Depression, anxiety, burnout and empathy among Spanish medical students

© 2021 Capdevila-Gaudens et al. This is an open access article distributed under the terms of the Creative Commons Attribution CC-BY 4.0 license http://creativecommons.org/licenses/by /4.0/ This document is the Accepted version of a Published Work that appeared in final form in PLOS. To access the final edited and published work see https://doi.org/10.1371/journal. pone.0260359Medical Education studies suggest that medical students experience mental distress in a proportion higher than in the rest of the population In the present study, we aimed to conduct a nationwide analysis of the prevalence of mental health problems among medical students. The study was carried out in 2020 in all 43 medical schools in Spain, and analyzes the prevalence of depression, anxiety, empathy and burnout among medical students (n = 5216). To measure these variables we used the Beck Depression Inventory Test for assessing depression, the Maslach Burnout Inventory Survey for Students was used for burnout, the State-Trait Anxiety Inventory (STAI) was used to assess anxiety state and trait and the Jefferson Empathy Scale 12 to obtain empathy scores. In relation to depression, the data indicate an overall prevalence of 41%, with 23.4% of participants having moderate to severe levels, and 10% experiencing suicidal ideation. Burnout prevalence was 37%, significantly higher among 6th year than among 1st year students. Anxiety levels were consistent with those reported previously among medical students (25%), and were higher than in the general population for both trait and state anxiety. The prevalence of trait anxiety was higher among women. Empathy scores were at the top end of the scale, with the highest-scoring group (>130) containing a greater percentage of women. Similarly to those published previously for other countries, these results provide a clear picture of the mental disorders affecting Spanish medical students. Medicine is an extremely demanding degree and it is important that universities and medical schools view this study as an opportunity to ensure conditions that help minimize mental health problems among their students. Some of the factors underlying these problems can be prevented by, among other things, creating an environment in which mental health is openly discussed and guidance is provided. Other factors need to be treated medically, and medical schools and universities should therefore provide support to students in need through the medical services available within their institutions

Project DABE: Empathy among Spanish Medical Students

©2022. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/ This document is the Published, version of a Published Work that appeared in final form in Educación Médica. To access the final edited and published work see https://doi.org/10.1016/j.edumed.2022.100769ntroduction Empathy refers to an aspect of personality, important in interpersonal relationships and in communication, considered to be an important value in the medical profession. In the present study, we have studied empathy in a sample of more than 5,000 medical students of all 43 medical schools in Spain. Methods The data belong to the DABE project, a study that included mental health variables and that was applied through a web survey just before COVID-19 pandemic restrictions started. To measure empathy, we used the Jefferson Empathy Scale (Student Version), which comprises 20 items relating to three underlying components, Perspective Taking, Compassionate Care, and Standing in the Patient’s Shoes. Results Empathy global score was high and it increased progressively every year during medical school. Empathy score was greater in the female students, with a 20% of participants showed high levels of empathy, again more in women. High empathy was associated with students having greater social support, more interest and participation in everyday experiences and satisfaction with social activities. The three components of empathy were also greater in women than in men. Empathy scores were significantly lower in those students that reported smoking and also in the students that reported use of frequent use of cannabis. Discussion Empathy scores are high in the spanish medical students population, with a 20% of them showing high levels. Empathy scores increase longitudinally during medical school, are greater in female students and lower in those smoking either tobacco or cannabis

Combined effect of water potential and temperature on seed germination and seedling development of cacti from a mesic Argentine ecosystem

