Factores asociados con la satisfacción del conocimiento, puntualidad y evaluaciones que realizan los docentes de diecisiete facultades de medicina peruanas

Introducción: la enseñanza correcta es un aspecto académico extremadamente importante, sin embargo, en nuestros medios no se ha evaluado, a diferencia de otros países que sí tienen registros. Objetivo: Determinar los factores asociados a la insatisfacción de la investigación realizada en dieciséis facultades de medicina peruana. Metodología: estudio transversal analítico de análisis de datos secundarios, se aplicó una encuesta auto-aplicada y se tomó como variable dependiente, los encuestados manifiestan que estaban muy insatisfechos y / o descontentos con la investigación realizada en su poder, esto se contrastó con otros. variables Se obtuvo asociación estadística con modelos lineales generalizados. Resultados: 46.4% (1369) dijeron que estaban insatisfechos con la investigación de su facultad. Aumentaron la frecuencia de insatisfacción el mayor año de estudio (RPC: 1.06; IC del 95%: 1. 00 a 1.13: valor de p: 0.049), insatisfacción con la biblioteca virtual de la universidad (RPC: 1,12: IC95: 1.01 a 1.25, valor de p: 0.025), con soporte para búsqueda (RPC: 1.16; 95% CI: 1.04 para 1.30; valor de p: 0.008), los acuerdos que tienen universidad (RPC: 2.25; IC del 95%: 1.47 a 3.46; valor de p <0.001) e instrucción de recepción en general (RPC: 1.30; IC del 95%: 1.08 a 1.57; Valor de p: 0,007), ajustado por sexo, edad, incentivos para la investigación, si su universidad tiene una investigación e insatisfacción con el conocimiento de los maestros y el laboratorio de computación. Conclusión: El estudiante de medicina está satisfecho con el desempeño de sus profesores, variando según el año de estudios y las características de la universidad. Es necesario que cada institución evalúe su realidad, Para que pueda implementar actividades para mejorar la calidad educativa de los futuros médicos del país

Efficacy and safety of menopausal hormone therapy on women with Human Immunodeficiency Virus Infection: a systematic review

Abstracts: 30th Annual Meeting of The North America Menopause Society September 25 – 28, 2019, Chicago, IL. P-41 Human immunodeficiency virus (HIV) infection is a relevant worldwide public health issue. Current, due to highly active antiretroviral therapy (HAART), most infected women reach mid-age, stage were estrogen deficiency changes occurs. An important proportion of these women develop premature menopause..

Falta de respeto y abuso durante el parto en catorce hospitales en nueve ciudades del Perú

evaluar la prevalencia de falta de respeto y abuso durante el parto y sus factores asociados en Perú. Métodos: En un estudio transversal de observación, las mujeres fueron encuestadas dentro de las 48 horas posteriores al parto en vivo en 14 hospitales ubicados en nueve ciudades peruanas entre abril y julio de 2016. La encuesta se basó en siete categorías de falta de respeto y abuso propuestas por Bowser y Hill. Para evaluar los factores asociados con cada categoría, los índices de prevalencia (PR) y los intervalos de confianza (IC) del 95% se calcularon utilizando modelos de Poisson ajustados con variaciones sólidas. Resultados: Entre 1528 participantes, 1488 (97.4%) experimentaron al menos una categoría de falta de respeto y abuso. La frecuencia de abandono de la atención aumentó con el parto por cesárea (RP 1.27, IC 95% 1.03–1.57), pero disminuyó en la región de la selva (PR 0.27, 0.14–0.53). La discriminación se asoció con la región de la selva (PR 5.67, 2.32–13.88). El abuso físico fue menos frecuente con cesárea que con el parto vaginal (RP 0.23, 0.11–0.49). Las prevalencias de abandono de la atención (PR 0.42, 0.29–0.60), atención no consentida (PR 0.70, 0.57–0.85), discriminación (PR 0.40, 0.19–0.85) y atención no confidencial (PR 0.71, 0.55–0.93 ) disminuyeron entre las mujeres que habían sido derivadas. Conclusión: Casi todos los participantes informaron haber experimentado al menos una categoría de falta de respeto y abuso durante la atención del parto, que se asoció con el tipo de parto, la derivación y la región geográfica. © 2017 Federación Internacional de Ginecología y Obstetricia Las prevalencias de abandono de la atención (PR 0.42, 0.29–0.60), atención no consentida (PR 0.70, 0.57–0.85), discriminación (PR 0.40, 0.19–0.85) y atención no confidencial (PR 0.71, 0.55–0.93 ) disminuyeron entre las mujeres que habían sido derivadas

Surgical site infection after gastrointestinal surgery in children: An international, multicentre, prospective cohort study

Introduction Surgical site infection (SSI) is one of the most common healthcare-associated infections (HAIs). However, there is a lack of data available about SSI in children worldwide, especially from low-income and middle-income countries. This study aimed to estimate the incidence of SSI in children and associations between SSI and morbidity across human development settings. Methods A multicentre, international, prospective, validated cohort study of children aged under 16 years undergoing clean-contaminated, contaminated or dirty gastrointestinal surgery. Any hospital in the world providing paediatric surgery was eligible to contribute data between January and July 2016. The primary outcome was the incidence of SSI by 30 days. Relationships between explanatory variables and SSI were examined using multilevel logistic regression. Countries were stratified into high development, middle development and low development groups using the United Nations Human Development Index (HDI). Results Of 1159 children across 181 hospitals in 51 countries, 523 (45·1%) children were from high HDI, 397 (34·2%) from middle HDI and 239 (20·6%) from low HDI countries. The 30-day SSI rate was 6.3% (33/523) in high HDI, 12·8% (51/397) in middle HDI and 24·7% (59/239) in low HDI countries. SSI was associated with higher incidence of 30-day mortality, intervention, organ-space infection and other HAIs, with the highest rates seen in low HDI countries. Median length of stay in patients who had an SSI was longer (7.0 days), compared with 3.0 days in patients who did not have an SSI. Use of laparoscopy was associated with significantly lower SSI rates, even after accounting for HDI. Conclusion The odds of SSI in children is nearly four times greater in low HDI compared with high HDI countries. Policies to reduce SSI should be prioritised as part of the wider global agenda

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background: The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods: In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results: Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle (753 of 1242, 60·6 per cent; odds ratio (OR) 0·17, 95 per cent c.i. 0·14 to 0·21, P < 0·001) or low (363 of 860, 42·2 per cent; OR 0·08, 0·07 to 0·10, P < 0·001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -9·4 (95 per cent c.i. -11·9 to -6·9) per cent; P < 0·001), but the relationship was reversed in low-HDI countries (+12·1 (+7·0 to +17·3) per cent; P < 0·001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0·60, 0·50 to 0·73; P < 0·001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion: Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone