Simulación clínica en reumatología : efecto de una intervención educativa basada en simulación clínica en el diagnóstico de artritis reumatoide y artrosis por parte de médicos generales, un experimento clínico aleatorizado

Objetivo: Evaluar la efectividad de una herramienta educativa para médicos generales basada en simulación clínica reumatológica, para el diagnóstico de artritis reumatoide y artrosis. Diseño: experimento clínico aleatorizado. Lugar: Bogotá, Colombia. Población: Médicos generales de consulta externa. Intervención: Los sujetos de investigación fueron asignados a uno de dos grupos: a) grupo experimental: intervención educativa en artritis reumatoide con simulación clínica, b) grupo control: intervención educativa sobre aspectos básicos de diagnóstico y tratamiento de osteoporosis. Medición: Cuatro semanas después de la intervención educativa, los integrantes de los dos grupos enfrentaron un proceso evaluativo que incluyó cuatro casos clínicos con pacientes reales (dos pacientes con artritis reumatoide y dos pacientes con artrosis), dos casos clínicos con dos modelos de simulación clínica (un caso de artritis reumatoide y un caso de artrosis) y seis casos clínicos virtuales (tres casos de artritis reumatoide y tres casos de artrosis), en los cuales los participantes anotaron los hallazgos semiológicos detectados, establecieron un diagnóstico y definieron los paraclínicos que solicitarían, si era el caso, para corroborar su diagnóstico Resultados: 160 médicos (80 para el grupo de intervención educativa activa en artritis reumatoide y 80 para el grupo control),89 eran mujeres (56%). Edad promedio 35,0 años (desviación estándar 7,7 años). Se definió como éxito cuando el médico diagnosticara en forma correcta a por lo menos 10 de los 12 casos que se le presentaron, se encontró una diferencia de 81,3% (Intervalo de Confianza del 95% 72-90%) en éxitos a favor del grupo activo (88,8% vs 7,5%) diferencia estadísticamente significativa (p=menor que 0,001). Se encontró un mayor número de aciertos en la detección de los hallazgos semiológicos en el grupo activo comparado con el control (valor de p menor que 0.001) Conclusiones: El presente estudio mostró la efectividad de una intervención educativa basada en simulación clínica para mejorar el abordaje diagnóstico en artritis reumatoide y artrosis, creándose un nuevo horizonte en la enseñanza de la reumatología moderna, lo cual redundará en un beneficio para los pacientes, y en una mejora de la calidad y el empleo de recursos del sistema de salud.Objective: To evaluate the effectiveness of an rheumatology educational tool based on clinical simulation for general practitioners, to improve the diagnosis of rheumatoid arthritis and osteoarthritis. Design: Randomized clinical trial Place: Bogotá, Colombia. Intervention: Research subjects were assigned to one of two groups: a) experimental group: educational intervention in rheumatoid arthritis based on clinical simulation, b) control group: educational intervention on basic aspects of diagnosis and treatment of osteoporosis Measurement: Four weeks after the educational intervention, members of the two groups faced an evaluation process that included four cases with real patients (two patients with rheumatoid arthritis and two patients with osteoarthritis), two cases with two clinical simulation models (a case of rheumatoid arthritis and an osteoarthritis case) and six virtual clinical cases (three rheumatoid arthrits cases and three osteoarthritis cases), in which participants noted the detected semiological findings, established a definitive diagnosis and paraclinical that would apply if it was the case, for corroborate the diagnosis. Results: 160 physicians (80 for the active group and 80 for the control group), 89 were women (56%). Average age 35.0 years (standard deviation 7.7 years). Success was defined as when the doctor diagnosed correctly at least 10 of the 12 cases submitted to it, a difference of 81.3% (confidence interval 95% 72-90%) was found in successes, and was statistically significant in favor of the active group (88.8% vs 7.5%) (p = menor que 0.001). A greater number of hits was found in the detection of the semiological findings in the active group compared with the control (valor de p menor que 0.001) Conclusions: The present study showed the effectiveness of an educational intervention based on clinical simulation to improve the diagnostic approach in rheumatoid arthritis and osteoarthritis, creating a new horizon in the teaching of modern rheumatology, which will result in a benefit for patients, and an improvement in the quality and use of health system resources.Magíster en Epidemiología ClínicaMaestrí

Social networks and traditional metrics of impact in pulmonary medicine journals: a correlation study

Introduction: The Scimago Journal Rank (SJR) impact factor is extensively used. However, as the Internet has become widely available, new metrics are coming into play. Our research aims to determine whether a correlation  between the SJR impact factor and metrics reflecting social media activity does exist.Materials and methods: We have used pulmonary medicine journals indexed in the SJR. Variables of social network usage have been extracted from verified accounts. Bivariate analyses have been performed with the Mann-Whitney U tests, the correlation between social media-derived variables and the SJR impact factor have been assessed with the Spearman correlation coefficient. Results are presented before and after adjustment for the years since the creation of the accounts.Results: From 130 journals, 38 had at least one social network account, Twitter being the most commonly used (22.85%). The H index was higher in journals with social network accounts (Median 60 vs 17; p < 0.01). The global correlation between the SJR and the number of followers on Twitter revealed moderate agreement (r = 0.46; p < 0.01), which was excellent in open access journals (rs = 0.90; p < 0.05).Conclusions: The use of social networks is directly correlated with traditional indicators of scientific impact. The joint use of alternative and traditional metrics may be useful for journals in order to generate strategies aiming to increase their audience, as well as for researchers when deciding about the best option of disseminating their articles

