El Portafolio: Generación de una herramienta de autoevaluación del profesor en la enseñanza superior

[ES] El portafolio es una herramienta manida en el ámbito de la pedagogía. La cuestión sobre su utilidad como herramienta de autoevaluación no es ya objeto de debate en ámbitos pedagógicos. No ocurre lo mismo respecto al modo de concebir, diseñar, crear e incorporar una herramienta que no genere un incremento de trabajo en el quehacer diario del profesor. La pregunta es, ¿se puede crear una herramienta que se integre en el proceso docente y que sirva de auto-retroalimentación sobre la calidad docente? Este trabajo es una apuesta multidisciplinar que pretende conjugar la disciplina de la pedagogía con el área de conocimiento de la organización para así proponer una herramienta diseñada y estructurada en un entorno de ofimática sencilla, una hoja de cálculo Excel. Se trata de una herramienta que parte de la filosofía personal del docente para contribuir a generar el diseño del proceso de aprendizaje-enseñanza y evaluar los esfuerzos de mejora de la misma desde un espíritu autocrítico. Para realizar esta labor, se partirá de un concepto muy conocido en el ámbito de conocimiento de organización y, concretamente, de la calidad: el ciclo de Deming o PDCA (plan de mejora continua). El estudio pretende mostrar la experiencia de docentes de la Universitat de Politècnica de València en su elaboración de una guía de autoevaluación de su praxis docente y metodológica aplicada a asignaturas concretas. La fundamentación teórica es sencilla: la retroalimentación precisa de una planificación que debe ejecutarse para poder ser controlada y, posteriormente, revisada para permitir una re-planificación.Bañón Gomis, AJ.; Cortés Meseguer, L.; Fernandez-Duran, L.; Torres Carot, R. (2013). El Portafolio: Generación de una herramienta de autoevaluación del profesor en la enseñanza superior. En New changes in technology and innovation : INNODOCT'13 : International Conference on Innovation, Documentation and Teaching Technologies, held on-line in Valencia, Spain, on 6-7 May, 2013. https://riunet.upv.es/handle/10251/30843. Universidad Politécnica de Valencia. 262-266. http://hdl.handle.net/10251/82120S26226

Clinical, Molecular and Genetic Characteristics of Early Onset Gastric Cancer: Analysis of a Large Multicenter Study

Gastric adenocarcinoma (GC) is a common tumor with high morbidity and mortality. Only 7% of patients with GC are diagnosed before age 50 (early onset gastric cancer (EOGC)), and their characteristics have been poorly described. We aimed to describe clinical, molecular, and genetic characteristics of EOGC. A total of 309 patients with EOGC were retrospectively studied in four Spanish centers. Personal information, family history, and tumor information were registered. Germinal genetic analysis was performed in patients who met current criteria of a hereditary syndrome at the time of diagnosis. The median age at diagnosis was 44 years. The majority (73.3%) of tumors were diffuse, and 78.3% were diagnosed in an advanced stage. Familial aggregation of GC was present in 18/117 (15.4%) cases, and 5/117 (4.3%) met criteria for familial GC. MMR-IHC was performed in 126/309 (40.7%) tumors: 4/126 (3.1%) had loss of expression in MLH1/PMS2, without an associated germline mutation. Sixteen germline genetic analyses were performed, detecting a pathogenic variant in four (25%) cases: one in BRCA2, one in TP53, and two in CDH1. Most EOGC are diffuse and diagnosed in an advanced stage. In these patients, DNA MMR system deficiency is uncommon. Although familial aggregation was observed in only 15% of cases, a germline mutation was found in 25% of patients tested with clinical criteria. This demonstrates that EOGC has a marked genetic heterogeneity, reinforcing the importance of an accurate genetic counseling and enhancing the emerging use of multigene panels

Proyecto de diseño de un programa de mejora para una empresa del sector vitivinicola a partir de la norma UNE 66174