"Global climatic change will be associated with an increase of droughts and heat waves, which can affect seed germination and plant population dynamics. Cactus species from mesic ecosystems are likely to be more affected by these events than species from arid ecosystems. The aim of the study was to assess the combined effect of water potentials and temperatures on seed germination and seedling traits in six globose cactus species from Córdoba Mountains: Echinopsis candicans, Gymnocalycium bruchii, G. capillense, G. mostii, G. quehlianum and Parodia mammulosa. A factorial experiment was performed in which four water potential levels (0, ?0.2, ?0.4 and ?0.6 MPa) were combined with two temperature levels (25 and 32 °C). Germination (%) and mean germination time (T50) were recorded and seedling shape (width and length) was measured. In general, a decrease in water potential and an increase in temperature resulted in low germination, with different behaviors among species. At 32 °C and low water potentials, germination was low or null for almost all species. There was not a clear trend in the response of T50 to the treatments. Seedling development was highly and negatively affected by the combination of factors, particularly at low water potentials. The responses of the analyzed cactus species to low water potential were similar to those of cactus species from more arid ecosystems. Our results suggest that the studied species would be severely affected by changes in temperature and precipitation as predicted under a climate change scenario.

Una experiencia de integración de la Formación Sanitaria Especializada con la Universitaria de Posgrado: Entrenamiento por etapas en cirugía laparoscópica.

Background: Design of a simulation model training in laparoscopic surgery for surgical residents. Methods: Three stages of progressive training were programmed within a Postgraduate Degree in Clinical Anatomy. Stage 1 was performed in a box-trainer with synthetic materials: managing small objects, dissection with clamp and scissors, and laparoscopic intracorporeal suture. Stage 2 used biological material (fresh digestive tract from a human corpse) in box-trainer, practicing section and intracorporeal anastomosis. In stage 3, laparoscopy was performed on a fresh corpse (appendectomy, cholecystectomy, lesser sac opening, right and left colectomy). A satisfaction survey was carried out to the participants. Results: Some six General and Digestive Surgery residents took the program. All of them completed the stage 1 and 2 exercises. In stage 3, the pneumoperitoneum could be performed without any complications, and tissues presented an adequate texture. First-year residents completed appendectomy and cholecystectomy, but more complex procedures required more experienced residents. The participants reflected that the program is adequate and useful to gain basic skills in laparoscopy. Conclusions: The proposed model is reproducible and adequate in acquisition of basic skills in laparoscopic surgery.Antecedentes: Diseño de un modelo de simulación para formación en cirugía laparoscópica. Métodos: Dentro del Máster Anatomía Aplicada a la Clínica se implementaron tres etapas de formación progresiva en médicos residentes. La etapa 1 se realizó en simulador con material no biológico: manejo de objetos, disección con pinza y tijera, y sutura laparoscópica. La etapa 2 utilizó material biológico (tubo digestivo en fresco) en simulador, para la práctica de sección intestinal y anastomosis intracorpórea. En la etapa 3 se realizaron técnicas laparoscópicas en cadáver en fresco (apendicectomía, colecistectomía, apertura de la transcavidad epiploica, hemicolectomías derecha e izquierda). Se añadió una encuesta de satisfacción a los participantes de la actividad. Resultados: El programa se impartió a 6 residentes de Cirugía General. Todos completaron los ejercicios de las etapas 1 y 2. En la etapa 3 se pudo realizar el neumoperitoneo sin dificultad y los tejidos presentaron una textura adecuada. Los residentes de primer año completaron la apendicectomía y la colecistectomía, pero procedimientos más complejos requirieron residentes con más experiencia. Los participantes encuestados reflejaron que el programa es adecuado y útil para el entrenamiento en laparoscopia. Conclusiones: El modelo propuesto es reproducible y adecuado en adquisición de competencias básicas en cirugía laparoscópica

Validación de la disección axilar dirigida por clip y radiotrazador como técnica de estadificación axilar del cáncer de mama tras quimioterapia neoadyuvante