Cardiac tamponade due to lupic pericarditis : report of two cases

La serositis es uno de los hallazgos clínicos en pacientes con lupus eritematoso sistémico. Cuando se presenta a nivel de pericardio, generalmente causa derrames pericárdicos crónicos que no generan inestabilidad hemodinámica en el paciente. Presentamos 2 casos clínicos de mujeres con lupus con derrame pericárdico que lleva a taponamiento cardiaco, presentación inusual de esta manifestación clínica del lupus eritematoso sistémico.Q4Informe de caso63-70Serositis is one of the clinical findings in patients with systemic lupus erythematosus. When is present generally causes chronic pericardial effusions and not generate hemodynamic instability in the patient. We present two cases of women with lupus with pericardial effusion leading to cardiac tamponade, unusual presentation of this clinical manifestation in systemic lupus erythematosus

Correlation of social networks with traditional metrics of impact on scientific journals in nursing

Q3Different bibliometric indexes allow researchers to evaluate the impact of scientific journals based on the number of citations received by their publications. However, the correlation of these indexes with alternative metrics that evaluate the presence of journals on social networks has not been evaluated in nursing journals. The objective of this study was to evaluate the correlation between the SCImago Journal Ranking Indicator (SJR) and alternative metrics of presence in four social networks (Twitter, Facebook, YouTube, Instagram) on indexed nursing journals. A correlation study was conducted in March 2019 through which the nursing journals included in the SJR were identified. Out of a total of 131 journals, 67 were excluded because they were active on social networks that were not their own. 64 were included for analysis. The most frequently used social networks were Twitter (75%) and Facebook (75%). The journals with presence on social networks had higher values for H Index (36.5 vs 12.0, p = 0.00037) and SJR (0.452 vs 0.268, p = 0.0069), and a higher number of publications (≥ 500 publications in 3 years, p = 0.03 ) than those without social networks. The correlation between the SJR and the number of followers on Twitter (r: - 0.067) and the number of followers on Facebook (- 0.18) were poor and in some cases negative. We concluded that the use of social networks as a means of dissemination and interaction by nursing journals is high, being used as a strategy of visibility and dissemination of journal contents.Revista Internacional - Indexad

Clinical practice guidelines for the prevention, early detection, diagnosis, treatment and monitoring of dyslipidemia : non-pharmacological treatment with exercise

Objetivo: Evaluar el impacto del ejerciciocomo una intervención no farmacológica parala prevención primaria y secundaria de eventoscardio y cerebrovasculares asociados a dislipidemiaen personas con hipercolesterolemia.Métodos: Se elaboró una guía de práctica clínicasiguiendo los lineamientos de la guía metodológicadel Ministerio de Salud y ProtecciónSocial para recolectar de forma sistemática laevidencia científica y formular las recomendacionesutilizando la metodología GRADE. Setomó la información específica acerca de ejerciciocomo medida terapéutica en el tratamientode dislipidemia. Resultados: Tanto el ejercicioaeróbico como el de resistencia se asocian adisminución en el colesterol con lipoproteínasde baja densidad y los triglicéridos, cambiosque fueron estadísticamente significativos; peroestos no son clínicamente relevantes, dado quese trata de una reducción mínima. No se encontróun cambio estadísticamente significativo enlos valores de colesterol de alta densidad. Conclusiones:Se presenta evidencia a favor del usode ejercicio como parte fundamental del tratamientode hipercolesterolemia. Aunque no seencontraron diferencias clínicamente significativasen los valores de colesterol o triglicéridos,el ejercicio físico es una actividad con ampliosbeneficios para el paciente en otros dominiosclínicos de interés, por lo que al considerar elriesgo y el beneficio de esta práctica, los beneficiosson claros y superan ampliamente el bajoriesgo al que se expone una persona al realizaruna rutina de ejercicio, como parte de su vidacotidiana.Artículo original34-43Objective: To evaluate the impact of exercise as a non-pharmacological intervention for primary and secondary prevention of cardiovascular events in people with hypercholesterolemia. Methods: A clinical practice guideline was developed following the guidelines of the methodological guidance of the Ministry of Health and Social Protection to collect systematically the evidence and make recommendations using the GRADE methodology. Results: Both aerobic and resistance exercise are associated with decreased LDL cholesterol and triglycerides, changes were statistically significant, but these changes are not clinically relevant since it is a minimal reduction in these values. No statistically significant change was found in HDL cholesterol values. Conclusions: Recommendations for the use of exercise as a fundamental part of the treatment of hypercholesterolemia are formulated. Although no clinically significant differences in the values of cholesterol or triglycerides, exercise is an activity with great benefits for the patient in other clinical domains of interest, being part of healthy lifestyles and exposure to low risk, so when you consider the risks and benefits of this practice, the benefits are clear and far outweigh the low risk to which a person is exposed when performing an exercise routine as part of their daily lives

