Update the Anesthetic Role in Obstetric Hemorrhage. A Narrative Review the New Evidence

La hemorragia obstétrica sigue siendo la causa principal de muerte materna en todo el mundo y se considera que más de la mitad de los casos de morbi- mortalidad grave por hemorragia son prevenibles. En los casos en que el desenlace fue la muerte materna, el diagnóstico y tratamiento se dieron de manera tardía; y la comunicación entre los equipos fue deficiente. La hemorragia obstétrica es considerada una emergencia y su incidencia varía según la adaptación de los protocolos de cada institución. Su reconocimiento temprano es crucial para brindar el soporte hemostático inmediato. Sin embargo, existe una falta de acuerdo respecto a las definiciones y manejo en las guías establecidas. Una definición clínica consensuada de la hemorragia obstétrica debe considerar el volumen de la pérdida de sangre, los signos vitales, los síntomas clínicos, la coagulación y los cambios o inestabilidad hemodinámica y en cuanto sea posible se debe ofrecer un tratamiento hemostático dirigido. Esta revisión tiene como objetivo puntualizar las recomendaciones de las nuevas guías clínicas sobre el manejo de la hemorragia posparto desde el rol del anestesiólogo y la implementación de las mismas en un caso de nuestra práctica clínica.Obstetric hemorrhage remains the leading cause of maternal death worldwide and more than half of cases of severe morbidity and mortality due to hemorrhage are considered preventable. In cases where the outcome was maternal death, the diagnosis and treatment occurred late; and communication between teams was poor. Obstetric hemorrhage is considered an emergency and its incidence varies depending on the adaptation of each institution's protocols. Early recognition is crucial to provide immediate hemostatic support. However, there is a lack of agreement regarding definitions and management in established guidelines. An agreed clinical definition of obstetric hemorrhage should consider the volume of blood loss, vital signs, clinical symptoms, coagulation, and hemodynamic changes or instability, and targeted hemostatic treatment should be offered as soon as possible. This review aims to clarify the recommendations of the new clinical guidelines on the management of postpartum hemorrhage from the role of the anesthesiologist and their implementation in a case from our clinical practice

The improvement of communication techniques, decision-making tools and the development of critical thinking as key work skills for the employability of Tourism and Commerce students

Depto. de Organización de EmpresasFac. de Comercio y TurismoFALSEsubmitte

Geodivulgar: Geología y Sociedad

Memoria final del Proyecto Innova Docencia 2023-23 nº 58. GEODIVULGAR: Geología y SociedadUCMDepto. de Geodinámica, Estratigrafía y PaleontologíaFac. de Ciencias GeológicasFALSEsubmitte

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)

Delaying surgery for patients with a previous SARS-CoV-2 infection

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