Introducción y objetivos: El tratamiento axilar estándar del cáncer de mama (CM) con ganglios metastásicos al diagnóstico (cN1-3) y quimioterapia neoadyuvante (QTNA) es la linfadenectomía axilar (LA). Para evitarla, se idearon nuevas técnicas de estadificación axilar post-QTNA, como la localización pre-QTNA del ganglio afecto con un marcador, realizando posteriormente una biopsia selectiva del ganglio centinela (BSGC) y del tejido ganglionar marcado (BCLIP), denominado “Disección Axilar Dirigida” (DAD). El objetivo de este trabajo es estudiar la factibilidad y la validez de dicha técnica en pacientes con CM cN1 sometidas a QTNA, y determinar factores predictivos del resultado de la LA, para identificar casos en los que pudiera omitirse. Material y método: Estudio prospectivo observacional entre enero 2016-agosto 2019. Se incluyeron pacientes con CM y estadificación cN1 confirmada histológicamente, tratadas con QTNA, sometidas a marcaje pretratamiento con clip, y con posterior realización de DAD y LA. Se realizó: (1) Un análisis de factibilidad de variables clínicas, radiológicas, anatomopatológicas, dificultades y complicaciones de las técnicas empleadas. (2) Un estudio de pruebas diagnósticas de la BSGC, la BCLIP, y la combinación de sus resultados (DAD), tomando como Gold Standard la LA. (3) Un estudio de casos y controles entre las pacientes con y sin afectación metastásica en la LA, y entre aquellas con un resultado “falso” y “verdadero” positivo en la DAD, realizándose un análisis univariante y multivariante (regresión logística) con las variables mencionadas, para conocer factores predictores del estado axilar tras QTNA. Resultados: 60 pacientes fueron incluidas. 22 pacientes (36,7%) tuvieron respuesta clínica completa a la QTNA, y 43 pacientes (71,7%) fueron ycN0 (en la reevaluación clínico-ecográfica postneoadyuvancia). No hubo dificultades ni complicaciones en la colocación del clip. 3 pacientes (5%) presentaron problemas en la colocación del arpón por dificultades en la visualización ecográfica postneoadyuvancia. La localización intraoperatoria del ganglio clipado fue problemática en 7 casos (11,7%). La tasa de respuesta patológica completa (pCR) fue de 30,5% (18 pacientes) y la de respuesta patológica axilar completa (ypN0) fue de 38,3% (23 pacientes). La sensibilidad (BSGC: 80,9% (IC95% 61,8-100); BCLIP: 80,8% (IC95% 63,7-97,8); DAD: 92,6% (IC95% 80,9-100)) y el valor predictivo negativo (BSGC: 84,6% (IC95% 68,8-100); BCLIP: 81,0% (IC95% 63,7-97,8); DAD: 91,3% (IC95% 77,6-100), figura 4.9) fueron superiores a la especificidad (BSGC: 68,7% (IC95% 51,1-86,4); BCLIP: 63,6% (IC95% 45,7-81,6); DAD: 63,6% (IC95% 45,7-81,6)) y valor predictivo positivo (BSGC: 62,9% (IC95% 42,9-83,0); BCLIP: 63,6% (IC95% 45,7-81,6); DAD: 67,6% (IC95% 51,1-84,0)). El tamaño del tumor al diagnóstico (Odds Ratio (OR) = 1,67; IC95% 1,02-2,74), el número de ganglios ecográficamente sospechosos al diagnóstico (OR = 2,20; IC95% 1,01-4,77), el HER2 positivo (OR 0,04; IC95% 0,003-0,54), la respuesta clínico-radiológica completa a la QTNA (OR = 0,07; IC95% 0,01-0,75), y la DAD positiva (OR 15,48; IC95% 1,68-142,78) fueron factores predictores independientes del resultado positivo en la LA. A partir del modelo de regresión logística, se realizó un score predictivo de LA positiva, con una buena calibración (test Hosmer-Lemeshow: p = 0,65), y discriminación (área bajo la curva = 0,93; IC95% 0,87-0,99), y con el mayor índice de Youden (0,7) en el 17% de riesgo de LA positiva (sensibilidad = 100%; especificidad = 70%). El único factor predictor independiente de un resultado falso positivo en la DAD fue el HER2 positivo (OR = 22,63; IC95% 1,14-450,98). Conclusiones: La DAD es factible y válida para descartar afectación metastásica axilar en pacientes con CM cN1 con respuesta a QTNA. En pacientes con bajo tamaño tumoral y número de ganglios sospechosos ecográficamente al diagnóstico, HER2 positivas, respuesta clínico-radiológica completa a la QTNA, DAD negativa, o más de