a long term effect. PBL is an effective and valid teaching method for medical education in a coherent and integrated way and offers advantages compared to other traditional teaching methods. It represents our attempt to adapt our curriculum to the methodological innovation asked from 2010 as described in the "Bologna Process"

TDR-LAB 2.0 improved TDR software for soil water content and electrical conductivity measurements

En la actualidad, la técnica “Reflectrometría de Dominio Temporal” (TDR por sus siglas en inglés) proporciona a los grupos de investigación en agronomía, hidrología o ciencias del suelo, un método fiable para la medida de la humedad (θ) y la conductividad eléctrica (σ) del suelo, factores que regulan el crecimiento y desarrollo de las plantas. La existencia de aplicaciones informáticas que manejen TDR es escasa, por lo que se plantea la necesidad de desarrollar aplicaciones compatibles con los diferentes equipos TDR disponibles en el mercado que aporten productividad y fiabilidad en la medida de θ y σ. En la actualidad, resulta inviable para un organismo investigador el coste extra del software de control necesario para cada nuevo dispositivo TDR. Para reducir costes y complejidad de manejo, surgió la versión inicial de la aplicación TDR-LAB

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

Bloqueo epidural alto por migración de un catéter paravertebral colocado mediante visión directa del cirujano para control analgésico tras toracotomía

The analgesic technique of choice for postoperative pain control after thoracic surgery remains a thoracic epidural analgesia. In the last 10 years, many studies have shown continuous paravertebral block as equally effective and even safer, with few cases of serious associated complications. We present the case of a 73-year-old female, ASA III, undergoing a left atypical pulmonary resection with intraoperative placement of a paravertebral catheter by surgeon’s direct vision for postoperative analgesia.5 hours later she presented a high epidural block (T1 sensitive, T4 motor). Local anaesthetic infusion was stopped, and the epidural catheter’s tip location was confirmed by contrast radiological image. In our case, catheter’s migration questions the sense of greater safety of this technique and emphasizes the mandatory need of strict monitoring in any performed procedure.La técnica analgésica de elección para el control del dolor postoperatorio tras una cirugía de tórax sigue siendo la analgesia epidural. En los últimos 10 años, varios estudios han presentado al bloqueo paravertebral continuo como igualmente efectivo e incluso más seguro con pocas complicaciones graves asociadas. Presentamos el caso de una paciente de 73 años, ASA III, sometida a cirugía de resección pulmonar con colocación de un catéter paravertebral por visión directa del cirujano para analgesia postoperatoria. 5 horas más tarde la paciente presentó clínica de bloqueo epidural alto (sensitivo hasta T1, motor hasta T4). Se detuvo la infusión de anestésico local, y se confirmó la localización de la punta del catéter mediante imagen radiológica con contraste. En este caso, la migración del catéter cuestiona la sensación de mayor seguridad de esta técnica y hace énfasis en la necesidad de mantener una monitorización estricta de cualquier procedimiento que realicemos

Depopulation impacts on ecosystem services in Mediterranean rural areas

Despite the exponential increase in human population at global scale, some rural areas have experienced a progressive abandonment over the last decades. Under particular socioecological and policy contexts, changes in demography may promote land-use changes and, consequently, alter ecosystem services (ES) supply. However, most studies on this topic have targeted urban population increase, whereas depopulation has been rarely addressed. Here, we examined how shifts in demographic variables (human population, population density, and number of villages) affect provisioning (water supply, food and biomass production) and regulating (soil retention, water and nutrient regulation) ES in Mediterranean rural areas with contrasting environmental, so-cioeconomic and land-use contexts. When depopulation results in underuse of socio-ecological systems, we ex-pected a decrease of provisioning and an increase of regulating ES, whereas we expected the opposite pattern when it results in land-use intensification. To test this hypothesis, we compared demographic data and ES estimated with Soil and Water Assessment Tool (SWAT) linked to land-use changes between the 1950s and 2000s in three rural areas of Arag ́on (NE Spain). Generalized Additive Mixed Models and Linear Mixed-Effect Models were used to analyze demographic trends, ES changes and the relationship between them. We found severe depopulation (− 42% inhabitants) and associated land-use changes in the three areas, which was particularly evident in isolated mountainous zones (− 63% inhabitants). Depopulation trends significantly affected land use and, consequently, all of the ES evaluated. In mountainous depopulated areas, land abandonment and rewilding resulted in the increase in water regulation (>1000%) and soil retention (>400%). In contrast, agriculture was intensified in more fertile and easy-to-access lowland areas, boosting the food production service (>600%). Accordingly, the interactions among depopulation, crop production and regulating ES should be considered in the management schemes and policies targeting rural areas for a balanced and sustainable supply of ES in the long term