[ES] Se busca la implantación de la mejora continua en una empresa del ámbito agroalimentario mediante la Norma 66174 para conseguir el éxito sostenido de la organización. Mediante los criterios de la norma citada anteriormente se realizan 4 planes de mejora sobre las 4 mayores debilidades que presenta la empresa. Dichas debilidades son: innovación, aprendizaje, prioridad + aprendizaje y autoevaluación.[EN] The aim of this dissertation is to establish the continuous improvement in an agri-food company through the 66174 standard in order to achieve a sustained business success. Using the criteria of the above mentioned standard, 4 performance improvement plans concerning the 4 greatest weaknesses of the company are carried out. These weaknesses are: innovation, learning, priority + learning and self-assessment.Carot Martínez, L. (2019). Proyecto de diseño de un programa de mejora para una empresa del sector vitivinicola a partir de la norma UNE 66174. http://hdl.handle.net/10251/125240TFG

Optimización de las estrategias en el cribado poblacional de cáncer colorrectal

El càncer colorectal (CCR) és una malaltia prevenible si s'apliquen programes de cribratge en població de risc mig i alt. L'avanç en el coneixement dels mecanismes que participen en el desenvolupament del propi càncer, en concret la demostració del potencial premaligne de l'adenoma i la possibilitat de la seva resecció durant la colonoscòpia, ha donat peu a diverses estratègies preventives. No obstant això, la colonoscòpia precisa d'importants recursos sanitaris i econòmics que ha motivat plantejar alternatives mitjançant proves de cribratge inicial per a millorar l'eficiència del programa, si bé no totes presentaran el mateix rendiment en funció de la lesió premaligna i la seva localització. De fet, tant el test de sang oculta en femta immunoquímic com la sigmoidoscòpia han demostrat reduir la incidència i mortalitat del CCR. Malgrat això, totes dues estratègies han estat criticades a causa de la limitació que presenten per a la detecció de lesions serrades proximals. L'evidència suggereix que fins a un 30% dels tumors es desenvolupen a partir de lesions serrades i aquestes lesions podrien ser els precursors del càncer d'interval pel que la seva detecció es considera un dels objectius futurs de les estratègies per a millorar els programes poblacions de cribratge. Així mateix, la implementació progressiva dels programes de cribratge poblacionals ha ocasionat un augment considerable del nombre de colonoscòpies derivades de les indicacions de vigilància endoscòpica de les lesions detectades en colonoscòpies basals. Les guies clíniques actuals únicament consideren la morfologia i histologia de les lesions ressecades per a realitzar les recomanacions de vigilància. No obstant això, la predisposició genètica, els factors ambientals i patològics també podrien influir en l'aparició d'aquestes lesions i la seva recurrència en el temps. Per tant, aquest projecte pretén avaluar dos aspectes claus en l'estratègia actual del programa de cribratge de CCR del nostre territori: 1- Avaluar el rendiment diagnòstic de la prova de sang oculta en femta immunoquímic i de la sigmoidoscòpia per a la detecció de lesions serrades en el còlon proximal mitjançant la comparació de la taxa de detecció de lesions serrades proximals en una població espanyola amb sigmoidoscòpia simulada en el context d'un estudi multicèntric controlat i aleatoritzat de cribratge poblacional (COLONPREV) i 2-Determinar factors predictius clínics, demogràfics, histopatològics i moleculars somàtics de recurrència de lesió d'alt risc en la colonoscòpia de vigilància als 3 anys, en individus amb adenomes avançats (displàsia d'alt grau, component vellós o ≥10 mm) i/o multiplicitat ≥3 pòlips identificats en la colonoscòpia basal d'un programa de cribratgeEl cáncer colorectal es una enfermedad prevenible si se aplican programas de cribado en población de riesgo medio y alto. El avance en el conocimiento de los mecanismos que participan en el desarrollo del propio cáncer, en concreto la demostración del potencial premaligno del adenoma y la posibilidad de su resección durante la colonoscopia, ha dado pie a diversas estrategias preventivas. Sin embargo, la colonoscopia precisa de importantes recursos sanitarios y económicos que ha motivado plantear alternativas mediante pruebas de cribado inicial para mejorar la eficiencia del programa, si bien no todas van a presentar el mismo rendimiento en función de la lesión