uno de estos factores, se podría plantear la omisión de la LA.Introduction and aims: The standard treatment of the axilla in breast cancer (BC) with affected lymph nodes at diagnosis (cN1-3) and neoadjuvant chemotherapy (NACT) is an axillary lymph node dissection (ALND). In order to avoid it, new (post-NACT) axillary staging techniques were developed, such as the localization of the affected lymph node prior to NACT with a marker, subsequently performing a sentinel lymph node biopsy (SLNB) and the marked node biopsy (MNB), named as “Targeted Axillary Dissection” (TAD). The aim of this research is to study the feasibility and value of this technique in patients with BC cN1 undergoing NACT, and to determine predictive factors of the result of the ALND, in order to identify patients in which it could be omitted. Material and method: Prospective observational study between January 2016 and August 2019. Patients with BC, and histologically confirmed cN1 staging, treated with NACT, and marked with a metallic clip prior to neoadjuvant treatment were included. We performed: (1) A feasibility analysis of clinical, radiological, pathological variables, difficulties and complications of the TAD. (2) A diagnostic test study of the SLNB, MNB and the combination of their results (TAD), using ALND as Gold Standard. (3) A case-control study between patients with and without metastatic involvement in ALND, and between those with a “false” and “true” positive result in TAD, performing univariate and multivariate analysis (logistic regression) with the mentioned variables, in order to know predictive factors of axillary state after NACT. Results: 60 patients were included. 22 patients (36.7%) had a complete clinical response to NACT, and 43 patients (71.7%) were ycN0 (in the post-neoadjuvant clinical and ultrasound evaluation). Neither limitations nor complications in clip placement were found. 3 patients (5%) presented problems in wire placement due to difficulties in post-neoadjuvant ultrasound imaging. Intraoperative location of the clipped node was problematic in 7 cases (11.7%). The pathological complete response rate (pCR) was 30.5% (18 patients) and the pathological axillary complete response rate (ypN0) was 38.3% (23 patients). Sensitivity (SLNB: 80.9% (95% CI 61.8-100); MNB: 80.8% (95% CI 63.7-97.8); TAD: 92.6% (95% CI 80.9- 100)) and negative predictive value (SLNB: 84.6% (95% CI 68.8-100); MNB: 81.0% (95% CI 63.7-97.8); TAD: 91.3% ( 95% CI 77.6-100), figure 4.9) were higher than specificity (SLNB: 68.7% (95% CI 51.1-86.4); MNB: 63.6% (95% CI 45.7-81 , 6); TAD: 63.6% (95% CI 45.7-81.6)) and positive predictive value (SLNB: 62.9% (95% CI 42.9-83.0); MNB: 63.6 % (95% CI 45.7-81.6); TAD: 67.6% (95% CI 51.1-84.0)). The tumor size at diagnosis (Odds Ratio (OR) = 1.67; 95% CI 1.02-2.74), the number of suspected nodes in ultrasound at diagnosis (OR = 2.20; 95% CI 1.01-4 , 77), HER2 positive (OR 0.04; 95% CI 0.003-0.54), a complete clinical-radiological response to NACT (OR = 0.07; 95% CI 0.01-0.75), and a positive TAD (OR 15.48; 95% CI 1.68-142.78) were independent predictors of a positive result in LA. Based on the logistic regression model, we developed a “positive ALND predictive score”, with a good calibration (Hosmer-Lemeshow test: p = 0.65), and discrimination (area under the curve = 0.93; 95% CI 0, 87-0.99), and with the highest Youden index (0.7) at cut-point of 17% risk of positive ALND (sensitivity = 100%; specificity = 70%). The only independent predictor of a false positive result in the TAD was the presence of HER2 (OR = 22.63; 95% CI 1.14-450.98). Conclusion: TAD is a feasible and valid technique to rule out axillary metastatic involvement in patients with BC cN1 with response to NACT. In patients with a small tumor and low number of suspected lymph nodes in ultrasound at diagnosis, HER2 positive, complete clinical-radiological response to NACT, a negative result in TAD, or more than one of these factors, omission of ALND could be considered