Aïllament epicàrdic de les venes pulmonars amb ultrasons d'alta intensitat per al tractament quirúrgic de la fibril·lació auricular no primària

Aquest és un estudi prospectiu observacional de cohorts de 59 malalts amb fibril·lació auricular no primària tractats amb ablació epicàrdica de venes pulmonars amb ultrasons

Decline in age at menarche among Spanish women born from 1925 to 1962

<p>Abstract</p> <p>Background</p> <p>While the timing of reproductive events varies across populations, a downward trend in age at menarche has nevertheless been reported in most of the developed world over the past century. Given the impact of change in age at menarche on health conditions, this study sought to examine secular trends in age at menarche among women living in Navarre (Northern Spain) who participated in a population-based breast cancer screening programme.</p> <p>Methods</p> <p>The study was based on 110545 women born from 1925 to 1962. Trends were tested using a linear regression model, in which year of birth was entered continuously as the predictor and age at menarche (years) as the response variable, using size of town and region of birth as covariates.</p> <p>Results</p> <p>Among women born in Navarre between 1925 and 1962, age at menarche declined steadily from an average of 13.72 years in the 1925-1929 birth-cohorts to 12.83 years in the 1958-1962 birth-cohorts. Controlling for size of town or city of birth, age at menarche declined by an average of 0.132 years every 5 years over the period 1925-1962. This decline was greater in women born in rural versus urban settings. Trends were also different among regions of birth.</p> <p>Conclusion</p> <p>We report a population-based study showing a downward trend in age of onset of menarche among Spanish women born in the period 1925-1962, something that is more pronounced among women born in rural settings and varies geographically.</p

Sex difference and intra-operative tidal volume: Insights from the LAS VEGAS study

BACKGROUND: One key element of lung-protective ventilation is the use of a low tidal volume (VT). A sex difference in use of low tidal volume ventilation (LTVV) has been described in critically ill ICU patients.OBJECTIVES: The aim of this study was to determine whether a sex difference in use of LTVV also exists in operating room patients, and if present what factors drive this difference.DESIGN, PATIENTS AND SETTING: This is a posthoc analysis of LAS VEGAS, a 1-week worldwide observational study in adults requiring intra-operative ventilation during general anaesthesia for surgery in 146 hospitals in 29 countries.MAIN OUTCOME MEASURES: Women and men were compared with respect to use of LTVV, defined as VT of 8 ml kg-1 or less predicted bodyweight (PBW). A VT was deemed 'default' if the set VT was a round number. A mediation analysis assessed which factors may explain the sex difference in use of LTVV during intra-operative ventilation.RESULTS: This analysis includes 9864 patients, of whom 5425 (55%) were women. A default VT was often set, both in women and men; mode VT was 500 ml. Median [IQR] VT was higher in women than in men (8.6 [7.7 to 9.6] vs. 7.6 [6.8 to 8.4] ml kg-1 PBW, P &lt; 0.001). Compared with men, women were twice as likely not to receive LTVV [68.8 vs. 36.0%; relative risk ratio 2.1 (95% CI 1.9 to 2.1), P &lt; 0.001]. In the mediation analysis, patients' height and actual body weight (ABW) explained 81 and 18% of the sex difference in use of LTVV, respectively; it was not explained by the use of a default VT.CONCLUSION: In this worldwide cohort of patients receiving intra-operative ventilation during general anaesthesia for surgery, women received a higher VT than men during intra-operative ventilation. The risk for a female not to receive LTVV during surgery was double that of males. Height and ABW were the two mediators of the sex difference in use of LTVV.TRIAL REGISTRATION: The study was registered at Clinicaltrials.gov, NCT01601223

4to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

Este volumen acoge la memoria académica de la Cuarta edición del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2017, desarrollado entre el 29 de noviembre y el 1 de diciembre de 2017 y organizado por la Universidad Politécnica Salesiana (UPS) en su sede de Guayaquil. El Congreso ofreció un espacio para la presentación, difusión e intercambio de importantes investigaciones nacionales e internacionales ante la comunidad universitaria que se dio cita en el encuentro. El uso de herramientas tecnológicas para la gestión de los trabajos de investigación como la plataforma Open Conference Systems y la web de presentación del Congreso http://citis.blog.ups.edu.ec/, hicieron de CITIS 2017 un verdadero referente entre los congresos que se desarrollaron en el país. La preocupación de nuestra Universidad, de presentar espacios que ayuden a generar nuevos y mejores cambios en la dimensión humana y social de nuestro entorno, hace que se persiga en cada edición del evento la presentación de trabajos con calidad creciente en cuanto a su producción científica. Quienes estuvimos al frente de la organización, dejamos plasmado en estas memorias académicas el intenso y prolífico trabajo de los días de realización del Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad al alcance de todos y todas