Flipped classroom based on objective structured clinical examinations analysis by undergraduate students of Pharmacology course from the Podiatry Degree improve their learning and assessment communication skills about medicines

Comunicación cartel con defensa oralWe aim to evaluate the impact of the individual and in-group analysis of OSCEs (filmed by other students) looking for correct and incorrect behaviours and contents in their learning of pharmacology. Summary of work and outcomes: A 5-year prospective study in which students of Pharmacology course from the Podiatry Degree analysed filmed OSCEs individually and in a group in a flipped classroom. Each group (max 5 students) analysed along 1 week a filmed OSCE, prepare a summary of correct and incorrect items related to clinical events, medicines uses, and people behaviours. The students presented their analysis results to the rest of the class. After each presentation, the other students of the class were encouraged to ask questions and after that, the students voluntarily answered a satisfaction survey. Result and Discussion: 405 students, 65.2% female, 20±5.3 years old were included. Students spend 13.4±5.4 h on making the filmed-OSCE analysis. The percentage of students satisfied with this way of studying pharmacology was 96.5%. OSCEs analysis by students increased their percentage of success in the final assessment in both OSCEs-related and OSCEs-non-related questions (+18.5% and +10.1%). Conclusion: Filmed Objective Structured Clinical Examinations analysis by undergraduate students on the Pharmacology course of Podiatry Degree improved their knowledge about medicines use and their communication skills during the assessment.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Filmed clinical cases improved communication skills of student of Pharmacology in Podiatry degree

Solving clinical case by writing-report lacks of students sympathies and interest in many cases. Make a short film is a novelty that really like to the students and may improve their arguing and planning capacities and their communication skills. Aim: To evaluate the impact of presenting and resolving clinical cases through filming a short-film in the communication skills development and in the learning of medicines in Podiatry undergraduate students. Methods: A two-year study in which students were invited to voluntarily form groups (3 students maximum). Each group has to design and film a short-film (8 min maximum) showing a clinical case in which medicines’ use was needed to treat feet pathology. A camera, a mobile-phone's video editor or whatever they may use was allowed. The job of each group was supervised and helped by a teacher. The students were invited to present their work to the rest of the class. After each short-film projection the students were encouraged to ask questions if they wanted to do it. After all the projections the students voluntarily answered a satisfaction survey. Results: Students of Pharmacology of Podiatry Degree, N=101, 55.6% female, 20±1.3 years old were enrolled. 37 short-films showing a clinical case were made. The average time spent by students in making the film was 12.4±8 h. The percentage of students which were satisfied with this way of presentation of the clinical cases was 75.2%. Conclusion: Filmed clinical cases performed by student of Pharmacology of the Podiatry Degree improved their communication skills.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech. Convocatoria de Ayudas de la Universidad de Málaga a Proyectos de Innovación Educativa, convocatoria 2013-2015, PIE 13-156 en Área de Ciencias de la Salud

Giant pancreatic cystic lymphangioma

Presentamos una paciente de 41 años diagnosticada de linfangioma quístico gigante en cuerpo-cola pancreático con aumento progresivo en el último año, de 20 cm de diámetro, como hallazgo incidental ecográfico. Se realiza punción-aspiración con aguja fina (PAAF), con resultado de lesión quística benigna. Ante el aumento de tamaño, se decide intervención quirúrgica. Se objetiva una tumoración quística retroperitoneal dependiente de cara posterior pancreática y se realiza resección completa laparoscópica hasta cápsula pancreática con preservación de páncreas y bazo. En la descripción anatomopatológica se confirma el diagnóstico de linfangioma quístico benigno. No se produjeron incidencias durante el postoperatorio inmediato y la paciente fue dada de alta al quinto día. Tras un año de seguimiento, la paciente permanece asintomática.A giant cystic lymphangioma in the pancreatic body-tail was diagnosed as an incidental ultrasound mass in a 41-year-old patient, with a progressive size that had increased in the last year by about 20 cm size. An ultrasound guided fine needle puncture was performed and the result was a benign cystic lesion. Given the increase in size, a surgical intervention was decided. A retroperitoneal cystic tumor dependent on the posterior pancreatic wall was identified and a full laparoscopic resection with pancreas and spleen preservation was performed. The pathological report confirmed the diagnosis of benign cystic lymphangioma. The patient was discharged on the fifth postoperative day without any remarkable complications. After one year of follow-up, the patient remains asymptomatic

El desarrollo y análisis de ECOEs mejoró las habilidades de comunicación, aprendizaje y evaluación de los estudiantes de Farmacología en el Grado de Podología.