premaligna y su localización. De hecho, tanto el test de sangre oculta en heces inmunoquímico como la sigmoidoscopia han demostrado reducir la incidencia y mortalidad del cáncer colorectal. A pesar de ello, ambas estrategias han sido criticadas debido a la limitación que presentan para la detección de lesiones serradas proximales. La evidencia sugiere que hasta un 30% de los tumores se desarrollan a partir de lesiones serradas y dichas lesiones podrían ser los precursores del cáncer de intervalo por lo que su detección se considera uno de los objetivos futuros de las estrategias para mejorar los programas poblaciones de cribado. Asimismo, la implementación progresiva de los programas de cribado poblacionales ha ocasionado un aumento considerable del número de colonoscopias derivadas de las indicaciones de vigilancia endoscópica de las lesiones detectadas en colonoscopias basales. Las guías clínicas actuales únicamente consideran la morfología e histología de las lesiones resecadas para realizar las recomendaciones de vigilancia. Sin embargo, la predisposición genética, los factores ambientales y patológicos también podrían influir en la aparición de dichas lesiones y su recurrencia en el tiempo. Por tanto, este proyecto pretende evaluar dos aspectos claves en la estrategia actual del programa de cribado de CCR de nuestro territorio: 1- Evaluar el rendimiento diagnóstico de la prueba de sangre oculta en heces inmunoquímico y de la sigmoidoscopia para la detección de lesiones serradas en el colon proximal mediante la comparación de la tasa de detección de lesiones serradas proximales en una población española con sigmoidoscopia simulada en el contexto de un estudio multicéntrico controlado y aleatorizado de cribado poblacional (COLONPREV) y 2-Determinar factores predictivos clínicos, demográficos, histopatológicos y moleculares somáticos de recurrencia de lesión de alto riesgo en la colonoscopia de vigilancia a los 3 años, en individuos con adenomas avanzados (displasia de alto grado, componente velloso o ≥10 mm) y/o multiplicidad ≥3 pólipos identificados en la colonoscopia basal de un programa de cribadoEvidence from several studies has shown that screening is effective and cost-effective for CRC prevention in average-risk populations. Scientific advancement in understanding of CCR biology, in particular the demonstration of the premalignant potential of the colorectal adenoma and the endoscopic polypectomy has given rise to various preventive strategies. However, colonoscopy requires significant health and financial resources, that has given reason for propose alternatives to improve the efficiency of the program. Indeed, fecal occult blood testing and flexible sigmoidoscopy have been shown to reduce CRC-specific mortality and incidence in randomized controlled trials. Regardless, both strategies have largely been criticized because of their potential limitation for detecting proximal lesions. Evidence suggests that up to 30% of CRC cases develops from serrated polyps and it has been suggested that SP are the key precursors of colonoscopy interval cancer. Overall, the evidence suggests that detection of proximal and large serrated lesions may should be one of the future goals of CRC screening strategies. Moreover, after a correct polypectomy, it is also necessary to continue periodic colonoscopy surveillance given the risk of metachronous lesions. As a result, the care and financial burden on our health system increases. The clinical guidelines follow up recommendations are based on the size, number, and pathologic characteristics of the removed lesions in baseline colonoscopy, although, genetic clinical factors could also have influence over time. Identifying predictors of metachronous lesions would provide a better risk stratification and improve the efficiency of surveillance programs. Therefore, this project aims to evaluate two key aspects in the current strategy of the CRC screening program: 1- We assess the detection rate of proximal serrated polyps by simulated sigmoidoscopy and faecal immunochemical test compared with total colonoscopy in a population-based, multicentre, nationwide, randomised controlled trial (ColonPrev study), 2- We aimed to determine predictive factors clinical, endoscopic and molecular biomarkers of metachronous risk lesions at 3 years in individuals with advanced adenomas (high grade dysplasia, villous component or ≥10 mm) and / or multiplicity ≥3 polyps in baseline screening colonoscop

