Basic Study and Clinical Implications of Left Ventricular False Tendon. Is it Associated With Innocent Murmur in Children or Heart Disease?

Introducción y objetivos: El falso tendón del ventrículo izquierdo es una estructura descrita anatómicamente por Turner. Se desconoce su función dentro de la fisiología cardiaca. Se ha postulado, sin alcanzar consenso, su relación con diversas alteraciones eléctricas funcionales. El objetivo es conocer cuando aparece, su prevalencia, su composición histológica y su asociación con el soplo inocente infantil o con enfermedad cardiaca. Métodos: La investigación básica se realizó por la disección anatómica en cadáveres de corazones humanos adultos para describir el falso tendón y su histología. La investigación clínica se realizó en población pediátrica mediante ecocardiografía y se analizó su relación con cardiopatía, el soplo inocente infantil u otras alteraciones. Prenatalmente se realizaron ecocardiografías fetales a diferentes edades gestacionales. Resultados: La presencia del falso tendón es la norma en la disección cardiaca, y está constituido por fibras de tejido muscular y conectivo. En la población pediátrica, la presencia ecocardiografía del falso tendón fue del 83%, y solo mostró relación estadísticamente significativa con el soplo inocente infantil y una menor aceleración de la aorta. Por ecocardiografía fetal, se objetivó su presencia desde al menos la semana 20 de gestación . Conclusiones: El falso tendón del ventrículo izquierdo es una normalidad clínica visible por ecocardiografía fetal ya desde la semana 20, con presencia hasta la edad adulta sin relación con enfermedad, únicamente con la presencia de soplo inocente en edad pediátrica; queda por determinar si es la causa del soplo y si es su ausencia o anomalías estructurales lo que se relaciona con enfermedad.Introduction and objectives: Left ventricular false tendon is a structure of unknown function in cardiac physiology that was first described anatomically by Turner. This condition may be related to various electrical or functional abnormalities, but no consensus has ever been reached. The purpose of this study was to determine the time of appearance, prevalence and histologic composition of false tendon, as well as its association with innocent murmur in children and with heart disease. Methods: The basic research was performed by anatomic dissection of hearts from adult human cadavers to describe false tendon and its histology. The clinical research consisted of echocardiographic study in a pediatric population to identify any relationship with heart disease, innocent murmur in children, or other abnormalities. Fetal echocardiography was performed prenatally at different gestational ages. Results: False tendon was a normal finding in cardiac dissection and was composed of muscle and connective tissue fibers. In the pediatric population, false tendon was present in 83% on echocardiography and showed a statistically significant association only with innocent murmur in children and slower aortic acceleration. The presence of false tendon was first observed on fetal echocardiography from week 20 of pregnancy

The Application of a System of Eye Tracking in Laparoscopic Surgery: A New Didactic Tool to Visual Instructions

Introduction: Laparoscopic surgery is an increasingly used technique, but it requires a high degree of learning, and communication between the operating room crew is considerably difficult. The use of eye tracking has been proposed as a didactic and evaluation tool in several settings, including in laparoscopy in simulators.Objectives: This study aimed to evaluate the usefulness of the use of eye tracking systems (Tobii glasses 2) in laparoscopic surgery as a didactic and assessment tool to improve communication in the operating room and improve patients' security.Methodology: An anonymous survey was sent to the students and medical teachers of a faculty of medicine and practicing doctors and residents. The message contained an explanation about the use of the Tobii glasses, a link to watch the video showing its use in a laparoscopic surgery, and the survey to complete after watching the video.Results: The survey was answered by 113 participants (51.3% medical students, 27.4% medical teachers, 18.6% practicing doctors, and 2.7% medicine residents). Eighty-three percent agreed with the usefulness of the “Tobii glasses” in the operating room for improving communication between the main surgeon and the assistant, for learning complex surgery techniques, for obtaining didactic videos, and for indicating anatomical structures. The item scored worst was the price of the glasses.Conclusions: It is possible to record and project expert gaze patterns in the operating room in real time using the Tobii glasses. This device allows improving communication among the surgical crew and the learning of residents and also improving the security of surgical patients

Optimización de las prácticas clínicas en el aprendizaje de Ginecología y Obstetricia por el alumno de Medicina

[SPA] En esta comunicación nos proponemos transmitir nuestra experiencia de evaluación de prácticas clínicas hospitalarias en las asignaturas de Obstetricia y Ginecología, mediante la utilización de un libro o cuadernillo de prácticas clínicas. Hemos implantado este sistema de evaluación recientemente ante la problemática para evaluar la realización y el aprovechamiento de las prácticas en el hospital por parte de los alumnos. La escasez de recursos docentes en el ámbito hospitalario, la presión asistencial a la que se encuentran sometidos los médicos-docentes así como la necesidad de atender satisfactoriamente la formación de los alumnos en el ámbito clínico han sido los retos a los que nos hemos enfrentado y que hemos intentado resolver mediante la cumplimentación de un libro de prácticas clínicas que sirva de guía en la realización de las prácticas tanto a los alumnos como a los médicos que colaboran en la docencia. [ENG] The aim of this communication is to report our experience evaluating hospital clinical practice in the subjects of Obstetrics and Gynecology using a booklet of clinical practice. We have recently implemented this evaluation system in order to improve the performance and utilization of hospital practice by students. We have faced many challenges at the hospital area as shortage of teaching resources, medical workload, inexperience in assisting students… So, we designed a booklet of clinical practice to be used as a guide for students and medical doctors. This resource has contributes to enhance teaching at hospital and to make easy the evaluation of this activity

Experiencia piloto de ECOE (Evaluación Clínica Objetivada Estructurada) en la Facultad de Medicina de la Universidad de Murcia en el curso académico 2012/2013

[SPA] Esta comunicación pretende describir la primera experiencia de ECOE (Evaluación Clínica Objetivada Estructurada) que se ha llevado a cabo de manera experimental (piloto) en la Facultad de Medicina de la Universidad de Murcia durante el curso académico 2012/2013 con los alumnos de sexto curso. Se trata de un sistema de evaluación totalmente novedoso en esta facultad. La innovación de este tipo de formato es su gran potencia evaluadora ya que mezcla métodos de evaluación muy distintos permitiendo explorar, en un mismo alumno y simultáneamente, varios niveles de conocimiento y habilidades: saber cómo y demostrar cómo, simulando situaciones clínicas lo más parecidas a la práctica médica habitual y en diferentes asignaturas de la carrera. Los resultados han sido muy satisfactorios como reflejamos en la comunicación. En la actualidad estamos preparando el ECOE de este curso académico, que ya tendrá valor en la calificación final del alumno. [ENG] This paper aims to describe the first experience of OSCE (Objectified Structured Clinical Evaluation) that has been performed experimentally in the Faculty of Medicine of the University of Murcia during the 2012/2013 academic year, among sixth year students. The OSCE is a completely novel evaluating system that explores several levels of knowledge and skills simultaneously in each student. It also allows the examiner to play real diary clinical situations and to test how the student unfolds in it. As reflected on this communication, results have been very convincing. Currently we are working on a new OSCE and this time, the score obtained by the student will already have value for his/her final grade

Design of a UMTS/GPRS Assisted Mesh Network (UAMN)

Wireless Mesh or multi-hop networks (WMNs) are well known thanks to its simplicity on deployment and the lack of infrastructure. These two advantages come with some drawbacks. WMNs have limitations with the support of Quality of Service (QoS), they do not assure coverage or even connectivity, and security, management and monitoring are not considered key requirements. In order to benefit of mesh networks and use them as an operator graded network, it is necessary to either improve mesh networks to fulfill all these requirements or use an alternative network that offers full availability, connectivity and security to assist the mesh network. Considering the two options, the second is the one selected making use of GPRS/UMTS as an assistant network. The document describes a set of requirements and the design of the functionalities needed to build an operator graded network using the cellular GPRS/UMTS. The aspects covered in the design are: security, quality of service, mobility, self configuration and optimization. The last point, optimization, is not directly involved with mesh networking, but it is an improvement easy to achieve when using a gateway node to access the Internet through a GPRS/UMTS connection. The design of the solution not only considers functionality, but also feasibility employing of the shelve elements. The mesh nodes and gateways are built on top of Linux operating system with the aim to reuse previous results and open source software. The final objective of the project is to build a usable system to be used as a proof of concept.Peer Reviewe

Diagnóstico y prevalencia de trastornos de la personalidad en atención ambulatoria. Estudio descriptivo.