Comunicación a congresoEl desarrollo y análisis de ECOEs mejoró las habilidades de comunicación, aprendizaje y evaluación de los estudiantes de Farmacología en el Grado de Podología. Bellido Estevez I, Blanco Reina E, Bellido Estevez MV, García Arnés JA, Gómez Luque A. Dep. Farmacología. Facultad de Medicina. IBIMA. S. de Anestesia. Hospitales Regional Carlos Haya y Virgen de la Victoria. Universidad de Málaga. Mlaga, España. Antecedentes/Objetivos: La enseñanza inversa facilita el aprendizaje activo. Las evaluaciones clínicas objetivas estructuradas (ECOEs) son herramientas evaluativas, multipropósito, versátiles, usadas para evaluar en el entorno clínico. Nuestro objetivo fue evaluar el impacto del desarrollo y análisis ECOEs en el aprendizaje de la farmacología. Métodos: Estudio prospectivo a lo largo de 5 años en el que los estudiantes de Farmacología del Grado de Podología desarrollaron y analizaron ECOEs usando técnicas de enseñanza inversa. Cada grupo (5 estudiantes máximo) analizó a lo largo de 1 semana una ECOE filmada y desarrollada por otros alumnos, preparó un resumen de los elementos correctos e incorrectos relacionados con eventos clínicos, usos de medicamentos y comportamientos de las personas. Cada grupo presentó sus resultados al resto de la clase, contestaron a las preguntas de sus compañeros y posteriormente a una encuesta de satisfacción. Resultados/Discusión: Fueron incluidos 405 estudiantes, 65,2% mujeres, 20±5,3 años. Los estudiantes dedicaron 13,4±5,4 h a analizar las ECOEs. El porcentaje de estudiantes satisfechos con esta forma de estudiar farmacología fue del 96,5%. Esta actividad incrementó el porcentaje de éxito en la evaluación final en las preguntas relacionadas con las ECOEs un 18,5% y en las no relacionadas un 10,1%. Conclusión: El desarrollo y análisis de ECOEs mejoró los conocimientos sobre el uso de medicamentos, habilidades de comunicación y evaluación de los estudiantes de Farmacología del Grado de Podología.Universidad de Málaga. Campus de Excelencia Internacional Andalucía Tech

Migración de clip tras colecistectomía

Presentamos el caso de una paciente joven intervenida de colecistectomía laparoscópica que sufre, como complicación en el postoperatorio, una migración del clip quirúrgico al colédoco (< 100 casos reportados hasta la fecha), cuyo tratamiento en la mayoría de los casos es mediante CPRE, para así exponer la infrecuencia de esta complicación y su manejo

SARS-CoV-2 viral load in nasopharyngeal swabs is not an independent predictor of unfavorable outcome

The aim was to assess the ability of nasopharyngeal SARS-CoV-2 viral load at first patient’s hospital evaluation to predict unfavorable outcomes. We conducted a prospective cohort study including 321 adult patients with confirmed COVID-19 through RT-PCR in nasopharyngeal swabs. Quantitative Synthetic SARS-CoV-2 RNA cycle threshold values were used to calculate the viral load in log10 copies/mL. Disease severity at the end of follow up was categorized into mild, moderate, and severe. Primary endpoint was a composite of intensive care unit (ICU) admission and/or death (n = 85, 26.4%). Univariable and multivariable logistic regression analyses were performed. Nasopharyngeal SARS-CoV-2 viral load over the second quartile (≥ 7.35 log10 copies/mL, p = 0.003) and second tertile (≥ 8.27 log10 copies/mL, p = 0.01) were associated to unfavorable outcome in the unadjusted logistic regression analysis. However, in the final multivariable analysis, viral load was not independently associated with an unfavorable outcome. Five predictors were independently associated with increased odds of ICU admission and/or death: age ≥ 70 years, SpO2, neutrophils > 7.5 × 103/µL, lactate dehydrogenase ≥ 300 U/L, and C-reactive protein ≥ 100 mg/L. In summary, nasopharyngeal SARS-CoV-2 viral load on admission is generally high in patients with COVID-19, regardless of illness severity, but it cannot be used as an independent predictor of unfavorable clinical outcome