Jejunal gist simulating a uterine myoma: A case report

Introduction: A small bowel gastrointestinal stromal tumor (GIST) is a rare neoplasm of the gastrointestinal tract. The manifestation of bleeding is a diagnostic challenge and could present as a life-threatening situation that needs urgent intervention. Presentation of case: 64-year-old woman consulted for episodes of melena and anemia. The upper and lower endoscopies were not diagnostic. Capsule endoscopy (CE) revealed a probable jejunal hemangioma, however double-balloon enteroscopy and magnetic resonance imaging (MRI) did not show any intestinal nodule but MRI show a pelvic mass apparently related to the uterus confirmed by a gynecologist. Even so, the patient returned with melena, and a contrast-enhanced computed tomography (CT) scan again identified a pelvic mass, highlighting that its vascularization drained into the superior mesenteric territory and seemed to invade the jejunum, with active bleeding, suspicious for jejunal GIST. A laparotomy was performed to remove the jejunal mass. Histopathology and immunohistochemical studies confirmed the diagnosis. Discussion: Bleeding is a common symptom in small bowel GISTs but its diagnoses could be difficult because its location. In most cases, gastroscopy and colonoscopy are not useful and CE or imaging studies are necessary to find the cause of bleeding. Moreover, it has recently proved that bleeding is a prognostic risk factor because it is related to tumor rupture and tumor invasion of blood vessels. Conclusion: In this case, bleeding caused by small bowel GIST was misdiagnosed in endoscopic procedures and the clinical management was delayed. CT angiography was the most effective investigation to detect the source of bleeding

Predictors of Metachronous Risk Polyps After Index Colonoscopy

Altres ajuts: Associación Española Contra el Cáncer (AECC) (PS14152544ANDR)We included patients with high-risk lesions (HRLs), defined as advanced adenoma (AA), large serrated polyps (SPs), and multiplicity (≥3 of any adenomas/SPs). Data on age, sex, cardiovascular risk factors, pharmacological treatment, and the histological characteristics in each individual, and mutations in genes involved in the most advanced index polyp, were collected. Parameters independently associated with a metachronous HRL diagnosis were evaluated through univariate and multivariate analyses. The results are reported as odds ratios and 95% confidence intervals along with P values. A total of 537 cases (median age: 60.7 years; 66% male) were included. Dyslipidemia and smoking correlated with metachronous HRLs. Multivariate logistic regression analysis showed that the presence of multiplicity with ≥3 polyps on the index colonoscopy was significantly associated with metachronous HRL, AA, proximal AA, and ≥3 polyps at 3 years. In addition, independent predictors of metachronous proximal AA were increasing age, female sex, and the loss of expression of the MLH1 protein. Multiplicity was a strong predictor of HRLs at 3 years, although the inclusion of other clinical variables (age, sex, smoking status, and dyslipidemia) improves surveillance recommendations. Without these risk factors, the surveillance could be extended to 5 years; we propose examining the somatic expression of MHL1 in all patients

Efficacy of a multifactorial strategy for bowel preparation in diabetic patients undergoing colonoscopy: a randomized trial.

Background and study aims: Previous studies have reported that diabetes mellitus is an independent risk factor for inadequate bowel preparation. Current guidelines do not recommend a specific preparation for this patient population. The aims of this study were to assess the efficacy, safety, and tolerability of an adapted preparation protocol for colon cleansing in patients with type 2 diabetes mellitus. Patients and methods: This randomized, single-blind, parallel group, superiority trial compared a conventional bowel preparation protocol (CBP) with a diabetes-specific preparation protocol (DSP). The CBP included a low-fiber diet for 3 days followed by a clear liquid diet for 24 hours before colonoscopy. The DSP included a multifactorial strategy combining an educational intervention, a low-fiber diet, and adjustment of blood glucose-lowering agents. All patients received 4 L of a polyethylene glycol solution in a split-dose regimen. The endoscopists were blinded to the preparation protocol. The primary outcome measure was inadequate bowel preparation according to the Boston Bowel Preparation Scale. Secondary outcome measures included hypoglycemic events, tolerability, and acceptability. Results: A total of 150 patients were included in the study (74 CBP and 76 DSP). Both groups were comparable in terms of baseline characteristics. Inadequate bowel cleansing was more frequent following CBP than DSP (20 % vs. 7 %, P = 0.014; risk ratio 3.1, 95 % confidence interval 1.2 - 8). Only CBP and performance status were independently associated with inadequate bowel preparation. Both preparations were equally tolerated and accepted by patients, and side-effects were similar between the groups. Conclusions: A multifactorial strategy for bowel preparation in patients with diabetes undergoing colonoscopy showed a threefold reduction in the rate of inadequate bowel preparation, with no differences in safety and tolerability compared with conventional preparation