Introducción: los trastornos de personalidad (TP) son difíciles de diagnosticar. La literatura científica informa de su elevada prevalencia en muestras clínicas, pero en la práctica clínica diaria su diagnóstico es muy poco frecuente. Objetivos: Este estudio pretende estimar la prevalencia de TP en una Unidad ambulatoria de Salud Mental (USM), en situación real, para primeras citas. Método: Se aplicó el Cuestionario Salamanca (CS) como instrumento de cribado y, con los puntos de corte mínimo (2/3) y máximo (5/6), se comparó con el diagnóstico clínico realizado por un psicólogo clínico o psiquiatra, sin conocer el resultado del cribado con CS. Resultados: El diagnóstico de TP realizado por un profesional fue de un 7%, frente al 100% de positivos obtenido por el CS en el punto de corte mínimo y el 53% con el máximo: 11,8% para Clúster A, 19,8% Clúster B y 21,4% en el C. Conclusiones: La elevada prevalencia de TPs en los centros de salud mental, junto con el infradiagnóstico clínico, son otros factores que ensombrecen el pronóstico de estos pacientes

Dyslipidaemia in HIV-infected women on antiretroviral therapy. Analysis of 922 patients from the Spanish VACH cohort

Background: Information concerning lipid disturbances in HIV-infected women on antiretroviral therapy (ART) is scarce. The objective of the study is to describe the lipid profile in a large cohort of HIV-infected women on contemporary ART and analyse differences between regimes and patient's characteristics. Methods: Observational, multicentre, cross-sectional study from the Spanish VACH Cohort. 922 women on stable ART without lipid-lowering treatment were included. Results: Median age was 42 years, median CD4 lymphocyte count was 544 cells/mm3, and 85.6% presented undetectable HIV-1 viral load. Median total cholesterol (TC) was 189 mg/dL (interquartile range, IQR, 165-221), HDL cholesterol 53 mg/dL (IQR, 44-64), LDL cholesterol 108 mg/dL (IQR, 86-134), and triglycerides 116 mg/dL (IQR, 85-163). Mean accumulated time on ART was 116 months; 47.4% were on NNRTI-based regimes, 44.7% on PI, and 6.7% on only-NRTI therapy. 43.8% were also hepatitis C (HCV) coinfected. Patients on PI treatment presented higher TC/HDL ratio than those on NNRTI (p < 0.001). Significantly higher HDL values were observed in NNRTI-treated patients. HCV-coinfected patients presented lower TC/HDL ratio than the non HCV-coinfected. In multivariate analysis, factors independently associated with TC/HDL ratio were age, triglyceride levels and HCV co-infection. PI treatment presented a non-significant association with higher TC/HDL ratio. Conclusions: In HIV-infected women, the NNRTI-based ART is associated with a better lipid profile than the PI-based. Factors unrelated to ART selection may also exert an independent, significant influence on lipids; in particular, age, and triglyceride levels are associated with an increased TC/HDL ratio while HCV co-infection is associated with a reduced TC/HDL ratio

Revisiting the epidemiology of bloodstream infections and healthcare-associated episodes: results from a multicentre prospective cohort in Spain (PRO-BAC Study)