MEDICAL PROFESSIONALISM PERCEPTION OF MEDICAL STUDENTS IN SPAIN

Introduction: Currently, the Doctor-Patient relationship of all cultures and societies is in crisis due to the distrust that has arisen in this social contract. This distrust origins from various changes that have occurred worldwide. We, as doctors, can contribute to solving this crisis, reaffi rming the values that integrate medical professionalism. In the absence of specifi c studies and programmes on medical professionalism in Spanish universities, we consider knowing the perception of medical professionalism by medical students at the University of Murcia essential to see if there is a need to introduce educational improvements in our faculty. Methods: A professionalism questionnaire from the Penn State University School of Medicine (PSCOM) was provided online, voluntarily and anonymously to all students of the Medicine degree of the University of Murcia. Results: The perception of professionalism in students was high, since all categories have more than 75% positive responses on average. The categories of Respect and Altruism were the best rated. On the other hand, there is a slight increase in negative responses as students progress through the degree. Between sexes, however, there were no differences in the criteria. Conclusions: Although the perception of professionalism is good, it is still a perception, so it should reach values closer to 100%. Therefore, the faculty is encouraged to carry out specifi c programmes to promote medical professionalism in the degree courses

Datos de Proyecto DABE, por SEDEM y CEEM.

Se presentan los datos obtenidos en la encuesta del proyecto DABE (de SEDEM y CEEM), en formato excel, para cumplir con los requisitos de Plos One de ofrecerlos en acceso abierto

Combined effect of water potential and temperature on seed germination and seedling development of cacti from a mesic Argentine ecosystem

Global climatic change will be associated with an increase of droughts and heat waves, which can affectseed germination and plant population dynamics. Cactus species from mesic ecosystems are likely to bemore affected by these events than species from arid ecosystems. The aim of the study was to assess thecombined effect of water potentials and temperatures on seed germination and seedling traits in six glo-bose cactus species from Córdoba Mountains: Echinopsis candicans, Gymnocalycium bruchii, G. capillense,G. mostii, G. quehlianum and Parodia mammulosa. A factorial experiment was performed in which fourwater potential levels (0, −0.2, −0.4 and −0.6 MPa) were combined with two temperature levels (25 and32◦C). Germination (%) and mean germination time (T50) were recorded and seedling shape (width andlength) was measured. In general, a decrease in water potential and an increase in temperature resulted inlow germination, with different behaviors among species. At 32◦C and low water potentials, germinationwas low or null for almost all species. There was not a clear trend in the response of T50to the treatments.Seedling development was highly and negatively affected by the combination of factors, particularly atlow water potentials. The responses of the analyzed cactus species to low water potential were similarto those of cactus species from more arid ecosystems. Our results suggest that the studied species wouldbe severely affected by changes in temperature and precipitation as predicted under a climate changescenario.Fil: Gurvich, Diego Ezequiel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Pérez Sánchez, R.. Universidad Autónoma de Nuevo León; MéxicoFil: Bauk, Karen. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Jurado, E.. Universidad Autónoma de Nuevo León; MéxicoFil: Ferrero, María Cecilia. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Funes, Guillermo. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Córdoba. Instituto Multidisciplinario de Biología Vegetal. Universidad Nacional de Córdoba. Facultad de Ciencias Exactas Físicas y Naturales. Instituto Multidisciplinario de Biología Vegetal; ArgentinaFil: Flores, J.. Instituto Potosino de Investigación Científica y Tecnológica; Méxic

Is cholecystectomy the treatment of choice for acute acalculous cholecystitis?: a systematic review of the literature