Nationwide genetic analysis of more than 600 families with inherited eye diseases in Argentina

This study corresponds to the first large-scale genetic analysis of inherited eye diseases (IED) in Argentina and describes the comprehensive genetic profile of a large cohort of patients. Medical records of 22 ophthalmology and genetics services throughout 13 Argentinian provinces were analyzed retrospectively. Patients with a clinical diagnosis of an ophthalmic genetic disease and a history of genetic testing were included. Medical, ophthalmological and family history was collected. A total of 773 patients from 637 families were included, with 98% having inherited retinal disease. The most common phenotype was retinitis pigmentosa (RP, 62%). Causative variants were detected in 379 (59%) patients. USH2A, RPGR, and ABCA4 were the most common disease-associated genes. USH2A was the most frequent gene associated with RP, RDH12 early-onset severe retinal dystrophy, ABCA4 Stargardt disease, PROM1 cone-rod dystrophy, and BEST1 macular dystrophy. The most frequent variants were RPGR c.1345 C > T, p.(Arg449*) and USH2A c.15089 C > A, p.(Ser5030*). The study revealed 156/448 (35%) previously unreported pathogenic/likely pathogenic variants and 8 possible founder mutations. We present the genetic landscape of IED in Argentina and the largest cohort in South America. This data will serve as a reference for future genetic studies, aid diagnosis, inform counseling, and assist in addressing the largely unmet need for clinical trials to be conducted in the region

5to. Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad. Memoria académica

El V Congreso Internacional de Ciencia, Tecnología e Innovación para la Sociedad, CITIS 2019, realizado del 6 al 8 de febrero de 2019 y organizado por la Universidad Politécnica Salesiana, ofreció a la comunidad académica nacional e internacional una plataforma de comunicación unificada, dirigida a cubrir los problemas teóricos y prácticos de mayor impacto en la sociedad moderna desde la ingeniería. En esta edición, dedicada a los 25 años de vida de la UPS, los ejes temáticos estuvieron relacionados con la aplicación de la ciencia, el desarrollo tecnológico y la innovación en cinco pilares fundamentales de nuestra sociedad: la industria, la movilidad, la sostenibilidad ambiental, la información y las telecomunicaciones. El comité científico estuvo conformado formado por 48 investigadores procedentes de diez países: España, Reino Unido, Italia, Bélgica, México, Venezuela, Colombia, Brasil, Estados Unidos y Ecuador. Fueron recibidas un centenar de contribuciones, de las cuales 39 fueron aprobadas en forma de ponencias y 15 en formato poster. Estas contribuciones fueron presentadas de forma oral ante toda la comunidad académica que se dio cita en el Congreso, quienes desde el aula magna, el auditorio y la sala de usos múltiples de la Universidad Politécnica Salesiana, cumplieron respetuosamente la responsabilidad de representar a toda la sociedad en la revisión, aceptación y validación del conocimiento nuevo que fue presentado en cada exposición por los investigadores. Paralelo a las sesiones técnicas, el Congreso contó con espacios de presentación de posters científicos y cinco workshops en temáticas de vanguardia que cautivaron la atención de nuestros docentes y estudiantes. También en el marco del evento se impartieron un total de ocho conferencias magistrales en temas tan actuales como la gestión del conocimiento en la universidad-ecosistema, los retos y oportunidades de la industria 4.0, los avances de la investigación básica y aplicada en mecatrónica para el estudio de robots de nueva generación, la optimización en ingeniería con técnicas multi-objetivo, el desarrollo de las redes avanzadas en Latinoamérica y los mundos, la contaminación del aire debido al tránsito vehicular, el radón y los riesgos que representa este gas radiactivo para la salud humana, entre otros

patrimonio intelectual

Actas de congresoLas VI Jornadas se realizaron con la exposición de ponencias que se incluyeron en cuatro ejes temáticos, que se desarrollaron de modo sucesivo para facilitar la asistencia, el intercambio y el debate, distribuidos en tres jornadas. Los ejes temáticos abordados fueron: 1. La enseñanza como proyecto de investigación. Recursos de enseñanza-aprendizaje como mejoras de la calidad educativa. 2. La experimentación como proyecto de investigación. Del ensayo a la aplicabilidad territorial, urbana, arquitectónica y de diseño industrial. 3. Tiempo y espacio como proyecto de investigación. Sentido, destino y usos del patrimonio construido y simbólico. 4. Idea constructiva, formulación y ejecución como proyecto de investigación. Búsqueda y elaboración de resultados que conforman los proyectos de la arquitectura y el diseño

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Inicio de artritis reumatoide durante el embarazo

Reportamos 2 casos de artritis reumatoide que inician durante el periodo de gestación, situación clínica muy poco frecuente y de la cual no encontramos otros casos clínicos reportados.Q4Informe de caso141-145Two cases are presented of rheumatoid arthritis that started during the gestation period, a rare clinical situation and for which no other clinical cases are reported