PROBAC REIPI/GEIH-SEIMC/SAEI Group.The epidemiology of bloodstream infections (BSIs) is dynamic as it depends on microbiological, host and healthcare system factors. The aim of this study was to update the information regarding the epidemiology of BSIs in Spain considering the type of acquisition. An observational, prospective cohort study in 26 Spanish hospitals from October 2016 through March 2017 including all episodes of BSI in adults was performed. Bivariate analyses stratified by type of acquisition were performed. Multivariate analyses were performed by logistic regression. Overall, 6345 BSI episodes were included; 2510 (39.8%) were community-acquired (CA), 1661 (26.3%) were healthcare-associated (HCA) and 2056 (32.6%) hospital-acquired (HA). The 30-day mortality rates were 11.6%, 19.5% and 22.0%, respectively. The median age of patients was 71 years (interquartile range 60–81 years) and 3656 (58.3%; 95% confidence interval 57.1–59.6%) occurred in males. The proportions according to patient sex varied according to age strata. Escherichia coli (43.8%), Klebsiella spp. (8.9%), Staphylococcus aureus (8.9%) and coagulase-negative staphylococci (7.4%) were the most frequent pathogens. Multivariate analyses confirmed important differences between CA and HCA episodes, but also between HCA and HA episodes, in demographics, underlying conditions and aetiology. In conclusion, we have updated the epidemiological information regarding patients’ profiles, underlying conditions, frequency of acquisition types and aetiological agents of BSI in Spain. HCA is confirmed as a distinct type of acquisition.This work was financed by grants from Plan Nacional de I+D+i 2013–2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades [PI16/01432] and the Spanish Network for Research in Infectious Diseases (REIPI) [RD16/0016/0001; RD16/0016/0008], co‐financed by the European Development Regional Fund ‘A way to achieve Europe’, Operative program Intelligent Growth 2014–2020

Effectiveness of a strategy that uses educational games to implement clinical practice guidelines among Spanish residents of family and community medicine (e-EDUCAGUIA project):A clinical trial by clusters

This study was funded by the Fondo de Investigaciones Sanitarias FIS Grant Number PI11/0477 ISCIII.-REDISSEC Proyecto RD12/0001/0012 AND FEDER Funding.Background: Clinical practice guidelines (CPGs) have been developed with the aim of helping health professionals, patients, and caregivers make decisions about their health care, using the best available evidence. In many cases, incorporation of these recommendations into clinical practice also implies a need for changes in routine clinical practice. Using educational games as a strategy for implementing recommendations among health professionals has been demonstrated to be effective in some studies; however, evidence is still scarce. The primary objective of this study is to assess the effectiveness of a teaching strategy for the implementation of CPGs using educational games (e-learning EDUCAGUIA) to improve knowledge and skills related to clinical decision-making by residents in family medicine. The primary objective will be evaluated at 1 and 6months after the intervention. The secondary objectives are to identify barriers and facilitators for the use of guidelines by residents of family medicine and to describe the educational strategies used by Spanish teaching units of family and community medicine to encourage implementation of CPGs. Methods/design: We propose a multicenter clinical trial with randomized allocation by clusters of family and community medicine teaching units in Spain. The sample size will be 394 residents (197 in each group), with the teaching units as the randomization unit and the residents comprising the analysis unit. For the intervention, both groups will receive an initial 1-h session on clinical practice guideline use and the usual dissemination strategy by e-mail. The intervention group (e-learning EDUCAGUIA) strategy will consist of educational games with hypothetical clinical scenarios in a virtual environment. The primary outcome will be the score obtained by the residents on evaluation questionnaires for each clinical practice guideline. Other included variables will be the sociodemographic and training variables of the residents and the teaching unit characteristics. The statistical analysis will consist of a descriptive analysis of variables and a baseline comparison of both groups. For the primary outcome analysis, an average score comparison of hypothetical scenario questionnaires between the EDUCAGUIA intervention group and the control group will be performed at 1 and 6months post-intervention, using 95% confidence intervals. A linear multilevel regression will be used to adjust the model. Discussion: The identification of effective teaching strategies will facilitate the incorporation of available knowledge into clinical practice that could eventually improve patient outcomes. The inclusion of information technologies as teaching tools permits greater learning autonomy and allows deeper instructor participation in the monitoring and supervision of residents. The long-term impact of this strategy is unknown; however, because it is aimed at professionals undergoing training and it addresses prevalent health problems, a small effect can be of great relevance. Trial registration: ClinicalTrials.gov: NCT02210442.Publisher PDFPeer reviewe