Background and objectives: There is currently no consensus with regard to the use of cholecystectomy or percutaneous cholecystostomy as the therapy of choice for acute acalculous cholecystitis. The goal of this study was to review the scientific evidence on the management of these patients according to clinical and radiographic findings. Methods: A systematic review of the literature from 2000 to 2016 was performed. The databases of PubMed, Índice Médico Español, Cochrane Library and Embase were searched according to the following inclusion criteria: publication language (English or Spanish), adult patients, acalculous etiology and appropriate study design. Results: A total of 1,013 articles were identified and ten articles were selected for review. These included five observational controlled studies and five case series which described the outcome of patients treated with percutaneous cholecystostomy and emergency cholecystectomy. No prospective or randomized studies were identified using the search criteria. The data from the literature and analysis of results suggested that percutaneous cholecystostomy may be a definitive therapy for acute acalculous cholecystitis with no need for subsequent elective cholecystectomy. Conclusions: Percutaneous cholecystostomy may be the first treatment option for patients with acute acalculous cholecystitis except in cases with a perforation or gallbladder gangrene. Patients at low surgical risk may benefit from cholecystectomy but both treatment options may be effective. Percutaneous cholecystostomy in patients with acute acalculous cholecystitis may be a definitive therapy with no need for a subsequent elective cholecystectomy. However, the overall quality of studies is low and the final recommendations should be considered with caution

An experience of integration of specializedmedical training with university postgraduatelearning: Stage-based training in laparoscopicsurgery

Antecedentes: Diseño de un modelo de simulación para formación encirugía laparoscópica. Métodos: Dentro del Máster Anatomía Aplicada a la Clínica seimplementaron tres etapas de formación progresiva en médicos residentes. La etapa1 se realizó en simulador con material no biológico: manejo de objetos, disección conpinza y tijera, y sutura laparoscópica. La etapa 2 utilizó material biológico (tubodigestivo en fresco) en simulador, para la práctica de sección intestinal yanastomosis intracorpórea. En la etapa 3 se realizaron técnicas laparoscópicas encadáver en fresco (apendicectomía, colecistectomía, apertura de la transcavidadepiploica, hemicolectomías derecha e izquierda). Se añadió una encuesta desatisfacción a los participantes de la actividad. Resultados: El programa se impartió a6 residentes de Cirugía General. Todos completaron los ejercicios de las etapas 1 y 2.En la etapa 3 se pudo realizarel neumoperitoneo sin dificultad y los tejidospresentaron una textura adecuada. Los residentes de primer año completaron laapendicectomía y la colecistectomía, pero procedimientos más complejos requirieronresidentes con más experiencia. Los participantes encuestados reflejaron que elprograma es adecuado y útil para el entrenamiento en laparoscopia. Conclusiones: Elmodelo propuesto es reproducible y adecuado en adquisición de competenciasbásicas en cirugía laparoscópica.Abstract: Background: Design of a simulation model training in laparoscopic surgeryfor surgical residents. Methods: Three stages of progressive training wereprogrammed within a Postgraduate Degree in Clinical Anatomy. Stage 1 wasperformed in a box-trainer with synthetic materials: managing small objects,dissection with clamp and scissors, and laparoscopic intracorporeal suture. Stage 2used biological material (fresh digestive tract from a human corpse) in box-trainer,practicing section and intracorporeal anastomosis. In stage 3, laparoscopy wasperformed on a fresh corpse (appendectomy, cholecystectomy, lesser sac opening,right and left colectomy). A satisfaction survey was carried out to the participants.Results: Some six General and Digestive Surgery residents took the program. All ofthem completed the stage 1 and 2 exercises. In stage 3, the pneumoperitoneum couldbe performed without any complications, and tissues presented an adequate texture.First-year residents completed appendectomy and cholecystectomy, but morecomplex procedures required more experienced residents. The participants reflectedthat the program is adequate and useful to gain basic skills in laparoscopy.Conclusions: The proposed model is reproducible and adequate in acquisition ofbasic skills in laparoscopic surgery