Dendritic cell deficiencies persist seven months after SARS-CoV-2 infection

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection induces an exacerbated inflammation driven by innate immunity components. Dendritic cells (DCs) play a key role in the defense against viral infections, for instance plasmacytoid DCs (pDCs), have the capacity to produce vast amounts of interferon-alpha (IFN-α). In COVID-19 there is a deficit in DC numbers and IFN-α production, which has been associated with disease severity. In this work, we described that in addition to the DC deficiency, several DC activation and homing markers were altered in acute COVID-19 patients, which were associated with multiple inflammatory markers. Remarkably, previously hospitalized and nonhospitalized patients remained with decreased numbers of CD1c+ myeloid DCs and pDCs seven months after SARS-CoV-2 infection. Moreover, the expression of DC markers such as CD86 and CD4 were only restored in previously nonhospitalized patients, while no restoration of integrin β7 and indoleamine 2,3-dyoxigenase (IDO) levels were observed. These findings contribute to a better understanding of the immunological sequelae of COVID-19

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Tratamientos psicológicos empíricamente apoyados para adultos: Una revisión selectiva

Antecedentes: los tratamientos psicológicos han mostrado su eficacia, efectividad y eficiencia para el abordaje de los trastornos mentales; no obstante, considerando el conocimiento científico generado en los últimos años, no se dispone de trabajos de actualización en español sobre cuáles son los tratamientos psicológicos con respaldo empírico. El objetivo fue realizar una revisión selectiva de los principales tratamientos psicológicos empíricamente apoyados para el abordaje de trastornos mentales en personas adultas. Método: se recogen niveles de evidencia y grados de recomendación en función de los criterios propuestos por el Sistema Nacional de Salud de España (en las Guías de Práctica Clínica) para diferentes trastornos psicológicos. Resultados: los resultados sugieren que los tratamientos psicológicos disponen de apoyo empírico para el abordaje de un amplio elenco de trastornos psicológicos. El grado de apoyo empírico oscila de bajo a alto en función del trastorno psicológico analizado. La revisión sugiere que ciertos campos de intervención necesitan una mayor investigación. Conclusiones: a partir de esta revisión selectiva, los profesionales de la psicología podrán disponer de información rigurosa y actualizada que les permita tomar decisiones informadas a la hora de implementar aquellos procedimientos psicoterapéuticos empíricamente fundamentados en función de las características de las personas que demandan ayuda. Background: Psychological treatments have shown their efficacy, effectiveness, and efficiency in dealing with mental disorders. However, considering the scientific knowledge generated in recent years, in the Spanish context, there are no updating studies about empirically supported psychological treatments. The main goal was to carry out a selective review of the main empirically supported psychological treatments for mental disorders in adults. Method: Levels of evidence and degrees of recommendation were collected based on the criteria proposed by the Spanish National Health System (Clinical Practice Guidelines) for different psychological disorders. Results: The results indicate that psychological treatments have empirical support for the approach to a wide range of psychological disorders. These levels of empirical evidence gathered range from low to high depending on the psychological disorder analysed. The review indicates the existence of certain fields of intervention that need further investigation. Conclusions: Based on this selective review, psychology professionals will be able to have rigorous, up-to-date information that allows them to make informed decisions when implementing empirically based psychotherapeutic procedures based on the characteristics of the people who require help

Manual de simulación clínica en especialidades médicas

Manual sobre técnicas y modos de simulación clínica en diversas especialidades médicas.La enseñanza y formación en medicina necesita el uso de la simulación. Existen evidencias de su uso desde hace cientos de años, pero, en los últimos años se ha incrementado y diseminado. La simulación clínica está validada científicamente en múltiples contextos médicos y de otras áreas profesionales de la salud. Y es considerada de gran importancia como proceso de entrenamiento y de mejora de las competencias y adquisición de habilidades médicas en campos que incluye desde la historia clínica, comunicación con el paciente, exploración, diagnóstico terapéutica médica-farmacológica y quirúrgica y seguridad al tratar al paciente. Hoy en día, para muchas técnicas y situaciones clínicas es inaceptable llegar junto a los pacientes sin un dominio adquirido en simulación. La simulación puede ocurrir sin el uso de recursos adicionales, solo las personas, o utilizando pocos o muchos recursos de baja hasta alta tecnología y se puede adaptar a los recursos disponibles, abarcando todas las áreas de conocimiento, y dentro de ellas competencias técnicas o actitudes, solas o en conjunto. El uso racional y basado en evidencia de la simulación es de la mayor importancia por la necesidad de una mayor efectividad y eficiencia en la transformación de los profesionales de la salud para que puedan mejorar su capacidad de atender a los pacientes. La simulación es también una buena herramienta de evaluación de competencias y habilidades en Medicina y otras disciplinas de las Ciencias de la Salud Este manual incluye técnicas y modos de simulación clínica en diversas especialidades médicas, útiles, para quien busque un manual práctico y actualizado.Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Terapias Avanzadas en Patología Cardiovascular Cátedra de Mecenazgo de la Universidad de Málaga. Cátedra de Investigación Biomédica Quirón Salu